General Surgery Revision

General Surgery 3 rd Year Revision Nick Harvey MemorableMedicine.com

Meeting the patient
Introduce (full name)
Explain role / nature of consultation
Gain consent
Wash hands

Surgical History
Don’t forget the basics (age, occupation etc)
Change in bowel habit
PR blood and/or mucous +/- lump
Dysphagia
Jaundice
Abdominal pain, dyspepsia
Urology – renal/ureteric colic, BPH/prostate Ca, testicle Ca
Vascular – AAA, PVD, varicose veins, ulcers, TIA/stroke
Breast – pain/discharge/size/other lumps; prev lumps; menarche/menopause/cycle)
Thyroid – status Qs (incl swallowing)
Orthopaedics – OA/RA, trauma
Fever/night sweats
Weight loss
Pain
NB: risk factors, symptoms of complications
PMH, DH, SH, FH.

Dysphagia

Jaundice

Examination
Abdominal
PR
Breast
Hernias
Neck/Thyroid (incl thyroid status)
Swellings
Varicose veins
Peripheral vascular disease
Ulcers
Observation chart
OSCE MARK SHEETS DON’T KNOW WHAT THE PATIENT HAS SO DO EVERYTHING!

Abdominal Examination
Inspection
Ask about tenderness
Palpation (pt level, eye contact)
Percussion
Auscultation
Eponyms
Special tests

Breast Examination

Groin Hernias

Neck/Thyroid Examination
Remember:
Tongue protrusion
Swallow
Palpate trachea
Offer to examine thyroid status

Investigations
Bloods
FBC, U&Es, LFTs, INR, amylase, CRP, Ca 2+ , TFTs
Tumour markers, autoantibodies
G&S, cross-match
XRs
Cultures
Cytology (FNA) and histology
U/S
CT
Endoscopy (incl ERCP)
Contrast enemas/swallows
MRI (esp MRCP)

Investigating Jaundice

Management
Medical/Conservative
ABC (oxygen!)
Analgesia – WHO ladder
Antibiotics
PPI/avoid NSAIDs/weight loss
Anticoagulation
NBM
NG tube
iv fluids
Surgical (incl consent)
Laparoscopy/laparotomy/other incision
Types of colectomy
…
Radiological & Endoscopic
EVAR, coils, stents,

Complications
Anaesthetic
Immediate
Arrhythmias, pneumothorax, anaphylaxis…
General
Early
UTI, basal atelectasis, pneumonia, c diff, DVT, PE
Surgery
Immediate
Primary haemorrhage, damage to a nearby structure (nerve, ureter, bowel)
Early
Infection, leak, dehiscence, secondary haemorrhage, ileus, pain
Late
Adhesions, recurrence, pain

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General Surgery Revision

by Nick Harvey on Jul 01, 2008

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General Surgery Revision — Presentation Transcript