General Surgery Revision

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Information about General Surgery Revision

Published on July 1, 2008

Author: memorablemedicine

Source: slideshare.net

Description

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

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.

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

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

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

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)

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,

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

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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