This document provides an overview of surgical principles and concepts. It discusses the basics of anatomy, cells, the essentials of life, causes of injury, and the body's response to injury. It then reviews each body system. Key concepts covered include the perioperative process, different types of surgical care, principles of examination and diagnosis, and approaches to patient management. Complications are discussed as well as the goals and modalities of treatment. Safety, quality improvement, and post-operative care are also summarized.

1. Dr. Deepak Raj Singh’s – Applied Basics
Department of Surgery
Kathmandu Medical college
Compiled by: Dr. UttamLaudari

2. Surgery= 70% anatomy + 30 % common sense
3 Rs to study
Receive
Ruminate
reproduce
Basics
Science revisited
Formal- mind, mathematics
Natural- physics, chemistry, biology
Social- manner, ethics, economics
2. Cell
3. Essential of life – oxygen, liquid, heat, nutrition, temperature
4. Cause of Injury
5. Response to Injury

3. Aim of organism
Survival ATP production
Reproduction

4. Review of system
• Nervous system
• Endocrine
• Respiratory
• Cardiovascular
• GI system
• Renal
• Musculoskeletal
• Integumentary
• Hematology
• reproductive

5. Essential of life- OF ENT
• Oxygen- hypoxia
• Fluid- shock
• Electrolytes- acid base/ electrolyte
• Nutrition- hypo/hyperglycemia
• temperature

6. Disease
• Imbalance between INJURY AND RESPONSE
TO INJURY

7. Cause of Injury
1. Metabolic ( disintegration of OF-ENT)
2. Anatomic/physiological
3. Congenital disease / embryology
4. Functional
5. Raynauds
6. Biliary dyskinesia
7. Genetic- production of proteins
8. Immunology- protection against biological
9. Structural ( hernia)/ functional ( IBS)
10. Environmental- natural, artificial ( physical, chemical,
environmental)

8. Response to injury
• Homeostatic response
• Healingresponse
– Wound- types of wound
– Hemostasis
– Inflammation
– Proliferation
– Regeneration/ repair/ Maturation
• Stress response- CARS, SIRS
• Growth response
• Degenerative response

9. • Adaptive response- atrophy, hypertrophy
• Maladaptive response- neoplastic, genetic

10. Approach to the patient:
• Body regions Interfaces
• Head base of skull
• Neck thoracic outlet
• Chest diaghpramatic hiatus
• Abdomen/pelvis
• Extremity, axilla and groin
• Traumatic- crush, compartment
• Non traumatic-septic arthritis
• Skin and subcutaneous
• Nontraumatic emergency- necrotizing
• Traumatic emergency
• Vessels
• Nerve
• Bone
• Viscera

11. Transplant-
• GI- small intestine,liver, pancreas
• Rejection
• Immune reaction prevention
• Early, hyper acute, acute

12. Principle of management:
• Screening/ monitoring
– Definition of screening
– Advantages and disadvantages
– Process of screening
Population
Disease to be screened
When to be screened

13. Principle of management:
• Monitoring- to follow the progress
– Assessment/ resuscitation (ACLS/ATLS)
– Airway- check , secure
– Breathing- oxygen delivery Ventillaiton
– Circulation
– Disability- AVPU, GCS, Pupil ( physiology of
Intracranial HTN)
– Exposure- in apparent injuries, orifices,
extremities

14. Principle of management:
• 3. Presentation-
– Asymptomatic
– Symptomatic
– Complication

15. Principle of management:
• 4. Diagnosis- 3C
– Condition
– Cause
– Complication
• Treatment/ prognosis
• Death

16. Principal of surgical care
1. Perioperative AND anesthetic care
2. Emergency/ trauma
3. Palliative/critical care
4. Minimal invasive/ ambulatory
5. Regenerative / replacement
Surgical care- region based
Critical care- system based
Palliative care- symptom based

17. Perioperative care
• Preoperative care
• Intraoperative care
• Postoperative care

18. Preoperative care
1. Is the surgery fit for patient?
2. Is the patient fit for surgery?
3. Optimization
4. Counseling and consent ( pros/ cons/
alternatives)
5. Preparation ( bowel prep, NPO etc)

19. Intraoperative care
1. Appraisal(WHO Check list etc.)
2. Access
3. Assessment
4. Action
– Dissection
– Vascular control
– Resect/ reconstruct/ replace --Nonbilogical- Implant
– Biological-transplant, regeneration
1. Ensure hemostasis

20. After care
• Form fill up
• Post operative order
• Transport patient to defined ward
• Hand over ( written order)

21. Post operative care
Aim- Early discharge
1. Avoid pain
2. Control nausea and vomit ( 30-40%)
3. Early feeding and Early ambulation
4. Avoid, anticipate and act upon complication ( systemic – consciousness
TPR BP/ specific)
5. Advise
– Dietary
– Activity
– Medication
– Physiotherapy
– Warning signs
– Routine follow up
6. Drains/ iv lines out

22. Anesthesia care
• Local
• Regional
• General- induction
• Sedation

23. Emergency/ Trauma
• Primary survery
• Resuscitation
• Secondary survey
• Definitive management
• Arrange
• Bring book
• C-Consider safety
Communication with anesthesiologist
Consider damage control

24. Practice
• 1. Social science
• 2. Tools
• 3. Skills
– Percutaneous
– Portoscopic
– Endovascular
– Endoscopic
– Open
– How to handle skin and s.c tissue
– Muscle/ tendon repair
– Nerves/vessels
– Bones/ joints
– Viscera- solid/ hollow

25. Safety and quality (EBM)
• EBM
– Asking- formulate the right question
– Acquiring- literature search, peer review articles, sources
– Appraising- level of evidence
– Applying
– Assessing- outcome/ audit
• PICO- population/ intervention/ comparison/ outcome of
study
Keeping update

26. Principle of examination
• Aim-
– Condition
– Cause
– Complication
• Information:
– History- Rule of 7
– Where- region/level
– What- solid/liquid/gas
– How- pathology
– Why- cause

27. Principle of examination
• Tools-
– Primary- sight
– Secondary
• Technique-
– Inspection
– Palpation
– Percussion
– Auscultation
– Special maneuvers

28. Diagnosis
• History
• Clinical examination
• Investigation
1. Laboratory
Hematology
Biochemistry
Microbiology
Immunology
Molecular
2. Electromechanical- ecg
3. Imaging
Xray with and without contras
Usg
CT
MRI
Nuclear scan
4.Scopic
5.Tissue diagnosis

29. Principles of management
1.Assess the patient
Stable or unstable
See early warning sign
Hemodynamics
Respiratory
Renal
Mentation
Temperature

30. Principles of management
2.Resuscitation
3.Diagnosis
3.Treatment

31. • Treatment:
• Aim:
1. Promotion
2. Preventive
3. Curative
4. Palliative
5. Rehabilitation
• Modalities of treatment:
Psychosocial
Noninvasive- physical, chemical, biological
Invasive
Percutaneous
Scopic
Endovascular
Portoscope
open

32. 6 causes of lung consolidation
• Mechanical – collapse
• Infection (TB/ non TB)
• Tumor
• Vascular ( infarction)
• Contusion

33. Postoperative complications:
• Local and systemic
• Systemic- Early warning signs
1. Hemodynamics
2. Respiratory
3. Renal
4. Mentation
5. temperatue