Q: Give information about all the topics litaraly all the topics in very short A: I now have all topics extracted. Here is a complete, concise summary of every topic from your Surgery Paper-2 notes: --- Surgery Paper-2 - All Topics Short Notes --- GENERAL / MISCELLANEOUS Numbered 1. Appendicitis - Inflammation of the appendix. RIF pain, fever, vomiting. McBurney's point tenderness. Mx: appendicectomy. 2. CSOM - Chronic Suppurative Otitis Media. Persistent ear discharge 2 weeks. Mx: antibiotics, tympanoplasty. 3. Pyorrhoea - Periodontal disease with pus from gum margins. Caused by bacterial infection. Mx: scaling, antibiotics. 4. BPH - Benign Prostatic Hyperplasia. Enlarged prostate causing obstructive LUTS. Mx: alpha-blockers, TURP. 5. Epistaxis - Nosebleed. 90% from Kiesselbach's plexus anterior. Mx: pinching, cautery, packing. --- ARTERIES Topic Short Note ------------------ Arterial occlusion Sudden or gradual blockage of artery. 6 P's: Pain, Pallor, Pulselessness, Paresthesia, Paralysis, Poikilothermia. Ischemic artery dis. Reduced blood flow causing tissue ischemia. Includes peripheral arterial disease. Aneurysm Abnormal focal dilation of artery 1.5x normal. Most common: AAA. Risk of rupture. Embolism Blockage by embolus clot, fat, air. Causes acute limb ischemia. Thrombosis In-situ clot formation. Arterial thrombosis - acute ischemia. Atherosclerosis Plaque buildup in arterial walls. Risk: HTN, DM, smoking. Leads to IHD, stroke, PVD. Buerger's Disease Thrombo-angiitis obliterans Inflammatory occlusion of small/medium vessels in young male smokers. Rest pain, gangrene. Mx: stop smoking. Raynaud's Disease Vasospasm of digital arteries triggered by cold/stress. Color changes: white-blue-red. --- VEINS Topic Short Note ------------------ Venous Thrombosis Clot in vein. Risk: Virchow's triad stasis, hypercoagulability, endothelial injury. Thrombophlebitis Superficial vein inflammation + thrombus. Painful, red cord. Mx: NSAIDs, warm compress. DVT Deep Vein Thrombosis Clot in deep vein usually calf/thigh. Risk of PE. Homan's sign. Dx: Doppler. Mx: LMWH/warfarin. Varicose Veins Dilated, tortuous superficial veins. Incompetent valves. Trendelenburg test. Mx: sclerotherapy, stripping. Venous Ulcer Chronic ulcer due to venous hypertension. Medial malleolus. Lipodermatosclerosis. Mx: compression bandaging. --- LYMPHATICS Topic Short Note ------------------ Lymphangiography Imaging of lymphatics using contrast. Diagnoses lymphedema, lymphoma staging. Lymphoedema Accumulation of lymph causing limb swelling. Primary congenital or secondary post-surgery/radiation. Hodgkin's Lymphoma Reed-Sternberg cells. Bimodal age. B symptoms. Staged by Ann Arbor. Mx: ABVD chemo. Non-Hodgkin's Lymphoma Heterogeneous group. More common than HL. Can be B or T cell. Mx: R-CHOP. Burkitt's Lymphoma Highly aggressive B-cell lymphoma. c-MYC translocation t8;14. "Starry sky" pattern. Associated with EBV. Cutaneous T-cell Lymphoma Mycosis fungoides commonest. Skin plaques/patches. Sezary syndrome variant. Chylous Ascites Milky fluid in peritoneal cavity due to lymph leak. Caused by trauma, malignancy, filariasis. Chylothorax Chyle in pleural space. Caused by thoracic duct injury. Dx: pleural fluid triglycerides 110 mg/dL. Sarcoidosis Non-caseating granulomas. Bilateral hilar lymphadenopathy. ACE levels elevated. Acute Lymphangitis Bacterial infection of lymph vessels. Red streaks on skin. Mx: antibiotics. --- NERVES Topic Short Note ------------------ Carpal Tunnel Syndrome Compression of median nerve at wrist. Tingling/pain in lateral 3.5 fingers. Tinel's + Phalen's test. Mx: splint, surgery. Claw Hand Ulnar nerve palsy. Ring and little finger clawed. Causes: cubital tunnel, leprosy. Foot Drop Weakness of dorsiflexion. Common peroneal nerve palsy. High-stepping gait. --- GI - UPPER Mouth to Stomach Topic Short Note ------------------ Cleft Lip Failure of fusion of maxillary and medial nasal processes. Mx: surgery at 3 months "rule of 10". Cleft Palate Failure of palatine shelf fusion. Speech problems. Mx: surgery at 9-12 months. Stomatitis Inflammation of oral mucosa. Causes: viral, candida, nutritional deficiency. Ca. Tongue Squamous cell carcinoma. Most common: lateral border. Risk: tobacco, alcohol, HPV. Dysphagia Difficulty swallowing. Mechanical or neurological. Investigate: barium swallow, endoscopy. GERD Gastroesophageal reflux. Heartburn, regurgitation. Mx: PPI, lifestyle changes, Nissen fundoplication. Hiatus Hernia Protrusion of stomach through esophageal hiatus. Sliding 90% vs paraesophageal. Peritonitis Inflammation of peritoneum. Rigid abdomen, guarding. Caused by perforation. Mx: emergency laparotomy. Pyloric Stenosis Infantile hypertrophic pyloric stenosis. Projectile vomiting at 4-6 weeks. Olive mass. Mx: Ramstedt's pyloromyotomy. Gastric Outlet Obstruction Vomiting of undigested food. Succussion splash. Causes: peptic ulcer, Ca stomach. Ca. Stomach Gastric adenocarcinoma. Late presentation. H. pylori association. Mx: gastrectomy + chemo. Peutz-Jeghers Syndrome Hamartomatous polyps + mucocutaneous pigmentation. AD. Risk of GI malignancy. Carcinoid Tumor Neuroendocrine tumor. Carcinoid syndrome flushing, diarrhea, wheezing. 5-HIAA in urine. Gastritis Mucosal inflammation. Type A autoimmune, Type B H. pylori. Mx: PPI, eradication. Peptic Ulcer Duodenal more common than gastric. H. pylori, NSAIDs. Mx: PPI + triple therapy. Hematemesis Vomiting blood. Causes: peptic ulcer, varices, Mallory-Weiss. Emergency - resuscitate first. --- GI - SMALL BOWEL Topic Short Note ------------------ Crohn's Disease Transmural inflammation, skip lesions, entire GI tract. Cobblestone mucosa. Mx: steroids, biologics, surgery. Ischemic Colitis Poor blood supply to colon SMA territory. Sudden pain + bloody diarrhea. Duodenum Diverticulum Usually asymptomatic. Periampullary - can cause obstructive jaundice. Intestinal Obstruction Mechanical or functional. Absolute constipation, vomiting, distension. Mx: NG tube, surgery. Intussusception Telescoping of bowel. Common in children. "Redcurrant jelly" stool. Mx: barium/air enema, surgery. Volvulus Twisting of bowel on its mesentery. Sigmoid most common. "Coffee bean" sign on X-ray. Meckel's Diverticulum Rule of 2s: 2% population, 2 inches long, 2 feet from ileocecal valve. Contains ectopic gastric mucosa. Small & Large Bowel Malignancy Small bowel - adenocarcinoma, carcinoid. Large bowel - adenocarcinoma, most in sigmoid/rectum. Intestinal Polyposis Multiple polyps FAP, Peutz-Jeghers. FAP: APC gene, 100% malignancy risk. Intestinal Diverticulum Pouches in bowel wall. Diverticulitis: pain, fever, rectal bleeding. Mx: antibiotics, surgery if complicated. Abdominal TB Ileocecal most common. Dough belly, ascites. Mx: ATT anti-TB therapy. Paralytic Ileus Functional obstruction. Post-op, peritonitis, electrolyte imbalance. Mx: conservative - NBM, NG, fluids. Hirschsprung's Disease Absence of ganglion cells in rectum/colon. Neonatal obstruction. Dx: rectal biopsy. Mx: Swenson's pull-through. Colostomy / Ileostomy Surgical diversion of bowel to abdominal surface. Temporary or permanent. Barium Enema Contrast X-ray of colon. Shows "apple core" lesion in Ca colon, "bird beak" in volvulus. --- GI - LARGE BOWEL / ANORECTAL Topic Short Note ------------------ Ulcerative Colitis Mucosal inflammation, continuous, starts from rectum. Pseudopolyps. Mx: 5-ASA, steroids, colectomy. Fistula in Ano Abnormal tract between anal canal and perianal skin. Goodsall's rule. Mx: fistulotomy. Fissure in Ano Tear in anal mucosa. Posterior midline. Pain on defecation. Mx: GTN cream, lateral sphincterotomy. Piles Haemorrhoids Dilated anal cushions. 1st-4th degree. Painless bright red bleeding internal. Mx: diet, banding, haemorrhoidectomy. Pruritus Ani Itching around anus. Causes: threadworms, skin conditions, moisture. Prolapse of Rectum Protrusion of rectal wall through anus. Concentric rings complete vs radial folds mucosal. Mx: rectopexy. Ano-rectal Abscess Collection in perianal spaces. Pain, swelling, fever. Mx: I&D. Abdominal Hernias Protrusion of viscus through abdominal wall. Types: inguinal most common, femoral, umbilical, incisional. Pelvic Abscess Collection in pelvis pouch of Douglas. Complication of appendicitis/peritonitis. Mx: drainage. Subphrenic Abscess Collection under diaphragm. Post-operative complication. Hiccups, referred shoulder pain. Mesenteric Cysts Rare cysts of lymphatic origin in mesentery. Mobile, transilluminant. Mx: excision. Psoas Abscess Collection in psoas sheath. Primary TB or secondary. Presents as groin swelling + hip flexion deformity. Fibrosis Peritoneal/retroperitoneal fibrosis. Can cause ureteric obstruction. --- LIVER Topic Short Note ------------------ Hepatomegaly Enlarged liver. Causes: hepatitis, fatty liver, malignancy, CCF. Amoebic Liver Abscess Entamoeba histolytica. Right lobe. "Anchovy sauce" pus. Mx: metronidazole + drainage. Hydatid Cyst Echinococcus granulosus. Right lobe. Casoni's test. Mx: PAIR Puncture, Aspiration, Injection, Re-aspiration + albendazole. Actinomycosis Actinomyces israelii. Woody hard swelling, sinus tracts with sulfur granules. Mx: penicillin. Pyogenic Liver Abscess Bacteria E. coli, Klebsiella. From portal vein. Right lobe. Mx: antibiotics + drainage. Gallstone Cholelithiasis. Cholesterol most common in West or pigment stones. Murphy's sign in cholecystitis. Mx: laparoscopic cholecystectomy. Cholecystitis Inflammation of gallbladder. Acute: RUQ pain, fever, Murphy's positive. Mx: cholecystectomy. Ca. Gallbladder Aggressive. Associated with gallstones. Mirizzi syndrome. Poor prognosis. Jaundice Bilirubin 2 mg/dL. Pre-hepatic, hepatic, post-hepatic obstructive. Splenomegaly Enlarged spleen. Causes: malaria, portal HTN, haematological disease, infections. Splenic Artery Aneurysm Most common visceral aneurysm. Risk in pregnancy. Mx: endovascular repair. Cyst of Spleen Primary epidermoid or secondary hydatid, post-traumatic. Portal HTN Increased portal pressure 12 mmHg. Causes: cirrhosis commonest. Features: varices, splenomegaly, ascites. Oesophageal Varices Dilated veins at GOJ due to portal HTN. Risk of massive bleed. Mx: terlipressin, banding, TIPS. Ascites Fluid in peritoneal cavity. SAAG 1.1 = portal HTN. Mx: diuretics, paracentesis. Hepatic Failure Coagulopathy, encephalopathy, jaundice. Acute paracetamol overdose or chronic cirrhosis. Hepatic Encephalopathy Neuropsychiatric syndrome due to liver failure. Ammonia accumulation. Flapping tremor asterixis. Mx: lactulose, rifaximin. Liver Insufficiency Chronic reduced liver function. Managed with supportive care. HCC Malignant tumor Hepatocellular carcinoma. Complication of cirrhosis/HBV/HCV. AFP raised. Mx: resection, TACE, transplant. Benign Liver Tumor Haemangioma most common, hepatic adenoma, FNH. Budd-Chiari Syndrome Hepatic venous outflow obstruction. Painful hepatomegaly, ascites, liver failure. Mx: anticoagulation, TIPS. Liver Cirrhosis End-stage fibrosis. Causes: alcohol, HBV/HCV. Spider naevi, gynecomastia, caput medusae. Sclerosing Cholangitis Primary PSC - associated with UC. Progressive biliary strictures. ERCP, liver transplant. Hydatid Liver Dis. see Hydatid Cyst above --- PANCREATITIS Topic Short Note ------------------ Pancreatitis Acute: raised amylase/lipase, epigastric pain. Chronic: steatorrhoea, DM, calcifications. Causes: gallstones, alcohol. Ca. Pancreas Adenocarcinoma head body tail. Painless jaundice, Courvoisier's sign. CA 19-9. Poor prognosis. Mx: Whipple's. Pancreatic Abscess/Cyst/Fistula Complications of pancreatitis. Pseudocyst: fluid collection without epithelium. Mx: cystogastrostomy. --- THORAX Chest Topic Short Note ------------------ Pneumothorax Air in pleural space. Tension pneumo - medical emergency. Mx: needle decompression + chest drain. Pleural Effusion Fluid in pleural space. Transudate vs exudate Light's criteria. Mx: tapping thoracocentesis. Haemothorax Blood in pleural space. Trauma most common. Mx: chest drain, thoracotomy if massive. Bronchoscopy Visualization of tracheobronchial tree. Rigid FB removal or flexible diagnosis. Emphysema Destruction of alveoli. Barrel chest, pink puffer. Part of COPD. Flail Chest Multiple rib fractures causing paradoxical chest movement. Mx: ventilatory support. Stove-in Chest Severe chest wall injury with multiple fractures. Lung Abscess Pus-filled cavity. Causes: aspiration, pneumonia, bronchiectasis. Mx: antibiotics, drainage. ARDS Acute Respiratory Distress Syndrome. Non-cardiogenic pulmonary edema. P/F ratio 200. Mx: lung-protective ventilation. ICD Intercostal Drain Chest drain insertion. Indications: pneumothorax, pleural effusion, haemothorax. Stiff Lung Reduced lung compliance. Associated with ARDS, pulmonary fibrosis. Pulmonary Embolism Clot in pulmonary artery. Pleuritic pain, hemoptysis, tachycardia. D-dimer. Mx: anticoagulation, thrombolysis. Lung Cyst Air-filled cavity. Congenital or acquired. Mediastinal Tumors By compartment: anterior thymoma, teratoma, lymphoma, middle lymphoma, cysts, posterior neurogenic. Pancoast Tumor Superior sulcus tumor. Horner's syndrome + shoulder/arm pain. Diaphragmatic Hernia Congenital Bochdalek, Morgagni or traumatic. Bowel in chest. Mx: surgical repair. Pericarditis Inflammation of pericardium. Friction rub. Saddle-shaped ST elevation. Mx: NSAIDs. Valvular Heart Disease Stenosis/regurgitation of valves. Murmurs. Mx: medical or valve replacement. Cardiac Tamponade Fluid compression of heart. Beck's triad: hypotension + JVD + muffled sounds. Mx: pericardiocentesis. --- KIDNEY Topic Short Note ------------------ Haematuria Blood in urine. Gross or microscopic. Causes: stones, tumor, infection, trauma. PCKD Polycystic Kidney Disease. AD PKD1/PKD2. Berry aneurysms association. HTN, renal failure. Renal TB Spread from pulmonary TB. "Moth-eaten" calyces on IVU. Sterile pyuria. Mx: ATT. Hydronephrosis Dilation of renal pelvis due to obstruction. Causes: stone, PUJ obstruction, tumor. Pyonephrosis Infected hydronephrosis. Mx: urgent drainage PCN + antibiotics. Perinephric Abscess Infection around kidney. Causes: renal abscess rupture, haematogenous. Mx: drainage. Renal Calculus Most common: calcium oxalate. Renal colic. Staghorn calculus - struvite. Mx: ESWL, PCNL, URS. Horseshoe Kidney Fusion of lower poles. Most common renal anomaly. Association with PUJ obstruction. Renal Carbuncle Cortical abscess. S. aureus. Mx: antibiotics, drainage. Wilm's Tumor Nephroblastoma Commonest renal tumor in children 5 yrs. Abdominal mass. Mx: nephrectomy + chemo/RT. Grawitz Tumor Renal Cell Ca Adenocarcinoma of kidney. Classic triad: loin pain + hematuria + mass. Paraneoplastic. Mx: nephrectomy. --- URETER & BLADDER Topic Short Note ------------------ Ureteric Calculi Stone impacted in ureter. Ureteric colic - loin to groin pain. Mx: analgesia, ESWL, ureteroscopy. Cystitis Bladder infection. Dysuria, frequency, urgency. E. coli commonest. Mx: antibiotics. Bladder Stone Stasis, infection, foreign body. Mx: cystolithotripsy. Ca. Bladder TCC transitional cell carcinoma most common. Painless hematuria. Mx: TURBT, cystectomy. BOO Bladder Outlet Obstruction Causes: BPH, stricture, stone. Features: poor flow, retention. VUR Vesicoureteric Reflux Urine backflow into ureters. Causes: recurrent UTI, renal scarring. Mx: prophylactic antibiotics, surgery. Diverticulum of Bladder Outpouching of bladder wall. Associated with BOO. Mx: diverticulectomy. --- PROSTATE Topic Short Note ------------------ BPH see above Enlarged prostate. Obstructive + irritative symptoms. Prostatitis Infection/inflammation of prostate. Acute: dysuria, fever, tender prostate. Mx: fluoroquinolones. Ca. Prostate Most common cancer in elderly males. PSA raised. Gleason grading. Mx: watchful waiting, radical prostatectomy, radiotherapy, ADT. --- URETHRA Topic Short Note ------------------ Stricture Narrowing of urethra. Causes: trauma, infection gonorrhea, iatrogenic. Mx: dilatation, urethroplasty. Hypospadias Urethral opening on ventral surface. Associated with chordee. Mx: surgical correction. Urethritis Inflammation of urethra. Gonococcal GC vs Non-gonococcal NGU - Chlamydia. Urethral Calculi Stones lodged in urethra. Acute retention. Mx: meatotomy or extraction. Retention of Urine Acute or chronic. Causes: BPH, stricture, neurological. Mx: catheterization, treat cause. Urethral Catheterization Foley catheter placement. Indications: retention, monitoring UO, surgery. Urinary Incontinence Involuntary urine leak. Types: stress SUI, urge, overflow, functional. Urinary Fistula Abnormal communication. Vesicovaginal post-obstetric most common. UTI Urinary Tract Infection. E. coli commonest. Uncomplicated vs complicated. Mx: antibiotics. --- PENIS Topic Short Note ------------------ Phimosis Tight foreskin that cannot retract. Physiological in infants. Mx: topical steroids, circumcision. Circumcision Surgical removal of foreskin. Indications: phimosis, paraphimosis, religious. Ca. Penis Squamous cell carcinoma. Associated with HPV, phimosis, poor hygiene. Mx: wide excision, penectomy. Balanoposthitis Inflammation of glans and foreskin. Candida, bacterial. Mx: topical antifungals/antibiotics. Peyronie's Disease Fibrous plaque in tunica albuginea. Penile curvature + pain on erection. Mx: conservative, surgery. Priapism Prolonged painful erection 4 hours. Ischemic low-flow is an emergency. Mx: aspiration, alpha-agonist injection. --- SCROTUM / TESTES Topic Short Note ------------------ Undescended Testis Cryptorchidism Failure of testis to descend. Risk of malignancy, infertility. Mx: orchidopexy before age 2. Retractile Testis Testis pulled into inguinal canal by cremasteric reflex. Normal. No treatment needed. Torsion of Testis Twisting of spermatic cord. Sudden severe pain. Surgical emergency - within 6 hours. "Bell clapper" deformity. Varicocele Dilated pampiniform plexus. Left side common 90%. "Bag of worms." Causes infertility. Mx: embolization/ligation. Hydrocele Fluid around testis. Transilluminates. Primary or secondary. Mx: Lord's/Jaboulay procedure. Fournier's Gangrene Necrotizing fasciitis of perineum/genitalia. Rapidly progressive. Mx: emergency debridement + broad-spectrum antibiotics. Epididymo-Orchitis Infection of epididymis ± testis. STI Chlamydia, gonorrhea in young; E. coli in elderly. Mx: antibiotics. Testicular Tumor Most common solid tumor in males 15-35 yrs. Types: seminoma radiosensitive vs NSGCT. Mx: radical orchidectomy + chemo/RT. --- Total topics covered: 120+ spanning arteries, veins, lymphatics, nerves, GI upper, lower, anorectal, liver, pancreas, thorax, kidney, ureter, bladder, prostate, urethra, penis, and scrotum. Use this as a quick revision guide. For each topic, focus on: Definition + Key feature + Investigation + Management.
