CME meeting at LNH
Panelists discuss common surgical problems encountered by family physicians

KARACHI: The sixth CME session at Liaquat National Hospital held on June 26th was devoted to general surgical problems encountered by family physicians in their practices. The panelists included   Dr. Salman Faridi consultant surgeon, Dr Rufina Soomro consultant surgeon, Dr Turab Pishori and Dr Nadeem Khurshaidi. The first topic which came under discussion was thyroid diseases. To a question regarding the use of L - thyroxine in pregnant patient, Dr. Turab said that such cases should be referred to endocrinologists as every thyroid case is not subjected to surgery.Dr. Khurshaidi said that TSH was the diagnostic marker of the disease and the ultrasound scan and FNAC plays a decisive role in reaching the decision whether to operate on it or not.

Dr. Faridi was of the view that the true isolated nodule is not as common as it was thought clinically. FNA could not distinguish between benign and malignant follicular lesion and cytology is the test to make the diagnosis, he added. He further emphasized the importance of thorough examination of the swelling before diagnosing it as thyroid related lump.  Dr. Rufina stated that pregnancy related endocrine changes make things complicated and the sensitivity and specificity of FNAC depends upon the expertise of the pathologist. Dr. Khurshaidi opined that FNAC is now the established modality for differentiating thyroid nodule into benign or neoplastic. Today surgery in benign cases is performed purely due to cosmetic reasons. With the advent of new treatment modalities the role of surgery has some what declined.

Replying to a question regarding abdominal pain and abdominal tuberculosis Dr. Rufina said that the empirical therapy should be started and the patient must be followed closely. Dr. Khurshaidi pointed out that in women with abdominal pain, suspected abdominal mass and  a raised CA 125 — is not always an ovarian tumor, as CA 125 could also be elevated in abdominal tuberculosis.

Talking about the rectal bleeding and perianal problems, Dr. Rufina informed the participants that people in our region are unaware of the perianal problems other than hemorrhoids and consider themselves as having piles regardless of the cause of rectal bleeding. Telling about the anal related problems even to the doctor was a stigma and was a barrier in medical and surgical referral. In our society, the family physicians should realize their responsibility of educating the patients so that, they do not shy away in revealing their problems.

Dr. Turab said that the patients with anal fissure, abscess, fistula and rectal cancer present with similar signs and symptoms. He stressed the importance of diagnosing rectal cancer as this may be masked by other commonly occurring rectal conditions and could go undetected. Dr. Rufina pointed out that the general physicians should differentiate rectal bleeding and acute anal conditions and all one need is a good clinical examination. She further pointed out that a very few patients require surgery for hemorrhoids as there were other effective modalities like sclerotherapy and rubber band ligation. Dr. Turab stated that high fiber diet is extremely important in relieving constipation.

Dr. Rufina highlighted the importance of screening in breast disease. It should  start at the age of 35 years and at the age of 30 years in those patients with positive family history of breast cancer & other risk factors.  Female general practitioners should teach the patients breast self examination. It will help in early detection besides preventing   advancement of the disease to a late stage. Even the trained midwives can play a significant role in this regard, she added.

This CME programme, it may be mentioned here is being conducted in collaboration with Macter International as a part of their Clinical Excellence and Leadership Programme.

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