General Surgery

A

• Acute Appendiceal Mass — Interval Appendectomy Strategy

  Phlegmon/abscess from perforated appendicitis: initial non‑operative management with antibiotics ± percutaneous drainage, then interval imaging and selective interval appendectomy based on age/neoplasm risk.
• Acute Appendicitis — Diagnosis and Initial Management

  Classic migration of pain to right lower quadrant with anorexia and fever; use ultrasound or CT to confirm; give antibiotics and timely surgical consult.
• Acute Appendicitis — Imaging Pathway, Antibiotics, and Laparoscopic Appendectomy

  Start with clinical risk assessment; obtain ultrasound in children/pregnancy and CT with contrast in adults when diagnosis uncertain. Provide pre‑op antibiotics and pain control; proceed to laparoscopic appendectomy for uncomplicated cases or consider antibiotics‑first in selected patients with shared decision making.
• Acute Cholecystitis — Diagnosis & Management

  Acute cholecystitis is inflammation of the gallbladder, usually caused by persistent cystic duct obstruction from a gallstone. Diagnosis combines a compatible clinical syndrome with inflammatory findings and characteristic imaging, most often right upper quadrant ultrasonography. Early laparoscopic cholecystectomy during the index admission is preferred for most operable patients because it provides definitive source control and reduces recurrent biliary events. Antibiotics treat associated bacterial infect
• Acute Cholecystitis — ED Management

  Right upper quadrant pain with fever and leukocytosis; ultrasound first line; start antibiotics and consult surgery for early cholecystectomy.
• Acute Limb Ischemia — Rutherford Grading, Heparin, and Revascularization

  Sudden limb pain, pallor, pulselessness, paresthesia, paralysis, and poikilothermia require immediate systemic heparin, urgent imaging (CTA) when viable, and revascularization (embolectomy, thrombectomy, or thrombolysis) based on Rutherford grade.
• Acute Mesenteric Ischemia — CTA First, Anticoagulation, and Revascularization

  Severe abdominal pain out of proportion to exam demands urgent CT angiography; resuscitate, correct precipitants, start anticoagulation, and coordinate endovascular or open revascularization with bowel viability assessment.
• Acute Mesenteric Ischemia — CTA First, Heparin, and Rapid Revascularization

  Severe abdominal pain out of proportion to exam suggests mesenteric ischemia. Obtain CTA immediately, give aggressive fluids and systemic heparin, start broad antibiotics, and arrange urgent endovascular or open revascularization with bowel assessment; plan for second-look laparotomy.
• Acute Mesenteric Ischemia — Early CTA and Anticoagulation

  Severe pain out of proportion to exam with risk factors needs urgent CTA, early anticoagulation for embolic or thrombotic causes, antibiotics, and surgical consultation.
• Acute Mesenteric Ischemia — Recognition and Management

  Acute mesenteric ischemia is a vascular emergency in which delayed diagnosis rapidly progresses to bowel infarction and death. Maintain suspicion in severe or unexplained abdominal pain, especially with atrial fibrillation or atherosclerotic disease. Obtain CT angiography without delay, begin resuscitation and broad-spectrum antibiotics, use anticoagulation when appropriate, and pursue urgent revascularization with bowel viability assessment.
• Adhesive Small Bowel Obstruction — NG Decompression, Water‑Soluble Contrast, and Operative Triggers

  Common post‑operative SBO managed initially with fluid resuscitation, NG decompression, and water‑soluble contrast challenge. Operate urgently for peritonitis, strangulation, or failure of non‑operative management.
• Appendicitis — Adult

  Acute appendicitis is inflammation of the vermiform appendix and remains a common surgical emergency. Diagnosis integrates history, examination, inflammatory markers, and imaging. CT is the most accurate test in many nonpregnant adults, while ultrasound and MRI are useful in younger patients and pregnancy. Treatment is usually appendectomy, although selected uncomplicated cases can be managed initially with antibiotics after shared decision making.

B

• Boerhaave Syndrome (Esophageal Perforation) — NPO, Broad Antibiotics, and Surgical Control

  Full‑thickness esophageal rupture after forceful emesis presents with chest/epigastric pain and subcutaneous emphysema. Diagnose with CT contrast esophagram; keep NPO, start broad‑spectrum antibiotics and antifungals, and obtain surgical/endoscopic repair with drainage.

C

• Colorectal Cancer — Emergency Obstruction or Perforation

  Emergency CRC presents with obstruction or perforation. Prioritize resuscitation, source control, and oncologic principles. Consider stenting as a bridge to surgery in left‑sided obstruction; perform resection with diversion when unstable or contaminated.

E

• Enhanced Recovery After Surgery — Colorectal Pathway

  ERAS pathways reduce complications and LOS in colorectal surgery. Elements span pre‑op counseling and nutrition, no prolonged fasting, multimodal analgesia, goal‑directed fluids, early feeding/mobilization, and standardized discharge criteria.

F

• Fournier Gangrene — Rapid Recognition and Debridement

  Fournier gangrene is necrotizing soft-tissue infection of the perineum and genital region. Pain out of proportion, rapidly progressive edema or discoloration, crepitus, systemic toxicity, or shock requires immediate broad-spectrum antibiotics and surgical consultation; imaging may define extent in stable patients but must never delay operative debridement.

G

• Gastric Volvulus — Borchardt Triad, Decompression & Emergency Surgery

  Gastric volvulus is pathologic rotation of the stomach that can cause closed-loop obstruction, strangulation, ischemia, and perforation. Acute disease classically causes severe epigastric or chest pain, unproductive retching, and inability to pass a nasogastric tube; resuscitation and decompression are followed by urgent operative or endoscopic management according to ischemic risk and patient stability.

N

• Necrotizing Soft Tissue Infection — Do‑Not‑Delay Debridement, Broad Antibiotics, and Re‑looks

  Rapidly progressive infection with severe pain, systemic toxicity, bullae, crepitus, or anesthesia of skin. Do not rely on LRINEC. Start broad IV antibiotics including toxin suppression and obtain emergent surgical debridement with planned re‑explorations.
• Necrotizing Soft Tissue Infection — Recognition and Management

  Necrotizing soft tissue infection is a rapidly progressive surgical emergency involving fascia and subcutaneous tissue, with high mortality when debridement is delayed. Disproportionate pain, systemic toxicity, rapidly advancing edema or erythema, bullae, skin anesthesia, crepitus, or shock should trigger immediate surgical consultation, broad IV antibiotics, resuscitation, and operative exploration without waiting for imaging when the clinical diagnosis is strong.

P

• Parathyroidectomy — Indications & Intraoperative PTH Monitoring

  Indications for parathyroidectomy in PHPT include symptoms, complications, or guideline thresholds; intraoperative PTH (IOPTH) using Miami criterion confirms cure; focused vs bilateral exploration based on imaging and surgeon preference.
• Pilonidal Disease — Surgical vs Non‑Surgical Care

  Chronic disease of the natal cleft from hair penetration and local inflammation. Prioritize hair removal, hygiene, and minimally invasive techniques; reserve wide excision for refractory disease, with off‑midline closure to reduce recurrence.

R

• Recurrent/Incisional Hernia — Repair Strategies

  Complex ventral/incisional hernias require pre‑hab (smoking cessation, weight loss), CT planning, and durable repair techniques (retrorectus or TAR) with appropriate mesh selection; consider botulinum and progressive pneumoperitoneum for loss of domain.

S

• Small Bowel Obstruction — Initial ED Management

  Colicky abdominal pain with vomiting and distension; diagnose with CT when appropriate; treat with fluids, nasogastric decompression for severe vomiting, and early surgical consultation.
• Small Bowel Obstruction — Initial Management

  Small bowel obstruction is interruption of normal intestinal transit, most often from postoperative adhesions but also from hernia, tumor, inflammatory stricture, volvulus, or other mechanical causes. The immediate task is to distinguish uncomplicated obstruction, which may resolve without surgery, from strangulation, ischemia, closed-loop obstruction, perforation, or another condition requiring urgent operation.
• Soft Tissue Sarcoma — Workup & Oncologic Principles

  Suspected STS requires MRI, planned core‑needle biopsy along future incision line, and referral to a sarcoma center. Aim for wide negative margins; use neoadjuvant or adjuvant radiation for large/high‑grade tumors; stage with chest imaging.
• Splenectomy — Vaccination & Infection Prevention

  Asplenia and hyposplenia create lifelong risk of overwhelming infection. Use the current CDC history-based pneumococcal schedule, MenACWY and MenB primary series with ongoing boosters, a Hib dose when indicated, annual/routine vaccines, and a clear plan for immediate evaluation and empiric antibiotics for fever.

T

• Thyroid Nodules — Surgical Indications & Approach

  Thyroid-nodule surgery is driven by malignancy risk, symptoms, and anatomy rather than nodule presence alone. Use TSH, ultrasound risk stratification, and cytology appropriately; observe selected low-risk lesions, and choose lobectomy versus total thyroidectomy with the 2025 ATA shift toward less extensive surgery for properly selected low-risk differentiated cancers.
• Thyroidectomy — Hypocalcemia Prevention & Management

  Post‑thyroidectomy hypocalcemia prevention centers on parathyroid preservation, selective autotransplantation, and early postoperative calcium/vitamin D protocols with lab monitoring.