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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3998_Библиотеки_им_академика_М_И_Перельмана
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Abbreviations
A&E accident and emergency
AAA abdominal aortic aneurysm
ABG arterial blood gas
ABPIs ankle brachial pressure indices
AMD age-related macular degeneration
ALT alanine aminotransaminase
AREDS Age-Related Eye Disease Study
AST aspartate aminotransaminase
ATLS Advanced Trauma Life Support
AUR acute urinary retention
BCR bulbocavernosus reex
BIPP bismuth iodoform parafn paste
BP blood pressure
BPH benign prostatic hyperplasia
BPPV benign positional paroxysmal vertigo
CBD common bile duct
CSF cerebrospinal uid
CT computed tomography
CTA CT angiography
CUR chronic urinary retention
CVA cerebrovascular accident
DCIS ductal carcinoma in situ
DCR dacryocystorhinostomy
DRE digital rectal examination
DSA digital subtraction angiography
EBV Epstein Barr virus
ERCP endoscopic retrograde cholangiopancreatography
ESR erythrocyte sedimentation rate
ESWL extracorporeal shock wave lithotripsy
FFP fresh frozen plasma
FISH uorescence in situ hybridization
FNAC ne-needle aspiration cytology
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x Abbreviations
GP general practitioner
Hb haemoglobin
HNPCC hereditary non-polyposis colorectal cancer
HoLEP holmium laser enucleation of prostate
HRCT high-resolution computed tomography
IC intermittent claudication
ICA internal carotid artery
ICP increased intracranial pressure
IOL intraocular lens
IVU intravenous urogram
LFT liver function test
MCA middle cerebral artery
MRCP magnetic resonance cholangiopancreatography
MRI magnetic resonance imaging
MSU midstream urine
NSAID non-steroidal anti-inammatory drug
Nd:YAG neodymium:yttrium-aluminium-garnet laser
PCA posterior communicating artery
PCNL percutaneous nephrolithotomy
PCPT prostate cancer prevention trial
PCV packed cell volume
PSA prostate-specic antigen
PUJ pelviureteric junction
PUK peripheral ulcerative keratitis
PV plasma viscosity
PVD peripheral vascular disease
PVD posterior vitreous detachment
RAPD relative afferent pupillary defect
RD retinal detachment
RP retinitis pigmentosa
SBO small bowel obstruction
SLE systemic lupus erythematosus
SLN sentinel lymph node
SUFE slipped upper femoral epiphysis
TCC transitional cell carcinoma
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Abbreviations xi
TED thromboembolic deterrent stocking
TED thyroid eye disease (Chap. 3)
TIA transient ischemic attack
TNM tumours, node, metastases
TRUS trans-rectal ultrasound of the prostate
TURBT trans-urethral resection of the bladder tumour
TURP trans-urethral resection of the prostate
U&Es urea and electrolytes
USI urodynamic stress incontinence
UTI urinary tract infection
VEGF vascular endothelial growth factor
XGPN xanthogranulomatous pyelonephritis
WCC white cell count
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General surgery
Matthew Clark, Jevan Taylor, Steven Thrush
KEY CONCEPTS
Landmarks for post-operative care and
complications 4
Late complications of surgery 4
The ve Bs 4
HERNIAS
Questions 5
Clinical cases 5
OSCE Counselling cases 6
Key concepts 7
Answers 8
Clinical cases 8
OSCE Counselling cases 11
Revision panel 11
GALLSTONES
Questions 12
Clinical cases 12
OSCE Counselling cases 13
Key concepts 14
Answers 15
Clinical cases 15
OSCE Counselling cases 18
Revision panel 18
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2 General surgery
APPENDICITIS
Questions 19
Clinical cases 19
OSCE Counselling cases 20
Key concepts 21
Answers 22
Clinical cases 22
OSCE Counselling cases 26
Revision panel 26
COLON AND RECTAL CANCER
Questions 27
Clinical cases 27
OSCE Counselling cases 28
Key concepts 29
Answers 30
Clinical cases 30
OSCE Counselling cases 33
Revision panel 34
SURGICAL EMERGENCIES
Questions 35
Clinical cases 35
Answers 36
Clinical cases 36
Revision panel 38
VASCULAR: ABDOMINAL AORTIC ANEURYSM
Questions 39
Clinical cases 39
OSCE Counselling cases 40
Key concepts 41
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General surgery 3
Answers 42
Clinical cases 42
OSCE Counselling cases 45
Revision panel 45
PERIPHERAL VASCULAR DISEASE (PVD)
Questions 46
Clinical cases 46
Key concepts 47
Answers 48
Clinical cases 48
VASCULAR: CAROTID
Questions 50
Clinical cases 50
Answers 51
Clinical cases 51
VENOUS DISEASE
Questions 54
Clinical cases 54
Key concepts 55
Answers 56
Clinical cases 56
BREAST
Questions 58
Clinical cases 58
OSCE Counselling cases 59
Key concepts 60
Answers 61
Clinical cases 61
OSCE Counselling cases 65
Revision panel 66
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4 General surgery
Key concepts
Complications can occur early or late in the post-operative period, and can be specic to the surgery
performed, or more general, occurring after almost all operations.
Landmarks for post-operative care and complications
First 24 hours
Primary haemorrhage is the most common feature presenting as tachycardia. Initially a t
young patient will have a stable blood pressure (BP) because the cardiovascular system is able
to compensate. As circulating volume falls further (>20–40 per cent), hypotension develops.
Resuscitation with colloid plus blood and stopping the haemorrhage is essential before
decompensation occurs.
A raised temperature (<37.9°C) in the rst 24-hour period is usually a reactive post-operative pyrexia,
but a rise >38°C is suspicious of a urinary tract infection (UTI) that was pre-existing but ared up after
urinary catheterization.
24 to 72 hours
Infection of the urinary tract, chest, surgical wounds and legs (deep vein thrombosis) must be checked
for causes of pyrexia during this time period.
After abdominal surgery, a pyrexia in this time period should also raise suspicion of direct injury to
the bowel that was missed during surgery and has caused peritonitis.
7 to 10 days
⦁ Secondary haemorrhage caused by infection
⦁ Thrombosis (deep vein thrombosis or pulmonary embolus)
⦁ Bowel anastomotic leak
⦁ Infected post-operative collection
⦁ Fistula formation from avascular necrosis (diathermy burns) presenting as late complications (e.g.
ureteric stula, vesicovaginal stula, rectovaginal stula or bowel perforation causing peritonitis)
⦁ Pressure sores
Late complications of surgery
⦁ Incisional hernia
⦁ Adhesions
⦁ False aneurysm
⦁ Infected prosthesis
The ve Bs
Who needs emergency out-of-hours surgery? Remember the ve ‘B’s:
Block (e.g. bowel obstruction)
Bleed (e.g. peptic ulcer)
Burst (e.g. ectopic pregnancy, perforated bowel)
Break (e.g. open fractures)
Burn (e.g. skin burns)
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Hernias 5
HERNIAS
Questions
Clinical cases
For each of the clinical case scenarios given
Q1: What is the likely differential diagnosis?
Q2: What features of the given history support the diagnosis?
Q3: What additional features in the history would you seek to support a particular
diagnosis?
Q4: What clinical examination would you perform and why?
Q5: What investigations would be most useful and why?
Q6: What treatment options are appropriate?
CASE 1.1 –
‘I’ve developed a lump in my groin’
A 25-year-old builder suddenly develops a golf-ball-sized, slightly tender lump in his right groin after
lifting a 20-kg bag of sand. He states that he felt a tearing sensation as it happened. He attends the
accident and emergency department.
CASE 1.2 –
‘I can’t push my lump back in anymore’
A 70-year-old retired man presents to surgical outpatient clinic with a slightly tender lump in his
left groin. He has had the lump for many months, but previously it would disappear overnight, or
if necessary he could gently push it back inside. His health is ne, other than a cough from years of
smoking. Over the last 2 weeks he has not been able to reduce the lump.
CASE 1.3 –
‘My hernia is sore and I’ve started to vomit’
A slim 73-year-old woman has had a groin lump for some time which she ignored. Over the last 3 days
it has become progressively more painful, with redness of the overlying skin. She has not opened her
bowels during this time (which is unusual for her), and yesterday she started to vomit.
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6 General surgery
OSCE Counselling cases
OSCE COUNSELLING CASE 1.1 –
‘Should I have my hernia repaired?’
A 47-year-old man presents, via his general practitioner (GP), with an intermittent left groin mass,
causing only moderate symptoms. Examination conrms an easily reducible inguinal hernia.
Q1: If an operation is offered, what specic risks should the patient be warned about?
OSCE COUNSELLING CASE 1.2 –
‘Why did my surgeon suggest I see a
urologist rst?’
An otherwise well 74-year-old man has a right inguinal hernia and chooses to proceed with hernia
repair. In his history he reveals that he has slight difculty initiating urination, poor stream and nocturia.
The surgeon suggests that he is seen by a urologist before proceeding with the operation.
Q1: What factors might the surgeon be thinking about in deferring the operation?
Q2: What will the urologist do?
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