General Surgery Revision

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A brief overview of the important topics in general surgery on which to pin revision.

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General Surgery Revision

  1. 1. General Surgery 3 rd Year Revision Nick Harvey MemorableMedicine.com
  2. 2. Meeting the patient <ul><li>Introduce (full name) </li></ul><ul><li>Explain role / nature of consultation </li></ul><ul><li>Gain consent </li></ul><ul><li>Wash hands </li></ul>
  3. 3. Surgical History <ul><li>Don’t forget the basics (age, occupation etc) </li></ul><ul><li>Change in bowel habit </li></ul><ul><li>PR blood and/or mucous +/- lump </li></ul><ul><li>Dysphagia </li></ul><ul><li>Jaundice </li></ul><ul><li>Abdominal pain, dyspepsia </li></ul><ul><li>Urology – renal/ureteric colic, BPH/prostate Ca, testicle Ca </li></ul><ul><li>Vascular – AAA, PVD, varicose veins, ulcers, TIA/stroke </li></ul><ul><li>Breast – pain/discharge/size/other lumps; prev lumps; menarche/menopause/cycle) </li></ul><ul><li>Thyroid – status Qs (incl swallowing) </li></ul><ul><li>Orthopaedics – OA/RA, trauma </li></ul><ul><li>Fever/night sweats </li></ul><ul><li>Weight loss </li></ul><ul><li>Pain </li></ul><ul><li>NB: risk factors, symptoms of complications </li></ul><ul><li>PMH, DH, SH, FH. </li></ul>
  4. 4. Dysphagia
  5. 5. Jaundice
  6. 6. Examination <ul><li>Abdominal </li></ul><ul><li>PR </li></ul><ul><li>Breast </li></ul><ul><li>Hernias </li></ul><ul><li>Neck/Thyroid (incl thyroid status) </li></ul><ul><li>Swellings </li></ul><ul><li>Varicose veins </li></ul><ul><li>Peripheral vascular disease </li></ul><ul><li>Ulcers </li></ul><ul><li>Observation chart </li></ul><ul><li>OSCE MARK SHEETS DON’T KNOW WHAT THE PATIENT HAS SO DO EVERYTHING! </li></ul>
  7. 7. Abdominal Examination <ul><li>Inspection </li></ul><ul><li>Ask about tenderness </li></ul><ul><li>Palpation (pt level, eye contact) </li></ul><ul><li>Percussion </li></ul><ul><li>Auscultation </li></ul><ul><li>Eponyms </li></ul><ul><li>Special tests </li></ul>
  8. 8. Breast Examination
  9. 9. Groin Hernias
  10. 10. Neck/Thyroid Examination <ul><li>Remember: </li></ul><ul><ul><li>Tongue protrusion </li></ul></ul><ul><ul><li>Swallow </li></ul></ul><ul><ul><li>Palpate trachea </li></ul></ul><ul><ul><li>Offer to examine thyroid status </li></ul></ul>
  11. 11. Investigations <ul><li>Bloods </li></ul><ul><ul><li>FBC, U&Es, LFTs, INR, amylase, CRP, Ca 2+ , TFTs </li></ul></ul><ul><ul><li>Tumour markers, autoantibodies </li></ul></ul><ul><ul><li>G&S, cross-match </li></ul></ul><ul><li>XRs </li></ul><ul><li>Cultures </li></ul><ul><li>Cytology (FNA) and histology </li></ul><ul><li>U/S </li></ul><ul><li>CT </li></ul><ul><li>Endoscopy (incl ERCP) </li></ul><ul><li>Contrast enemas/swallows </li></ul><ul><li>MRI (esp MRCP) </li></ul>
  12. 12. Investigating Jaundice
  13. 13. Management <ul><li>Medical/Conservative </li></ul><ul><ul><li>ABC (oxygen!) </li></ul></ul><ul><ul><li>Analgesia – WHO ladder </li></ul></ul><ul><ul><li>Antibiotics </li></ul></ul><ul><ul><li>PPI/avoid NSAIDs/weight loss </li></ul></ul><ul><ul><li>Anticoagulation </li></ul></ul><ul><ul><li>NBM </li></ul></ul><ul><ul><li>NG tube </li></ul></ul><ul><ul><li>iv fluids </li></ul></ul><ul><li>Surgical (incl consent) </li></ul><ul><ul><li>Laparoscopy/laparotomy/other incision </li></ul></ul><ul><ul><li>Types of colectomy </li></ul></ul><ul><ul><li>… </li></ul></ul><ul><li>Radiological & Endoscopic </li></ul><ul><ul><li>EVAR, coils, stents, </li></ul></ul>
  14. 14. Complications <ul><li>Anaesthetic </li></ul><ul><ul><li>Immediate </li></ul></ul><ul><ul><ul><li>Arrhythmias, pneumothorax, anaphylaxis… </li></ul></ul></ul><ul><li>General </li></ul><ul><ul><li>Early </li></ul></ul><ul><ul><ul><li>UTI, basal atelectasis, pneumonia, c diff, DVT, PE </li></ul></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>Immediate </li></ul></ul><ul><ul><ul><li>Primary haemorrhage, damage to a nearby structure (nerve, ureter, bowel) </li></ul></ul></ul><ul><ul><li>Early </li></ul></ul><ul><ul><ul><li>Infection, leak, dehiscence, secondary haemorrhage, ileus, pain </li></ul></ul></ul><ul><ul><li>Late </li></ul></ul><ul><ul><ul><li>Adhesions, recurrence, pain </li></ul></ul></ul>

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