General Surgery
Showing 27 of 27 topics
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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.
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Classic migration of pain to right lower quadrant with anorexia and fever; use ultrasound or CT to confirm; give antibiotics and timely surgical consult.
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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.
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RUQ pain, fever, leukocytosis; ultrasound first line; early laparoscopic cholecystectomy is standard; antibiotics as adjunct; percutaneous cholecystostomy for high-risk surgical candidates.
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Right upper quadrant pain with fever and leukocytosis; ultrasound first line; start antibiotics and consult surgery for early cholecystectomy.
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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.
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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.
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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.
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Severe pain out of proportion to exam with risk factors needs urgent CTA, early anticoagulation for embolic or thrombotic causes, antibiotics, and surgical consultation.
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High-mortality emergency: severe pain out of proportion to exam; obtain CTA promptly; resuscitate and give broad-spectrum antibiotics; urgent revascularization and surgery as indicated.
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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.
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Suspect with migratory RLQ pain, anorexia, and tenderness; CT with IV contrast is preferred imaging in adults; laparoscopic appendectomy is standard; selected uncomplicated cases may be treated nonoperatively.
B
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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
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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
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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
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Polymicrobial necrotizing infection of perineum; early antibiotics, urgent surgical debridement, and hemodynamic support are essential.
N
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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.
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Rapidly progressive infection with severe pain and systemic toxicity; early broad-spectrum antibiotics, urgent surgical exploration and debridement, and hemodynamic support are key.
P
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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.
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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
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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
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Colicky abdominal pain with vomiting and distension; diagnose with CT when appropriate; treat with fluids, nasogastric decompression for severe vomiting, and early surgical consultation.
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Diagnose with CT; initial management includes NPO, NG decompression, fluids and electrolytes; operate for peritonitis, strangulation, or closed-loop obstruction.
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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.
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Asplenic/hyposplenic patients need targeted vaccinations, infection education, and sometimes antibiotic prophylaxis; schedule vaccines pre‑op when possible or ≥2 weeks post‑op.
T
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Select patients for hemithyroidectomy vs total thyroidectomy based on Bethesda cytology, nodule size/suspicion, symptoms, radiation/family risk, and patient preference; plan nerve and parathyroid preservation with appropriate lymph node strategy.
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Post‑thyroidectomy hypocalcemia prevention centers on parathyroid preservation, selective autotransplantation, and early postoperative calcium/vitamin D protocols with lab monitoring.
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