General and Vascular Surgery
The acute abdomen, hernias, breast, vascular disease and peri-operative care.
- The Acute Abdomen How visceral, parietal and referred pain localise the diagnosis, the causes by region, and the resuscitation that runs alongside the workup.
- Appendicitis Why the pain migrates, how the Alvarado and AIR scores stratify risk, when to image before theatre, and whether antibiotics can replace appendicectomy.
- Intestinal Obstruction and Ileus Telling mechanical obstruction from ileus and pseudo-obstruction, the 3-6-9 rule on the plain film, and when drip and suck must give way to surgery.
- Volvulus Sigmoid versus caecal volvulus, the coffee bean sign, endoscopic decompression with a flatus tube, and why recurrence forces the question of resection.
- Gastrointestinal Perforation Causes by site, why a normal erect chest film does not exclude free gas, and the resuscitation and source control that determine survival.
- Peritonitis Primary, secondary and tertiary peritonitis, the 250 neutrophil rule for spontaneous bacterial peritonitis, and where intra-abdominal abscesses collect.
- Hernias Inguinal canal anatomy, direct versus indirect versus femoral, the four clinical states from reducible to strangulated, and who needs a repair.
- Hiatus Hernia Sliding versus paraoesophageal, the four components of the anti-reflux mechanism, when reflux needs urgent endoscopy, and the case for fundoplication.
- Gallstones and Biliary Colic How stones form, what separates biliary colic from cholecystitis, and why NICE offers cholecystectomy for symptomatic stones but leaves silent ones alone.
- Cholecystitis Murphy sign and the Tokyo criteria, why acalculous disease is the more dangerous form, and the case for cholecystectomy within 72 hours.
- Acute Cholangitis Charcot triad and Reynolds pentad, the Tokyo severity grades that set the timing of ERCP, and why antibiotics alone never treat an obstructed duct.
- Haemorrhoids The anal cushions and the dentate line, the four Goligher degrees, banding versus haemorrhoidectomy, and when rectal bleeding needs a cancer referral.
- Anal Fissure The ischaemic vicious cycle behind a posterior midline tear, topical GTN and diltiazem, and why sphincterotomy is done laterally.
- Perianal Abscess and Fistula The cryptoglandular theory, the anatomical classes of abscess, Parks classification and Goodsall rule, and why continence governs every surgical choice.
- Rectal Prolapse Concentric rings versus radial folds, why incontinence dominates the presentation, and choosing between abdominal rectopexy and a perineal procedure.
- Abdominal Aortic Aneurysm Screening and surveillance thresholds, why 5.5 cm is the repair trigger, recognising rupture, and the NICE position on open repair versus EVAR.
- Aortic Dissection Stanford A versus B, the blood pressure differential and pulse deficit, why beta-blockade comes before any vasodilator, and who goes straight to theatre.
- Peripheral Arterial Disease Claudication through to chronic limb-threatening ischaemia, interpreting the ABPI, and why supervised exercise and a statin come before any angioplasty.
- Acute Limb Ischaemia The six Ps and the six-hour window, telling embolus from thrombosis, the Rutherford categories, and anticipating reperfusion injury.
- Gangrene Dry, wet and gas gangrene, the LRINEC score and its limits, and why radical debridement rather than antibiotics decides survival.
- Varicose Veins and Venous Insufficiency Reflux and ambulatory venous hypertension, the CEAP classes, why the ABPI must precede compression, and the NICE order of interventions.
- Carotid Artery Disease Amaurosis fugax and the crossed pattern of symptoms, NASCET versus ECST measurement, and why endarterectomy is done within seven days.
- Breast Cancer Risk factors and the referral criteria, triple assessment scoring, what ER, PR and HER2 status dictates, and the surgical and adjuvant pathway.
- Fibroadenoma and Breast Cysts The ANDI framework, the breast mouse and the halo sign, when a benign-looking lump still needs excising, and managing cyclical mastalgia.
- Breast Abscess and Mastitis Why milk must keep flowing, aspiration rather than incision for an abscess, periductal mastitis and smoking, and the inflammatory cancer that mimics it.
- Assessing a Breast Lump The differential by age, a systematic examination sequence, the triple assessment scores and what discordance means, and the referral thresholds.
- Pre-operative Assessment ASA grading and functional capacity in METs, the selective tests NICE recommends, perioperative drug decisions, fasting rules and consent after Montgomery.
- Post-operative Complications Using the day since surgery to narrow the diagnosis, the five Ws of post-operative fever, spotting an anastomotic leak early, and failure to rescue.
- Surgical Fluid and Electrolyte Management Where infused fluid actually goes, the five Rs of NICE CG174, saline versus Hartmann's, and replacing gastrointestinal losses like with like.
- Wound Healing and Surgical Drains The four phases of healing and what impairs them, wound classification and surgical site infection, suture removal times, and how drains work.