General Surgery

Acute Abdomen

RLQ Pain Appendicitis Etiology Lymphoid hypertrophy Fecalith Foreign body Tumor Parasite Presentation M > F 10-30y Periumbilical pain 1-12h THEN → RLQ pain → MacBurny point N/V Anorexia Fever ↑WBC with left shift RLQ tenderness Signs Rovsing sign → LLQ palpation causes RLQ pain Psoas sign → Pain with hip...

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Abdomen Surgery

Ischemic Bowel Disease Chronic → Chronic Mesenteric Ischemia Etiology ↓ Blood flow to mesentery Progressive from mild ischemia to full occlusion Sloughing of mucosa Analogous to angina Presentation Abdominal pain after eating → Intestinal Angina Bloody diarrhea Diagnosis Best initial → CT abdomen → vs acute mesenteric ischemia in which you get AXR...

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Trauma

ABC Assessment Airway No airway No facial trauma No cervical spine injury → Orotracheal tube Cervical spine injury → Flexible bronchoscopy → Orotracheal tube Facial trauma → Cricothyroidotomy Breathing Proper ventilation → O2Sat >90% Circulation 2 large IV lines Aggressive fluid resuscitation Abdominal Trauma Signs Cullen sign → Bruising around umbilicus Hemarrhagic pancreatitis AAA...

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Postop Fever

Postop Fever 1-2d → Wind (Atelectasis/Pneumonia) 3-5d → Water (UTI) 5-7d → Walking (DVT) Day 7 → Wound (Wound) 8-15d → Weird (Drugs (can happen any time)/Abscess) Ob/Gyn → Womb (Endometritis) Time Etiology Diagnosis Treatment Prophylaxis During surgery Malignant hyperthermia (Anesthetics) O2 Dantrolene Cool IVF Family Hx Right after Bacteremia Blood...

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Preop Evaluation

Cardiovascular History of CV disease → Number 1 limiting factor EF <35% → ↑risk of non-CV surgery Recent MI Postpone surgery 6m Stress test CHF To ↓ mortality ACE inhibitor β-blocker Spirinolactone DM equivalent to coronary heart disease M >45y → Already a risk factor Management M <35y → ECG History...

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