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

  RUQ pain, fever, leukocytosis; ultrasound first line; early laparoscopic cholecystectomy is standard; antibiotics as adjunct; percutaneous cholecystostomy for high-risk surgical candidates.
• 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

  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.
• 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

  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

• 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

  Polymicrobial necrotizing infection of perineum; early antibiotics, urgent surgical debridement, and hemodynamic support are essential.

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

  Rapidly progressive infection with severe pain and systemic toxicity; early broad-spectrum antibiotics, urgent surgical exploration and debridement, and hemodynamic support are key.

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

  Diagnose with CT; initial management includes NPO, NG decompression, fluids and electrolytes; operate for peritonitis, strangulation, or closed-loop obstruction.
• 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

  Asplenic/hyposplenic patients need targeted vaccinations, infection education, and sometimes antibiotic prophylaxis; schedule vaccines pre‑op when possible or ≥2 weeks post‑op.

T

• Thyroid Nodules — Surgical Indications & Approach

  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.
• Thyroidectomy — Hypocalcemia Prevention & Management

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