SurgSpace / Specialties / General Surgery
General Surgery
The abdomen and its contents, the acute abdomen, hernias, biliary disease, bowel, breast and endocrine surgery, and the foundation every other surgical specialty builds on.
Backdrop: A laparoscopic operating theatre mid-case · Dr.jayesh amin · CC BY-SA 3.0
Apply it
Cases & Practice
Patients to decide on, images to interpret, and the first day on the rotation.
Patients to decide on, images to interpret, and the briefing for the first day on the rotation.
Decisions, one patient at a time
Cases
Imaging practice
Read the image, then decide
Surgical decision-making
Does this patient need surgery?
22-year-old woman, 18 hours of migrating RLQ pain, guarding at McBurney's point, CRP 80, negative pregnancy test.
Theatre tonight
Defensible in a classic story, but a female pelvis widens the differential.
Image first
Ultrasound (or CT where age and habitus argue) buys diagnostic certainty at the cost of hours.
Observe and reassess
Active observation still exists: examinations repeated by the same person, trends over impressions.
The decision balances diagnostic certainty against perforation's timer. The learner should see what moves it: sex and age (the differential), duration (the timer), and peritonism (the trump card).
Adhesional SBO, second episode, no peritonism, lactate normal, CT shows a transition point but no closed loop.
Drip and suck
The standard opening: decompression, fluids, and a written reassessment plan.
Theatre now
The right answer only when strangulation signs or a closed loop are present, which this CT lacks.
Water-soluble contrast
Both a prognostic test and, often, a treatment: contrast reaching the colon predicts resolution.
Nonoperative management is an active treatment with exit criteria, not a decision to look away. The board is won by writing down, in advance, what would change the plan and when it will next be checked.
Acute cholecystitis, 36 hours in, settling on antibiotics. The registrar asks: book her for six weeks, or add her to tomorrow's list?
Index-admission cholecystectomy
The modern default: operate on this admission while the anatomy is no worse than it will be.
Interval cholecystectomy
The older pattern; a real fraction re-present before the six weeks arrive.
No operation
Reserved for patients whose fitness makes any operation the greater risk.
Timing questions are outcome questions: readmission with a worse abdomen is the cost of waiting, and the frailty of the patient is the cost of not. The heart of the decision is whose risk is being traded for whose convenience.
The rotation
Your first day here
- Rounds start with drains, wounds and trends: know each patient's operation and post-operative day before the round reaches the bed.
- Before a lap chole, know the Critical View of Safety: it is the most likely question of the whole rotation.
- Before a hernia repair, know the inguinal canal: the anatomy examiners love because the operation walks straight through it.
- The emergency take runs on the acute abdomen method: read the shared module before your first on-call.
- Examine the hernial orifices in every obstructed patient; the finding everyone misses is the one you will be asked about.
- In theatre, watch the decisions rather than the knots: why this incision, why this plane, why stop here.
Hub shaped by the Surgical Specialties Lead with the General surgery reviewer (open seat). Images and videos carry their source; educational use for supervised learning, not clinical guidance.