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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.

5 operations in depth5 interactive cases

Backdrop: A laparoscopic operating theatre mid-case · Dr.jayesh amin · CC BY-SA 3.0

See the disease

Conditions

The diseases, each with the image that defines it.

Each disease with the image that defines it: what it looks like, what the scan shows, and which operation answers it.

Acute appendicitis

The commonest surgical emergency, and the first diagnosis every student owns.

Pathophysiology
Luminal obstruction (faecolith, lymphoid hyperplasia) raises pressure, compromises the wall, and the appendix inflames, then perforates on roughly a day's timer.
Presentation
Migration from periumbilical to the right iliac fossa, anorexia, low-grade fever; McBurney's tenderness with guarding as the peritoneum joins in.
Investigations
A clinical diagnosis supported by inflammatory markers; ultrasound or CT when the story is atypical, the patient is female, or the differential is real.
Learn more
Management
Appendicectomy remains the standard; antibiotics-first exists for selected uncomplicated cases, with a known recurrence rate the patient must hear.
Complications
Perforation, abscess, and the wound infection that follows a dirty field: the reasons the timer matters.
Open appendectomyCase: Right lower quadrant pain
CT
Axial CT slice of the lower abdomen showing the appearance of appendicitis
CT abdomen · hyperdense inflamed appendix

Gallstone disease

One stone, a whole spectrum: colic to cholecystitis to cholangitis to pancreatitis.

The spectrum
Where the stone sits writes the disease: in the gallbladder it is colic or cholecystitis; in the common duct it is obstruction, cholangitis or pancreatitis.
Presentation
Post-prandial RUQ pain radiating to the shoulder blade; add fever and Murphy's sign for cholecystitis; add jaundice and rigors and Charcot's triad names the emergency.
Investigations
Ultrasound for stones and wall thickness; LFTs and duct diameter to ask about the common duct; MRCP when that question stays open.
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Management
Laparoscopic cholecystectomy, increasingly on the index admission; ERCP clears the duct when a stone has escaped into it.
The operative idea
The whole operation is built around one view: the Critical View of Safety, proving duct and artery before anything is divided.
Laparoscopic cholecystectomyCase: Right upper quadrant pain and fever
Ultrasound
Right upper quadrant ultrasound showing a gallstone with its acoustic shadow
RUQ ultrasound · gallstone with posterior acoustic shadowing

Peptic ulcer disease, surgically

A medical disease that keeps two surgical emergencies.

The modern shape
Helicobacter and acid suppression made elective ulcer surgery historical; what remains for surgeons is the ulcer that bleeds and the ulcer that perforates.
Bleeding
Resuscitation, endoscopic control, and interventional radiology have the first three turns; surgery takes over when the gastroduodenal artery keeps winning.
Perforation
Sudden epigastric pain, a rigid abdomen, free air under the diaphragm: source control by laparotomy and an omental patch.
Emergency laparotomyCase: Melena and a falling pressure
X-ray
X-ray showing the appearance of pneumoperitoneum
Pneumoperitoneum · free gas from a perforated viscus

  • Small bowel obstruction

    A mechanical problem with a metabolic countdown.

    Causes
    Adhesions from previous surgery lead by a distance, then hernias, then malignancy: the order that writes the history questions.
    Presentation
    Colicky central pain, vomiting (early if proximal), distension, and absolute constipation late; tinkling then absent bowel sounds as the bowel tires.
    Investigations
    CT with contrast is the modern answer: level, cause, and the closed loop or ischaemia that changes everything.
    Learn more
    Management
    Nonoperative first for adhesional obstruction without red flags: decompress, resuscitate, reassess on a schedule. Surgery for hernia, strangulation, or a failed trial.
    The judgement
    Knowing which obstruction can wait is the specialty's signature judgement; the consult simulation practises exactly this call.
    Small bowel resection & anastomosisEmergency laparotomyCase: Vomiting and distension

  • Groin hernia

    Anatomy examined through a defect in itself.

    Anatomy
    Indirect hernias ride the cord through the deep ring, lateral to the inferior epigastrics; direct hernias push through Hesselbach's triangle, medial to them.
    Presentation
    A groin lump with cough impulse, reducible until the day it is not; pain and irreducibility are the escalation the patient is warned about.
    Management
    Symptomatic inguinal hernias are repaired electively with mesh; femoral hernias are repaired whenever found, because their strangulation rate allows no watching.
    Learn more
    Complications
    Recurrence, chronic groin pain from nerve handling, and the strangulation that converts a clinic letter into a midnight laparotomy.
    Open inguinal hernia repair (Lichtenstein)Case: The groin lump that will not go back

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.