1. Chest Pain

Definition

Causes

• Cardiac: Angina pectoris (stable/unstable), acute myocardial infarction (heart attack), pericarditis, aortic dissection
• Pulmonary: Pulmonary embolism, pneumothorax, pleuritis, pneumonia
• Gastrointestinal: Gastroesophageal reflux disease (GERD), esophageal spasm, peptic ulcer
• Musculoskeletal: Costochondritis, rib fractures
• Psychological: Panic disorder, anxiety

Symptoms (Associated Features)

• Substernal pressure, squeezing, or crushing pain (classic cardiac)
• Radiation to the left arm, jaw, shoulder, or back
• Shortness of breath, diaphoresis (sweating), nausea, vomiting
• Sharp, pleuritic pain (worsens with breathing — pulmonary cause)
• Burning sensation after meals (esophageal/GERD cause)
• Pain reproduced by palpation (musculoskeletal)

Surgical Procedures

• Coronary Artery Bypass Grafting (CABG): For significant coronary artery disease; a graft vessel reroutes blood around blocked coronary arteries
• Percutaneous Coronary Intervention (PCI/Angioplasty): Catheter-based balloon dilation and stent placement to open blocked coronary arteries
• Aortic Repair/Replacement: For aortic dissection or aortic stenosis — open or endovascular repair
• Esophagomyotomy (Heller Myotomy): For achalasia/esophageal spasm causing non-cardiac chest pain — laparoscopic division of lower esophageal sphincter muscle
• Antireflux Surgery (Fundoplication – Nissen): For GERD-related chest pain refractory to medication

2. Knee Pain / Knee Joint Surgeries

Definition

Causes

• Traumatic: Ligament tears (ACL, PCL, MCL, LCL), meniscal tears, fractures, patellar dislocation
• Degenerative: Osteoarthritis (most common), rheumatoid arthritis
• Inflammatory: Gout, pseudogout, septic arthritis
• Overuse: Patellar tendinitis, iliotibial band syndrome, patellofemoral pain syndrome
• Structural: Bipartite patella, osteochondral defects, Baker's cyst

Symptoms

• Pain (anterior, medial, lateral, or posterior knee)
• Swelling and effusion (fluid in the joint)
• Stiffness, reduced range of motion
• Clicking, locking, or "giving way" of the knee
• Tenderness on palpation over specific structures
• Crepitus (grinding sensation) in osteoarthritis

Surgical Procedures

• Arthroscopy: Minimally invasive camera-guided procedure; used for diagnostic purposes and treatment of meniscal tears, ligament injuries, and cartilage damage
• ACL Reconstruction: Torn anterior cruciate ligament replaced with autograft (patellar tendon or hamstring) or allograft; typically arthroscopic
• Meniscectomy / Meniscal Repair: Removal or suture repair of torn meniscus via arthroscope
• Total Knee Arthroplasty (TKA): Replacement of all three knee compartments (femoral, tibial, patellar components) with prosthetic implants; performed for end-stage arthritis
• Unicompartmental Knee Arthroplasty (UKA): Replacement of only one compartment of the knee; less invasive than TKA
• High Tibial Osteotomy (HTO): Realignment of the tibia to shift weight off the damaged compartment; used in younger patients with medial compartment arthritis
• Patellofemoral Surgery: Lateral release, trochleoplasty, or tibial tubercle osteotomy for patellofemoral instability
• Computer-Navigated / Robotic TKA: Enhanced accuracy for component placement and alignment using real-time intraoperative feedback

3. Kidney Stone (Nephrolithiasis)

Definition

Causes

• Metabolic: Hypercalciuria, hyperoxaluria, hyperuricosuria, hypocitraturia
• Dietary: Low fluid intake (concentrated urine), high sodium, high animal protein, high oxalate foods (spinach, nuts)
• Anatomical: Urinary tract obstruction, medullary sponge kidney
• Infections: Urease-producing bacteria (Proteus) → struvite stones
• Medications: Acetazolamide, loop diuretics, excessive vitamin C/D
• Systemic diseases: Primary hyperparathyroidism, gout, Crohn's disease, gastric bypass surgery

Symptoms

• Sudden, severe flank pain (renal colic) — colicky, radiating to groin
• Hematuria (blood in urine) — gross or microscopic
• Nausea and vomiting
• Urinary urgency and frequency
• Dysuria (painful urination)
• Fever and chills (if associated infection/pyelonephritis — emergency)
• Asymptomatic in stones confined to renal pelvis

Surgical Procedures

• Extracorporeal Shock Wave Lithotripsy (ESWL): Non-invasive; focused acoustic shock waves fragment stones ≤2 cm into passable pieces
• Ureteroscopy (URS) with Laser Lithotripsy: A ureteroscope passed through the urethra/bladder into the ureter; laser (Holmium) fragments the stone; fragments removed with a basket
• Percutaneous Nephrolithotomy (PCNL): For large (>2 cm) or staghorn calculi; a nephroscope is inserted directly into the kidney through a small back incision to remove/fragment the stone
• Open/Laparoscopic Ureterolithotomy: Rarely used today; direct incision to remove a large ureteral stone
• Nephrectomy: Only in extreme cases of a non-functioning kidney due to recurrent obstruction

4. Gallbladder Stone (Cholelithiasis)

Definition

Causes

• Cholesterol stones (most common): Excess cholesterol secretion in bile, reduced bile acids, gallbladder hypomotility (bile stasis)
• Pigment stones (black): Hemolytic disorders (sickle cell disease, hereditary spherocytosis) → excess bilirubin
• Pigment stones (brown): Biliary tract infections, parasites
• Risk factors (4 F's): Fat, Forty, Female, Fertile; also diabetes, rapid weight loss, total parenteral nutrition, pregnancy

Symptoms

• Many patients are asymptomatic ("silent gallstones")
• Biliary colic: Right upper quadrant (RUQ) or epigastric pain after fatty meals, lasting 30 min – 6 hours
• Acute cholecystitis: Persistent RUQ pain, fever, nausea, vomiting, Murphy's sign positive
• Jaundice: If a stone obstructs the common bile duct (choledocholithiasis)
• Acute pancreatitis: Stone obstructs the pancreatic duct orifice
• Nausea, bloating, fatty food intolerance

Surgical Procedures

• Laparoscopic Cholecystectomy (Gold Standard): Removal of the entire gallbladder via 3–4 small ports; standard treatment for symptomatic cholelithiasis; short hospital stay, rapid recovery
• Open Cholecystectomy: Used when laparoscopic approach is not possible (severe inflammation, adhesions, suspected cancer)
• Endoscopic Retrograde Cholangiopancreatography (ERCP) with Sphincterotomy: For common bile duct stones — endoscope reaches the bile duct opening, sphincter is cut, and stones are extracted with a basket or balloon; usually performed before or after cholecystectomy
• Percutaneous Cholecystostomy: Drainage tube inserted into the gallbladder under imaging guidance; used as a bridge in critically ill patients unfit for surgery
• Choledochotomy: Surgical incision into the common bile duct to remove stones; rarely needed

5. Hernia

Definition

Causes

• Congenital weakness: Patent processus vaginalis (inguinal hernia in children)
• Acquired weakness: Aging, obesity, chronic cough, constipation (straining), previous surgery (incisional hernia)
• Increased intra-abdominal pressure: Heavy lifting, pregnancy, ascites, chronic straining
• Type-specific: Hiatal hernia — weakening of diaphragmatic hiatus; femoral hernia — more common in women

Symptoms

• Visible or palpable bulge (especially on straining, coughing, standing)
• Dull aching or sharp localized pain
• Dragging or heavy sensation
• Incarceration: Hernia contents trapped and cannot be reduced — severe pain, nausea, vomiting
• Strangulation (surgical emergency): Blood supply cut off — severe pain, fever, tender, hard lump; bowel may become gangrenous

Surgical Procedures

• Open Tension-Free Hernioplasty (Lichtenstein Repair): Mesh placed over the defect through a groin incision; most common open approach for inguinal hernias
• Laparoscopic Total Extraperitoneal Repair (TEP): Mesh placed behind the abdominal wall without entering the peritoneal cavity; excellent for bilateral hernias
• Laparoscopic Transabdominal Preperitoneal Repair (TAPP): Mesh placed via the peritoneal cavity; versatile and widely used
• Robotic Inguinal Hernia Repair (RIHR): Emerging technique with comparable outcomes to laparoscopic repair with potential ergonomic benefits (RIVAL trial, 2020)
• Open Umbilical/Incisional Hernia Repair: Mayo repair (overlapping edges) or mesh placement for umbilical hernias
• Component Separation Technique: For large abdominal wall/incisional hernias; muscles are separated to allow tension-free primary closure with mesh reinforcement
• Nissen Fundoplication / Paraesophageal Hernia Repair: For hiatal hernias, the herniated stomach is reduced back into the abdomen and the hiatus is tightened

6. Abdominal Pain (General)

Definition

Causes

• GI tract: Appendicitis, peptic ulcer disease, bowel obstruction, irritable bowel syndrome (IBS), inflammatory bowel disease (IBD — Crohn's/Ulcerative colitis), diverticulitis, gastroenteritis, colorectal cancer
• Hepatobiliary: Cholecystitis, hepatitis, pancreatitis
• Urological: Renal colic, urinary tract infection, pelvic pathology
• Gynecological: Ectopic pregnancy, ovarian torsion, endometriosis, pelvic inflammatory disease
• Vascular: Mesenteric ischemia, aortic aneurysm rupture
• Functional/Other: Constipation, gas, psychosomatic pain, hernia

Symptoms

• Pain character: crampy, colicky, burning, sharp, or dull
• Location guides diagnosis: RUQ (liver/gallbladder), LUQ (spleen/stomach), RLQ (appendix, ovary), LLQ (sigmoid colon), central (umbilical — small bowel, aorta)
• Associated: fever, nausea, vomiting, diarrhea, constipation, anorexia, jaundice, bloody stool, urinary symptoms
• Peritoneal signs (rigid abdomen, rebound tenderness, guarding) = surgical emergency

Surgical Procedures (by underlying cause)

• Appendectomy: Open or laparoscopic removal of the appendix for acute appendicitis (most common abdominal emergency)
• Bowel Resection: Removal of diseased bowel segment for obstruction, IBD, cancer, or ischemia
• Exploratory Laparotomy: Open abdominal exploration when the cause is uncertain and the patient is critically unstable
• Laparoscopic Diagnostic Surgery: Minimally invasive exploration for unexplained pain
• Colostomy/Ileostomy: Diversion of bowel when primary anastomosis is unsafe
• Emergency Laparotomy for Perforation: For perforated peptic ulcer, perforated diverticulitis, or bowel perforation with peritonitis

7. Congenital Conditions

Definition

Causes

• Genetic mutations: Single-gene disorders (e.g., cystic fibrosis, PKU)
• Chromosomal abnormalities: Down syndrome (Trisomy 21), Turner syndrome
• Multifactorial: Interaction of genetic predisposition and environment (e.g., neural tube defects, cleft palate)
• Teratogens: Alcohol (fetal alcohol syndrome), rubella infection in pregnancy, thalidomide, radiation
• Unknown/idiopathic: Many congenital malformations have no identifiable cause

Symptoms (Vary Widely by Condition)

• Congenital Heart Defects (VSD, ASD, TOF, PDA): Cyanosis, heart murmur, poor feeding, failure to thrive
• Pyloric Stenosis: Projectile non-bilious vomiting at 2–8 weeks of age; olive-shaped mass in epigastrium
• Cleft Lip/Palate: Visible facial malformation; feeding difficulties, speech problems
• Hirschsprung's Disease: Failure to pass meconium at birth; chronic constipation, abdominal distension
• Tracheoesophageal Fistula (TEF): Choking/coughing with feeds; inability to pass nasogastric tube
• Clubfoot (Talipes Equinovarus): Foot twisted inward and downward
• Spina Bifida: Neural tube defect; ranging from asymptomatic (spina bifida occulta) to severe neurological deficits (myelomeningocele)

Surgical Procedures

• Pyloromyotomy (Ramstedt's Procedure): For pyloric stenosis; longitudinal incision of the pyloric muscle (open or laparoscopic)
• Open-Heart Surgery: Repair of VSD, ASD, Tetralogy of Fallot; performed on cardiopulmonary bypass
• PDA Ligation: Closure of patent ductus arteriosus via thoracoscopic or open surgery
• Cleft Lip Repair (Millard Rotation-Advancement): Lip repair at ~3 months; palate repair at 9–12 months
• Swenson/Soave/Duhamel Pull-Through Procedure: For Hirschsprung's disease; removal of aganglionic bowel and pull-through of normal bowel to the anus
• TEF Repair: Division of the fistula and esophageal anastomosis via thoracotomy or thoracoscopy
• Spina Bifida Closure: Neurosurgical closure of the meningeal defect, often with VP shunt placement for hydrocephalus
• Ponseti Method + Surgery: Serial casting for clubfoot; if unsuccessful, surgical release of tight structures

8. Acute and Chronic Disease

Definition

• Acute disease: A condition of rapid onset, severe symptoms, and short duration (hours to days/weeks). Examples: acute appendicitis, acute MI, acute pancreatitis, sepsis
• Chronic disease: A condition that is long-lasting (≥3 months), often progressive, and may not be curable. Examples: diabetes mellitus, hypertension, COPD, chronic kidney disease, heart failure, cancer

Causes

• Acute: Infections, trauma, vascular events (embolism, infarction), acute obstruction, toxic exposure
• Chronic: Lifestyle factors (obesity, smoking, sedentary behavior), genetic predisposition, environmental factors, unresolved acute disease, autoimmune mechanisms, aging

Symptoms

• Acute: Sudden onset, severe pain, fever, hemodynamic instability, rapid deterioration; requires urgent intervention
• Chronic: Gradual onset, fatigue, persistent pain, organ dysfunction (dyspnea, edema, anuria), weight loss, recurrent exacerbations; managed long-term

Surgical Procedures (Examples by Disease)

Acute Conditions:

Chronic Conditions:

Summary Table

1. Chest Pain — broad differential from cardiac to GI; surgical options span CABG to fundoplication
2. Knee Pain / Knee Joint Surgeries — traumatic and degenerative causes; surgeries from arthroscopy to total knee replacement
3. Kidney Stone (Nephrolithiasis) — metabolic/dietary causes; non-invasive ESWL to PCNL for large stones
4. Gallbladder Stone (Cholelithiasis) — classic "4 F's" risk profile; laparoscopic cholecystectomy is the gold standard
5. Hernia — weakness/pressure causes; options range from open mesh to robotic laparoscopic repair
6. Abdominal Pain (General) — wide variety of organ causes; surgery depends on the underlying diagnosis (appendectomy, bowel resection, etc.)
7. Congenital Conditions — covers major surgical conditions: pyloric stenosis, cardiac defects, TEF, Hirschsprung's, cleft lip/palate, spina bifida
8. Acute vs. Chronic Disease — distinguished by onset and duration; surgical examples provided for each category in tabular form