Surgery Notes - All Topics (Short Summary)

🧠 NERVES

1. Carpal Tunnel Syndrome

• Compression of the median nerve at the wrist under the flexor retinaculum
• S/S: Tingling/numbness in lateral 3½ fingers, night pain, Tinel's & Phalen's sign +ve
• Rx: Splinting, steroid injection; surgical release (carpal tunnel decompression) if severe

2. Claw Hand

• Loss of intrinsic hand muscles (interossei + lumbricals)
• Ulnar nerve injury → ring & little finger clawing; total claw = combined median + ulnar
• Rx: Physiotherapy; Zancolli's lasso procedure surgically

3. Foot Drop

• Common peroneal nerve palsy → inability to dorsiflex foot
• Causes: trauma to fibular neck, prolonged squatting, fractures
• Rx: Foot drop splint; tendon transfer (tibialis posterior) if permanent

🫁 GIT - UPPER

4. GERD (Gastro-Esophageal Reflux Disease)

• Regurgitation of acid due to incompetent LES
• S/S: Heartburn, regurgitation, dysphagia
• Rx: PPI, lifestyle changes; Nissen fundoplication (surgical)

5. Hiatus Hernia

• Stomach herniates through esophageal hiatus of diaphragm
• Types: Sliding (Type I - most common), Rolling/Paraesophageal (Type II), Mixed (Type III)
• Rx: Conservative; surgery - fundoplication ± mesh repair

6. Pelvic Abscess

• Collection of pus in the rectovesical/rectouterine pouch (Pouch of Douglas)
• Causes: Appendicitis, PID, post-operative
• Rx: Drainage - transrectal/transvaginal; antibiotics

7. Subphrenic Abscess

• Pus collection between diaphragm and liver/stomach
• Causes: Post-op (appendicitis, peptic ulcer perforation)
• S/S: Fever, shoulder tip pain, hiccoughs
• Rx: CT-guided drainage or open drainage

8. Mesenteric Cysts

• Rare cystic swellings in mesentery; can present as abdominal lump
• Rx: Surgical excision

9. Fibrosis (Retroperitoneal Fibrosis)

• Fibrous tissue surrounding aorta/IVC/ureters
• S/S: Back pain, ureteric obstruction
• Rx: Steroids, ureterolysis (surgical)

10. Psoas Abscess

• Pus in psoas muscle sheath
• Primary (TB) or secondary (Crohn's, vertebral osteomyelitis)
• S/S: Groin/back pain, flexion deformity of hip, psoas sign +ve
• Rx: CT-guided drainage + antitubercular therapy if TB

11. Gastritis

• Inflammation of gastric mucosa
• Acute (NSAIDs, H. pylori, stress) or Chronic (H. pylori - type B; Autoimmune - type A)
• Rx: PPI, H. pylori eradication

12. Peptic Ulcer

• Ulcer in stomach (gastric) or duodenum (duodenal, more common)
• Cause: H. pylori, NSAIDs; duodenal → high acid, gastric → normal/low acid
• Rx: Medical - PPI + triple therapy; surgical - truncal vagotomy, partial gastrectomy (Billroth I/II)

13. Hematemesis

• Vomiting of blood (upper GI bleed - above ligament of Treitz)
• Causes: Peptic ulcer, varices, Mallory-Weiss tear, gastric carcinoma
• Rx: Resuscitation, OGD, endoscopic haemostasis; surgery if uncontrolled

🫁 GIT - ESOPHAGUS & MOUTH

14. Cleft Lip

• Failure of fusion of maxillary and medial nasal processes
• Unilateral (more common, left side) or bilateral
• Rx: Rule of 10s - 10 weeks age, 10 lb weight, 10 g/dL Hb; Millard rotation-advancement repair

15. Cleft Palate

• Failure of fusion of palatal shelves
• May be isolated or with cleft lip
• Rx: Surgery at 6-18 months (Wardill-Kilner pushback or Furlow palatoplasty)

16. Stomatitis

• Inflammation of oral mucosa; ulcers, soreness
• Causes: Viral (HSV), nutritional deficiency, autoimmune
• Rx: Antiviral, antiseptic mouthwash, vitamins

17. Carcinoma Tongue

• Squamous cell carcinoma, most common at lateral border/anterior 2/3
• Risk: tobacco, alcohol, leukoplakia
• Rx: Surgery (hemiglossectomy) ± neck dissection ± radiotherapy

18. Dysphagia

• Difficulty swallowing; oropharyngeal vs esophageal
• Causes: Achalasia, stricture, esophageal carcinoma, external compression
• Rx: Treat underlying cause; bougie dilatation, Heller's myotomy (achalasia)

19. Peritonitis

• Inflammation of peritoneum; primary (spontaneous) or secondary (perforation)
• S/S: Board-like rigidity, tenderness, absent bowel sounds
• Rx: Resuscitation, IV antibiotics, emergency laparotomy

20. Pyloric Stenosis

• Adult: scarring from peptic ulcer; Infantile (congenital hypertrophic): 3-6 weeks male infants
• S/S: Projectile non-bilious vomiting, hypochloremic hypokalemic metabolic alkalosis, olive-shaped mass
• Rx: Infantile - correct electrolytes first, then Ramstedt's pyloromyotomy

21. Gastric Outlet Obstruction

• Obstruction at pylorus/duodenum; causes: peptic ulcer scar, Ca stomach, Ca head of pancreas
• S/S: Vomiting of old undigested food, succussion splash
• Rx: Medical stabilization, endoscopic balloon dilatation; surgery (gastrojejunostomy)

22. Carcinoma Stomach

• Adenocarcinoma (95%); associated with H. pylori, blood group A, pernicious anemia
• S/S: Early satiety, weight loss, Virchow's node, Sister Mary Joseph nodule
• Rx: Total/subtotal gastrectomy; D2 lymph node dissection; adjuvant chemo

🫁 GIT - SMALL & LARGE INTESTINE

23. Peutz-Jeghers Syndrome

• Autosomal dominant; hamartomatous polyps in GIT + mucocutaneous pigmentation (lips, buccal mucosa)
• Risk of malignancy; intussusception common complication
• Rx: Surveillance endoscopy; polypectomy

24. Carcinoid Tumor

• Neuroendocrine tumor; most common in appendix and ileum
• Carcinoid syndrome (flushing, diarrhea, bronchospasm) = liver metastasis
• Rx: Appendicectomy (if <2cm); right hemicolectomy; octreotide for syndrome

25. Crohn's Disease

• Transmural granulomatous inflammation; skip lesions; can affect any part of GIT (terminal ileum most common)
• S/S: Diarrhea, abdominal pain, perianal disease, fistulae, "cobblestone" appearance
• Rx: Steroids, azathioprine, infliximab; surgery for complications (strictureplasty, resection)

26. Ischemic Colitis

• Reduced blood supply to colon (splenic flexure most vulnerable - watershed area)
• S/S: Sudden colicky pain, bloody diarrhea
• Rx: Conservative (IV fluids, antibiotics); surgery if gangrenous/perforated

27. Small Bowel Malignancy / Large Bowel Malignancy

• Small bowel: rare; adenocarcinoma, lymphoma, carcinoid, GIST
• Large bowel (Colorectal Ca): most common GI malignancy; adenocarcinoma; DUKE's staging
• S/S: Change in bowel habits, PR bleeding, weight loss, obstruction
• Rx: Right/left hemicolectomy, anterior resection, APR depending on location; adjuvant chemo

28. Intestinal Polyposis

• Multiple polyps in colon; FAP (familial adenomatous polyposis - APC gene) → 100% malignant potential
• Rx: Prophylactic proctocolectomy + ileal pouch-anal anastomosis (IPAA)

29. Intestinal Diverticulum / Meckel's Diverticulum

• Meckel's: True diverticulum; Rule of 2s - 2 inches long, 2 feet from ileocaecal valve, 2% population, presents in 2 years
• Contains ectopic gastric/pancreatic tissue; can bleed, obstruct, or get inflamed (mimics appendicitis)
• Rx: Meckels diverticulectomy or segmental ileal resection

30. Colostomy / Ileostomy

• Colostomy: Opening of colon to skin; end (Hartmann's) or loop; for colorectal ca, obstruction
• Ileostomy: Opening of ileum; spouted (to protect colon anastomosis); for UC, Crohn's, FAP
• Complications: Prolapse, retraction, parastomal hernia, skin excoriation

31. Barium Enema

• Radiological investigation of large bowel; "apple core" lesion = colorectal ca; "bird beak" = volvulus
• Largely replaced by colonoscopy; used when colonoscopy not feasible

32. Paralytic Ileus

• Failure of intestinal peristalsis without mechanical obstruction; post-op most common cause
• S/S: Distension, no bowel sounds, no passage of flatus
• Rx: Conservative - NBM, nasogastric tube, IV fluids, neostigmine

33. Hirschsprung's Disease

• Congenital absence of ganglion cells (Auerbach's plexus) in rectum ± colon
• S/S: Failure to pass meconium in 48 hours, abdominal distension, ribbon-like stools
• Dx: Barium enema (narrow segment), rectal biopsy (absent ganglion cells)
• Rx: Swenson's/Duhamel/Soave pull-through procedure

34. Ulcerative Colitis

• Mucosal inflammation; starts at rectum, continuous, no skip lesions; only large bowel
• S/S: Bloody mucous diarrhea, tenesmus, toxic megacolon
• Rx: 5-ASA, steroids, biologics; surgery - proctocolectomy + IPAA (curative)

35. Intestinal Obstruction

• Mechanical (adhesions, hernia most common) or functional
• S/S: Colicky pain, vomiting, distension, absolute constipation
• Rx: "Drip and Suck" (IV fluids + NGT); surgery if strangulated/failed conservative

36. Intussusception & Volvulus

• Intussusception: telescoping of bowel; most common in infants (ileocolic); "redcurrant jelly" stools; Rx: air enema reduction or surgery
• Volvulus: Twisting of bowel on its mesentery; sigmoid most common; "omega loop" on X-ray; Rx: colonoscopic decompression; if gangrenous → Hartmann's

37. Appendicitis

• Inflammation of appendix; most common surgical emergency in young adults
• S/S: Periumbilical pain → RIF (McBurney's point), Rebound tenderness, Rovsing's, Psoas sign
• Rx: Appendicectomy (open or laparoscopic); antibiotics for uncomplicated cases (some evidence)

38. Abdominal TB

• Ileocaecal most common site; hyperplastic or ulcerative forms
• S/S: Dough-like abdomen, ileocaecal mass, subacute obstruction
• Rx: ATT (anti-tubercular therapy) × 6-9 months; surgery for obstruction/perforation

39. Fissure in Ano

• Longitudinal tear in anoderm distal to dentate line; posterior midline most common
• Acute: Painful defecation + bleeding; Chronic: sentinel pile + hypertrophied papilla
• Rx: Lateral internal sphincterotomy (LIS); botox injection; topical GTN/diltiazem

40. Piles / Haemorrhoids

• Dilated veins at anorectal junction; above dentate line = internal (painless bleeding); below = external (painful)
• Grading: I-IV based on prolapse
• Rx: High fiber diet; injection sclerotherapy, rubber band ligation; haemorrhoidectomy (Milligan-Morgan/stapled)

41. Pruritus Ani

• Perianal itching; causes: threadworms, poor hygiene, anal fissure, contact dermatitis
• Rx: Treat underlying cause; hygiene measures, topical steroids/antifungals

42. Prolapse of Rectum

• Protrusion of rectal wall through anus; complete (full thickness) or partial (mucosal)
• S/S: Reducible (initially), incontinence
• Rx: Delorme's procedure; Altemeier's (perineal); Rectopexy (abdominal - Ripstein/Wells)

43. Anorectal Abscess

• Collection of pus in perianal/ischiorectal/supralevator spaces; caused by blocked anal glands
• S/S: Painful perianal swelling, fever, difficulty sitting
• Rx: Incision and drainage (I&D); antibiotics adjunct

44. Fistula in Ano

• Abnormal tract between anal canal and perianal skin; Parks' classification
• Causes: Post-anorectal abscess, Crohn's, TB
• S/S: Persistent perianal discharge
• Rx: Fistulotomy (low fistula); Seton (high fistula); LIFT procedure

45. Abdominal Hernias

• Defect in abdominal wall allowing protrusion of contents
• Types: Inguinal (most common - indirect > direct), Femoral (below & lateral to pubic tubercle), Umbilical, Incisional, Epigastric
• Rx: Herniorrhaphy/hernioplasty (Lichtenstein mesh repair for inguinal)

46. Duodenal Diverticulum

• Usually near Ampulla of Vater; mostly asymptomatic; rarely causes pancreatitis/cholangitis
• Rx: Surgery only if symptomatic

🫀 LIVER

47. Benign Liver Tumors

• Hemangioma (most common), hepatic adenoma (OCP related), FNH (focal nodular hyperplasia)
• Rx: Observation; resection if symptomatic or diagnosis uncertain

48. HCC (Hepatocellular Carcinoma / Malignant Tumor)

• Most common primary liver malignancy; associated with cirrhosis, HBV, HCV, aflatoxin
• S/S: Weight loss, RUQ pain, hepatomegaly, raised AFP
• Rx: Surgical resection, transplantation (Milan criteria), ablation (RFA), TACE, sorafenib

49. Portal Hypertension

• Portal venous pressure >10 mmHg; causes: cirrhosis (most common), portal vein thrombosis, Budd-Chiari
• Complications: Varices, ascites, splenomegaly, hepatic encephalopathy
• Rx: Propranolol, endoscopic banding; TIPSS; portocaval shunt (surgical)

50. Oesophageal Varices

• Dilated submucosal veins in lower esophagus due to portal HTN
• Risk of life-threatening upper GI bleed
• Rx: Acute - terlipressin, Sengstaken-Blakemore tube, endoscopic banding/sclerotherapy; Prophylaxis - beta-blockers

51. Ascites

• Fluid accumulation in peritoneal cavity; SAAG >1.1 = portal HTN related
• Causes: Cirrhosis (most common), malignancy, cardiac failure
• Rx: Low sodium diet, diuretics (spironolactone + furosemide); therapeutic paracentesis; TIPSS

52. Hepatic Failure

• Acute (fulminant) or chronic; causes: viral hepatitis, paracetamol overdose, Budd-Chiari
• S/S: Jaundice, coagulopathy, encephalopathy, hypoglycemia
• Rx: Supportive, treat cause; N-acetylcysteine (paracetamol OD); liver transplant

53. Hepatic Encephalopathy

• Neuropsychiatric complications of liver failure; ammonia accumulation
• Grades I-IV; asterixis (flapping tremor) characteristic
• Rx: Lactulose, rifaximin, treat precipitants (GI bleed, infection, constipation)

54. Liver Insufficiency

• Impaired synthetic function; low albumin, coagulopathy (low prothrombin)
• Rx: Nutritional support, treat underlying disease, transplant

55. Budd-Chiari Syndrome

• Hepatic venous outflow obstruction (hepatic vein/IVC thrombosis)
• Causes: hypercoagulable states (polycythemia vera, pregnancy, OCP)
• S/S: Triad - hepatomegaly, ascites, abdominal pain; "caudate lobe" hypertrophy
• Rx: Anticoagulation, thrombolysis, TIPSS, liver transplant

56. Liver Cirrhosis

• End-stage fibrosis replacing normal architecture; irreversible
• Causes: Alcohol (most common in West), HBV/HCV, NASH, autoimmune
• Child-Pugh & MELD score for severity
• Rx: Treat cause; manage complications; transplant

57. Sclerosing Cholangitis (Primary)

• Progressive fibrosis and stricturing of biliary tree; associated with UC
• S/S: Jaundice, pruritus, cholangitis; "beaded" appearance on ERCP/MRCP
• Rx: UDCA; endoscopic dilation; liver transplant (only definitive treatment)

58. Pyogenic Liver Abscess

• Pus in liver from bacterial infection; most common cause: biliary disease/cholangitis, portal pyemia
• S/S: Fever, RUQ pain, tender hepatomegaly; "anchovy sauce" pus (if Amoebic)
• Rx: IV antibiotics + CT-guided drainage; surgery if failed

59. Amoebic Liver Abscess

• Entamoeba histolytica; single abscess usually in right lobe; "anchovy sauce" aspirate
• S/S: Fever, RUQ pain; raised right hemidiaphragm on CXR
• Rx: Metronidazole; aspiration only if: failure to respond, secondary infection, imminent rupture

60. Hydatid Disease of Liver

• Echinococcus granulosus (tapeworm); cystic lesion in liver; "daughter cysts" inside
• S/S: RUQ pain, hepatomegaly; anaphylaxis if ruptured
• Dx: Serology (ELISA), CT (daughter cysts + calcification)
• Rx: PAIR (Puncture-Aspiration-Injection-Reaspiration) or surgical cystectomy; albendazole

Total Topics Covered: 60 across Nerves, GIT (Upper/Lower), and Liver sections. Each summary covers the key surgical points - definition, cause, signs, and treatment - as needed for surgery exams.