DIMS Lectures Surgery PDF

Here is the complete pdf lecture of general surgery by Dr. Tahir Malik

Introduction

Clinical surgery involves the diagnosis, preoperative, operative, and postoperative management of surgical conditions affecting various organ systems.

1. Principles of Surgery

Preoperative Assessment:

History and Physical Examination: Identifying risk factors, comorbidities, and surgical fitness.
Laboratory and Imaging Investigations:
- Complete Blood Count (CBC), Renal Function Tests (RFTs), Coagulation Profile.
- Chest X-ray and ECG for high-risk patients.
- CT, MRI, or Ultrasound for surgical planning.
Anesthetic Evaluation: Assessing airway, cardiovascular status, and anesthesia risks.

Surgical Techniques:

Open Surgery: Traditional method using large incisions.
Minimally Invasive Surgery (Laparoscopy): Smaller incisions, faster recovery.
Robotic Surgery: Advanced precision with robotic assistance.

Postoperative Care:

Monitoring Vital Signs: Managing pain, fluid balance, and preventing complications.
Wound Care: Preventing surgical site infections (SSIs).
Early Mobilization: Prevents deep vein thrombosis (DVT) and pulmonary complications.

2. Common Surgical Conditions

1. Acute Abdomen

Definition: Sudden, severe abdominal pain requiring urgent evaluation.
Causes:
- Appendicitis, Cholecystitis, Intestinal Obstruction.
- Perforated Peptic Ulcer, Diverticulitis.
Diagnosis:
- Abdominal X-ray (Air under diaphragm for perforation).
- Ultrasound or CT Abdomen.
Management:
- IV Fluids, Pain Management, Antibiotics.
- Emergency Surgery if indicated (Appendectomy, Laparotomy).

2. Hernias

Definition: Protrusion of an organ through a weak spot in the muscle wall.
Types:
- Inguinal Hernia (Most Common).
- Femoral Hernia (More common in females, risk of strangulation).
- Umbilical Hernia, Incisional Hernia.
Management:
- Elective or emergency surgical repair (Herniorrhaphy, Mesh Repair).

3. Gastrointestinal Surgery

Appendicitis:
- Classic presentation: Periumbilical pain migrating to the RLQ.
- Management: Appendectomy (Open or Laparoscopic).
Cholecystitis:
- Diagnosis: Positive Murphy’s sign, Ultrasound (Gallstones, wall thickening).
- Management: Cholecystectomy.
Bowel Obstruction:
- Causes: Adhesions, Hernias, Tumors.
- Management: Nasogastric Decompression, IV Fluids, Surgery if unresolved.

3. Vascular Surgery

1. Peripheral Arterial Disease (PAD)

Definition: Narrowing of peripheral arteries due to atherosclerosis.
Symptoms: Intermittent claudication, rest pain, ulcers.
Diagnosis: Ankle-Brachial Index (ABI), Doppler Ultrasound.
Management: Lifestyle modification, Antiplatelet therapy, Bypass surgery if severe.

2. Deep Vein Thrombosis (DVT)

Risk Factors: Immobility, Surgery, Cancer, Hypercoagulable states.
Symptoms: Leg swelling, pain, redness.
Diagnosis: Doppler Ultrasound.
Management: Anticoagulation (Heparin, Warfarin), Compression stockings.

4. Trauma Surgery

1. ATLS (Advanced Trauma Life Support) Protocol

Primary Survey (ABCDE):
- Airway: Ensure airway patency.
- Breathing: Oxygenation, chest decompression for pneumothorax.
- Circulation: Control bleeding, IV fluids, blood transfusion.
- Disability: Neurological assessment.
- Exposure: Full-body examination.

2. Blunt and Penetrating Trauma

Head Injury: Glasgow Coma Scale (GCS), CT Brain.
Chest Trauma: Rib fractures, hemothorax, pneumothorax.
Abdominal Trauma: FAST scan, Exploratory Laparotomy for internal bleeding.

Case Example:

1. A 40-year-old male presents with acute RLQ pain, nausea, and fever. Examination reveals tenderness at McBurney’s point and rebound tenderness.

2. A 55-year-old female presents with severe epigastric pain, nausea, and jaundice for 3 days. Ultrasound shows gallstones with common bile duct dilation.

3. A 30-year-old male involved in a motorcycle accident presents with hypotension, abdominal distension, and tachycardia. FAST scan reveals free fluid in the peritoneal cavity.

⚠Caution!
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1. Diagnosis: Acute Appendicitis

2. Diagnosis: Choledocholithiasis with Biliary Obstruction

3.Blunt Abdominal Trauma with Internal Hemorrhage

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