1. Guidance Sheet for Junior Doctors at
General Surgery Department
nior Doctors at
M.H.Alshain
M.Y.Salama
2. Guidance Sheet for Junior Doctors at General Surgery Department
1
M.H.Alshain
M.Y.Salama
Acute Abdomen
Acute Appendicitis
Workup
CBC.
UG.
Abdominal US.
+Beta-hCG.
+CT Abdomen.
Pre-op
NPO.
2 L D5% + 1 L NS.
+ Cefuroxime 750mg IV q8hr.
+ Metronidazole 500mg IV q8hr.
+Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN.
+Metoclopramide 10mg IV/IM q4-6hr PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
+Pantoprazole 40mg IV qDay.
Post–op
NPO (Break fasting after 6hr).
IV Fluid.
Cefuroxime 750mg IV q8hr.
Metronidazole 500mg IV q8hr.
Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN.
+Metoclopramide 10mg IV/IM q4-6hr PRN.
+Pantoprazole 40mg IV qDay.
On Discharge
Cefuroxime Axetil (Cefotil) 500mg PO q12hr.
Metronidazole 500mg PO q8hr.
Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN.
3. Guidance Sheet for Junior Doctors at General Surgery Department
2
M.H.Alshain
M.Y.Salama
Intestinal Obstruction
Workup
CBC.
UG.
RFT.
+ Amylase.
Blood Grouping & Crosshatching.
Abdominal X Ray.
+Water solube contrast CT Abdomen.
Management
Conservative management up to 48 hrs this
include NPO, NG tube, Fluid, Analgesia,
Catheterization and PPI.
Peritonitis
Workup
CBC.
UG.
RFT.
Amylase.
Blood Grouping & Crosshatching.
Erect Chest x ray.
Management
NPO, NG tube, Fluid, Analgesia,
Catheterization, Antibiotics and PPI.
Intestinal Obstruction /Peritonitis
Pre-op
NPO + NG tube+ Catheter.
2 L D5% + 1 L NS +Potassium replacement.
Cefuroxime 750mg IV q8hr OR Cefepime
(Protec) 2g IVq12hr.
Metronidazole 500mg IV q8hr.
+Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN
+Metoclopramide 10mg IV/IM q4-6hr PRN OR
Promethazine (Phenergan) 25mg IV/IM q4-
6hr PRN.
+Pantoprazole 40mg IV qDay.
Post-op
NPO + NG tube+ Catheter
IV Fluid
Cefuroxime 750mg IV q8hr
Metronidazole 500mg IV q8hr
Diclofenac Sodium 75mg IM q12hr AND/OR
Paracetamol 500mg IV q4-6hr or PRN
4. Guidance Sheet for Junior Doctors at General Surgery Department
3
M.H.Alshain
M.Y.Salama
Metoclopramide 10mg IV/IM q4-6hr PRN OR
Promethazine (Phenergan) 25mg IV/IM q4-
6hr PRN
Pantoprazole 40mg IV qDay
On Discharge
Cefuroxime Axetil (Cefotil) 500mg PO q12hr
OR Cefopodoxime 200mg PO q12hr
Metronidazole 500mg PO q8hr
Pantoprazole 40mg PO qDay
Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN
5. Guidance Sheet for Junior Doctors at General Surgery Department
4
M.H.Alshain
M.Y.Salama
Acute Pancreatitis
Workup
CBC.
UG.
RBG.
ABG.
Abdominal US.
LFT.
Amylase & Lipase.
Abdominal US.
Abdominal X Ray.
Erect Chest x Ray.
CT Abdomen.
RFT +Electrolytes + Mg, Ca.
Management
NPO, NG tube, Fluid, Analgesia,
Catheterization, Antibiotics, Sliding scale,
Oxygen and PPI.
Inpatient
NPO + NG tube.
O2 therapy
D5%, NS, RL 250-500ml/hr.
Nasojejunal feeding or TPN.
Antibiotics regimens:
Regimen A :Cefuroxime 1.5g IV q8hr +
Metronidazole 500mg IV q8hr
Regimen B: Ceftriaxone 1g IV q12hr+
Metronidazole 500mg IV q8hr.
Regimen C: Imipenem (Bacquere) 500mg IV
q6hr or 1g IV q8hr.
DKA management:
I. Correction of fluid
1-3 L NS during 1st hr.
1L NS during 2nd
hr.
1L NS during following 2hrs.
1L NS every 4hrs.
When sugar<180mg/dL replace with DNS.
When sugar<90mg/dL replace with D5% not
more than 2L/24h.
II. Insulin therapy: started a 1 h after IV fluid
replacement is started.
6oU insulin in 500m NS at rate 50ml/h
III.Electrolyte correction:
K>6mmol/L none
K 4.5-6mmol/L 10mmol/h
K3-4.5mmolL 20mmol/h.
K<3mmolL 40mmol/h
Hypocalcemia Management:
6. Guidance Sheet for Junior Doctors at General Surgery Department
5
M.H.Alshain
M.Y.Salama
Calcium glucanet 10% 10ml in 100ml D5% in 10
min and q8hr. 0.5-2mg/kg/hr IV.
Others:
Pethidine 50-150mg IM q3-4hr PRN OR
Paracetamol 500mg IV q4-6hr or PRN.
Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Pantoprazole 40mg IV q12hr.
On Discharge
Cefixime (Suprax) 2oomg PO q12hr.
Cefuroxime Axetil (Cefotil) 500mg PO q12hr.
Metronidazole 500mg PO q8hr.
Pantoprazole 40mg PO qDay.
Paracetamol 500mg PO q4-6hr or PRN.
+Fixed doses.
+Metformin 500mg Poq12hr.
7. Guidance Sheet for Junior Doctors at General Surgery Department
6
M.H.Alshain
M.Y.Salama
Acute Cholengitis
Workup
CBC.
UG.
RFT.
LFT.
+Amylase.
Abdominal US.
+MRCP-ERCP.
+CT Abdomen.
+Bleeding Profile.
+Hepatitis screening.
Management
NPO, NG tube, Fluid, Analgesia,
Catheterization, Antibiotics and PPI.
Inpatient
NPO.
2 L D5% + 1 L NS.
Antibiotics regimens:
Regimen A :Cefuroxime 1.5g IV q8hr +
Metronidazole 500mg IV q8hr
Regimen B: Ceftriaxone 1g IV q12hr+
Metronidazole 500mg IV q8hr.
Regimen C: Imipenem (Bacquere) 500mg IV
q6hr or 1g IV q8hr + Metronidazole 500mg IV
q8hr.
Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN
Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Pantoprazole 40mg IV qDay.
On Discharge
Cefixime (Suprax) 2oomg PO q12hr.
Cefuroxime Axetil (Cefotil) 500mg PO q12hr.
Metronidazole 500mg PO q8hr.
Pantoprazole 40mg PO qDay.
Paracetamol 500mg PO q4-6hr or PRN.
Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN.
8. Guidance Sheet for Junior Doctors at General Surgery Department
7
M.H.Alshain
M.Y.Salama
Acute Cholecystitis
Workup
CBC.
UG.
RFT.
LFT.
+Amylase.
Abdominal US.
+MRCP-ERCP.
+CT Abdomen.
+Bleeding Profile.
+Hepatitis screening.
Management
NPO, NG tube, Fluid, Analgesia,
Catheterization, Antibiotics and PPI.
Interval Cholecystectomy.
Inpatient
NPO.
2 L D5% + 1 L NS.
Cefuroxime 750mg IV q8hr.
Metronidazole 500mg IV q8hr.
Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN.
Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Pantoprazole 40mg IV qDay.
Post-op
NPO.
IV Fluid.
Cefuroxime 750mg IV q8hr.
Metronidazole 500mg IV q8hr.
Diclofenac Sodium 75mg IM q12hr OR
Paracetamol 500mg IV q4-6hr or PRN
Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Pantoprazole 40mg IV qDay.
On Discharge
Cefuroxime Axetil (Cefotil) 500mg PO q12hr.
Metronidazole 500mg PO q8hr.
Pantoprazole 40mg PO qDay.
Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN
9. Guidance Sheet for Junior Doctors at General Surgery Department
8
M.H.Alshain
M.Y.Salama
Obstructive Jaundice
Workup
CBC.
UG.
RFT.
LFT.
+Amylase.
Abdominal US.
+MRCP-ERCP.
+CT Abdomen.
+Bleeding Profile.
+Hepatitis screening.
Management
NPO, NG tube, Fluid, Analgesia,
Catheterization, Antibiotics and PPI.
Interval Cholecystectomy.
Inpatient
NPO.
2 L D5% + 1 L NS.
Cefuroxime 750mg IV q8hr.
Metronidazole 500mg IV q8hr.
FFP.
Lactulose syrup PO 30mL q8hr.
Vitamin K 10mg PO/IV/IM/SC
Diclofenac Sodium 75mg IV q12hr OR
Paracetamol 500mg IV q4-6hr or PRN
Metoclopramide 10mg IV q4-6hr or PRN OR
Promethazine (Phenergan) 25mg IV q4-6hr
PRN.
Pantoprazole 40mg IV qDay.
10. Guidance Sheet for Junior Doctors at General Surgery Department
9
M.H.Alshain
M.Y.Salama
Anorectal Conditions
Sigmoidoscopy or Colonoscopy
+MRI
+ CT
Hemorrhoid
Outpatient
Sitz baths bid/tds.
Increase fiber and adequate fluid intake.
Lactulose syrup 10ml PO q8hr or Bisacodyl
(Laxin) 5-15 mg PO once.
Xyloproct ointment or cream bid/tds (Topical
hydrocortisone + analgesics)
Dafelon 500 mg 1g tds for 4 days 1g bid for 3
days 500mg bid.
+ Metronidazole 500mg PO q8hr.
+Diclofenac Sodium 75mg PO q12hr. OR
Paracetamol 500mg PO q4-6hr or PRN.
Anal fissure
Outpatient
Sitz baths bid/tds.
Increase fiber and adequate fluid intake
Lactulose syrup 10ml PO q8hr or Bisacodyl
(Laxin) 5-15 mg PO once
Xylocaine ointment or cream bid/tds (Topical
analgesics)
Glycerol trinitrate 0.4% ointment
+ Metronidazole 500mg PO q8hr
+Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN
Perianal fistula
Outpatient
Sitz baths bid/tds
Increase fiber and adequate fluid intake
Lactulose syrup 10ml PO q8hr or Bisacodyl
(Laxin) 5-15 mg PO once
Metronidazole 500mg PO q8hr
+Diclofenac Sodium 75mg PO q12hr OR
Paracetamol 500mg PO q4-6hr or PRN
Pre-op
Enemas at 11 p.m preop day and at 6 a.m op
day
On discharge
11. Guidance Sheet for Junior Doctors at General Surgery Department
10
M.H.Alshain
M.Y.Salama
Sitz baths bid/tds.
Increase fiber and adequate fluid intake.
Lactulose syrup 10ml PO q8hr or Bisacodyl
(laxin) 5-15 mg PO once.
Metronidazole 500mg PO q8hr.
12. Guidance Sheet for Junior Doctors at General Surgery Department
11
M.H.Alshain
M.Y.Salama
DSF (Diabetic Septic Foot) for Amputation
Workup
Vital signs (HTN or Shock).
CBC (Anemia, Infection, Thrombocytosis).
ESR (Vasculitis).
BG & Crosshatching.
HBA1C, RBG.
U. for sugar & acetone (DKA).
RFT (HTN).
ECG (arrhythmias).
Blood or Wound Swab for C/S (Infection)
Bleeding profile.
Lipid profile (HDL, LDH, and Cholesterol).
CTA or Duplex Doppler US.
Lower Limb x ray.
Pre-op
NPO
DKA management:
I. Correction of fluid
1-3 L NS during 1st hr.
1L NS during 2nd
hr.
1L NS during following 2hrs.
1L NS every 4hrs.
When sugar<180mg/dL replace with DNS not
more than 2L/24h.
II. Insulin therapy: started a 1 h after IV fluid
replacement is started.
6oU insulin in 500m NS at rate 50ml/h
III.Electrolyte correction:
K>6mmol/L none
K 4.5-6mmol/L 10mmol/h
K3-4.5mmolL 20mmol/h
IV.Antibiotic Regimens:
Regimen A :Cefuroxime 1.5g IV q8hr +
Metronidazole 500mg IV q8hr
Regimen B: Ceftriaxone 1g IV q12hr+
Metronidazole 500mg IV q8hr.
Regimen C : Imipenem (Bacquere) 500mg IV
q6hr or 1g IV q8hr OR Meropenem 500mg IV
q8hr OR 1g q12hr.
A,B or C + Clindamycin 300mg PO q8hr OR
Doxycyclin 100mg PO q8hr OR Vancomycin
500mg IV q8hr.
V.Others:
Diclofenac Sodium 75mg IM q12hr AND/OR
Paracetamol 500mg IV q4-6hr or PRN.
13. Guidance Sheet for Junior Doctors at General Surgery Department
12
M.H.Alshain
M.Y.Salama
Pantoprazole 40mg IV qDay.
Post-op
Insulin therapy:
Soluble insulin, sliding scale OR Fixed doses +
correcting doses.
+Metformin 500mg Poq12hr.
Cefuroxime 1.5g IV q8hr OR Ceftriaxone 1g IV
q12hr.
Metronidazole 500mg IV q8hr.
+ Clindamycin 300mg PO q8hr OR Doxycyclin
100mg PO q8hr OR Vancomycin 500mg IV
q8hr.
Diclofenac Sodium 75mg IM q12hr AND/OR
Paracetamol 500mg IV q4-6hr or PRN.
+Domperidone 10mg PO OR Erythromycin
500mg PO q8hr before meals OR
Metoclopramide 10mg IV/IM q4-6hr or PRN .
Pantoprazole 40mg PO qDay.
Enoxaparin (Calixine) 40mg SC qDay
On discharge
Insulin Fixed doses.
+Metformin 500mg Poq12hr.
Cefuroxime Axetil 500mg PO q12hr OR
Cefixim 2oomg PO q12hr.
Metronidazole 500mg PO q8hr.
+ Clindamycin 300mg PO q8hr OR Doxycyclin
100mg PO q8hr OR Vancomycin 500mg PO
q8hr.
Diclofenac Sodium 75mg PO q12hr AND/OR
Paracetamol 500mg PO q4-6hr or PRN.
+Domperidone 10mg PO OR Erythromycin
500mg PO q8hr before meals.
Pantoprazole 40mg PO qDay.
+Aspirin 75mg PO qDay or Warfarin OP qDay.
+Amlodipine 5-10 mg PO qDay.
+Bisoprolol 2.5-20 mg PO qDay.
+Duloxetine 60mg PO qDay OR Gabapentin
(Conventin) 300mg PO q8hr.
+Atorvastatin 20mg PO qDay.
Pentoxifylline (Trental) 4mg OP q8hr for > 8
weeks.
14. Guidance Sheet for Junior Doctors at General Surgery Department
13
M.H.Alshain
M.Y.Salama
Cellulitis
Outpatient
Cephalexin 500mgm PO q6hr 10-14d or
Amoxicillin-clavulanate 1g PO q12hr 10-14d or
Clindamycin 300mg PO q8hr
Inpatient
Amoxicillin-clavulanate 1.2g IV q12hr OR
Benzyl penicillin 2-4 MU IV q4-6hr.
+ Cefotaxime 2g IV q6hr + (Metronidazole
500mg IV q8hr OR Clindamycin 300mg PO
q8hr).
Diclofenac Sodium 75mg IM q12hr AND/OR
Paracetamol 500mg IV q4-6hr or PRN.
Pantoprazole 40mg IV qDay.
On discharge
Amoxicillin-clavulanate 1g PO q12hr.
+Cefixim 2oomg PO q12hr+
(Metronidazole 500mg PO q8hr OR
Clindamycin 300mg PO q8hr).
Diclofenac Sodium 75mg PO q12hr AND/OR
Paracetamol 500mg PO q4-6hr or PRN.
Pantoprazole 40mg PO qDay.
Necrotizing Fasciitis
Inpatient
Cefotaxime 2g IV q6hr + (Metronidazole
500mg IV q8hr OR Clindamycin 300mg PO
q8hr).
+ Amoxicillin-clavulanate 1.2g IV q12hr OR
Benzyl penicillin 2-4 MU IV q4-6hr.
Diclofenac Sodium 75mg IM q12hr AND/OR
Paracetamol 500mg IV q4-6hr or PRN.
Pantoprazole 40mg IV qDay.
On discharge
Cefixim 2oomg PO q12hr.
+ (Metronidazole 500mg PO q8hr.
OR Clindamycin 300mg PO q8hr).
+ Amoxicillin-clavulanate 1g PO q12hr.
Diclofenac Sodium 75mg PO q12hr AND/OR
Paracetamol 500mg PO q4-6hr or PRN.
Pantoprazole 40mg PO qDay
15. Guidance Sheet for Junior Doctors at General Surgery Department
14
M.H.Alshain
M.Y.Salama
Epididymo-orchitis
STI
Ceftriaxone 250-500 mg IM + (Azithromycin
1g PO once OR Doxycyclin 100mg PO q12hr for
7-14d)
UTI
Ciprofloxacin 500mg PO q12hr for 10-14 OR
Amoxicillin-clavulanate 1g PO q12hr 10-14d OR
Trimethoprim-sulfamethoxazole
160mg/800mg POq12hr for 10d.
+
Scrotal support.
Diclofenac Sodium 75mg PO q12hr AND/OR
Paracetamol 500mg PO q4-6hr or PRN.
Prostatitis
Outpatient
STI (<34yrs)
Ceftriaxone 250-500 mg IM + (Azithromycin
1g PO once OR Doxycyclin 100mg PO q12hr for
7-14d)
UTI (>34yrs)
Ciprofloxacin 500mg PO q12hr for 10-14 OR
Amoxicillin-clavulanate 1g PO q12hr 10-14d OR
Trimethoprim-sulfamethoxazole
160mg/800mg POq12hr for 10d.
+
Tamsulosin 0.4mg PO qDay.
16. Guidance Sheet for Junior Doctors at General Surgery Department
15
M.H.Alshain
M.Y.Salama
Renal colic
Outpatient
Pethidine 50-150mg IM OR Paracetamol
500mg IV OR Diclofenac Sodium 75mg IM.
Potassium citrate powder q8hr.
+ Ciprofloxacin 500mg PO q12hr for 10-14.
+ Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Inpatient
IV Fluid
Pethidine 50-150mg IM q3-4hr PRN OR
Paracetamol 500mg IV q4-6hr or PRN OR
Diclofenac Sodium 75mg PO q12hr.
Potassium citrate powder q8hr.
+ Metoclopramide 10mg IV/IM q4-6hr or PRN
OR Promethazine (Phenergan) 25mg IV/IM
q4-6hr PRN.
Active Medical Expulsive Therapy (MET)
Nifedipin 3omg/day PO for 7 days OR
Tamsulosin 0.4mg PO qDay.
Prednisone 20mg PO q12hr for 5 days
Trimethoprim-sulfamethoxazole
160mg/800mg PO qday for 7 days.
Paracetamol 1g PO q6hr for 7 days.
Ibuprofen 600-800mg PO q8hr.
Prochlorperazine (Largactil) 25mg PO PRN.
17. Guidance Sheet for Junior Doctors at General Surgery Department
16
M.H.Alshain
M.Y.Salama
Post Operative Fluid Management (Normal RFT)
Day 0 post-op
Dextrose 5%
Dextrose 5%
Dextrose 5%
Dextrose 5%
Dextrose 5%
Dextrose 5%
Day 1 post-op
Dextrose 5%
Normal Saline
Dextrose 5%
Dextrose 5%
Dextrose 5%
Normal Saline
Day 2 post-op
Dextrose 5%
Normal Saline + 20mmol KCL
Dextrose 5%
Dextrose 5%20mmol KCL
Dextrose 5%
Normal Saline + 20mmol KCL
NG tube +Drains + Stoma = RL or NS.
Na required= (125-S.Na) X0.6Xweight
K required= (4.5-S.K) X0.4Xweight
18. Guidance Sheet for Junior Doctors at General Surgery Department
17
M.H.Alshain
M.Y.Salama
Parental Oral
Metronidazole (Flagyl)
500mg IV q8hr
Metronidazole (Flagyl)
500mg PO q8hr
Cefuroxime (Maxile)
750mg IV q8h
Cefuroxime Axetil
(Cefotil) 500mg PO q12hr
Ceftriaxone (Samixone)
1g IV q12hr
Cefixime (Suprax) 2oomg
PO q12hr
Cefotaxime (Cefotax) 1g
IV q8hr
Cefixime (Suprax) 2oomg
PO q12hr
Ceftazidime (Fortum) 1g
IV q12hr
Cefixime (Suprax) 2oomg
PO q12hr
Ceftizoxime (Cefizox) 1g
IV q12hr
Cefixime (Suprax) 2oomg
PO q12hr
Cefepime (Protec) 2g
IVq12hr
Cefopodoxime 200mg PO
q12hr
Amoxicillin-clavulanate
(Amoclan) 1.2g IV q12hr
Amoxicillin-clavulanate
(Amoclan) 1g PO q12hr
Diclofenac
Sodium(Vortex) 75mg IM
q12hr
Diclofenac
Sodium(Divido) 75mg PO
q12hr
Imipenem (Bacquere)
500mg IV q6hr or 1g IV
q8hr
Meropenem 500mg IV
q8hr OR 1g q12hr
Promethazine
(Phenergan) 25mg IV/IM
q4-6hr PRN
Pantoprazole(Pantodac)
40mg IV qDay
Pantoprazole(Pantodac)
40mg PO qDay
Enoxaparin (Calixine)
40mg SC qDay
Nefopam (Nopain) 20mg
IM q12hr
Gabapentin (Conventin)
300mg
Bisacodyl (Laxin) 5-15 mg
PO once
Dafelon 500 mg
19. Guidance Sheet for Junior Doctors at General Surgery Department
18
M.H.Alshain
M.Y.Salama
Operation Note
Patient name: __________ Age: ___
Date of Procedure: _____ Time: ___
Procedure: ____________________
Pre op diagnosis: _______________
Post op diagnosis: ______________
Anesthesia: ____________________
Position: ______________________
Pre medication: _________________
Incision: _______________________
Surgeon: _______________________
Assistant: ______________________
Anesthetist: ____________________
Scrub nurse: ___________________
Findings: ______________________
Description of Procedure:
_________________________________
Closure: __________________________
Dressing: _________________________
Estimated blood loss: _______________
Complications: _____________________
Post op plan: _______________________
___________________________________
Histopathology Form
NAME: _____________________AGE:___
Date:________INDICATION: __________
REFERRING DOCTOR:________________
Clinical remark:
Operation:
Specimen/s:
The Investigation:
Dr: _________________
Tel: _________________