ADULT SURGERY

Disease 1st Inv / Dx IOC/ Best Appearance / Sign Treatment

Dysphasia Dohlman’s Opn
Barium swallow
Zenker’s diverticulum Diverticulo-eso- Stomy Linear Stapler)
Bird beak App. CCB’s - Nitrates
Rat Tail app. Pneumatic balloon dilatation
Standard Inv -
Achalasia Cardia Barium Swallow Abs. of Gastric Air bubble Rx OC - Sx - Myotomy
Eso-manometry
DES - Ba Swallow - Cork - Heller’s Opn ( Open Sx/ laparoscopic Sx)
screw App - POEM
Schatzki’s Ring Endoscopy, Barium Swallow lye strictures Single endoscopic dilation
UGIE
lower Eso - 24 hrs Ph monitoring Gold standard Inv of GERD
GERD Floppy Nissen’s Fundoplication
Stomach ulcer - Biopsy - Demeester Score
Duodenal ulcer - Biopsy
intestinal columnar metaplasia Endoscopic
Barrett’s Esophagus Endoscopy of squamous mucosa of lower mucosal resection of dysplatic areas
esophagus followed by RFA + PPI's
Sliding hiatus Hernia Chest X-Ray CECT 2nd B. Meal CXR - Stomach Bubble in
Thorax. Floppy Nissen’s Fundoplication
Paraesophageal H H Chest X- Ray CECT B. Meal
GE Jun. Above diaphragm
CT Scan (BEST)
Boerhaave Syndrome Chest X - Ray contrast Swallow CXR - Pneumomediastinum Thoracotomy + Mediastinal lavage
( Ionocol)
1st INV - If identified- Endo Sclerotherapy
IVF, IV Fails Mucosal ” Adrenaline
Acute Gastritis
1st - UGIE if not identified- 2nd INV - ” Diathermy
Angiography. ” Clips
Chronic Gastritis /
PPI’s (RxOC)
Peptic Ulcer life style modification fails —> PPI’s. If it’s Fails
—> UGIE Surgery SxRx - Dec. HCl secretion.
Duodenal ulcer (1st Inv in PU) SxRxOC --> Highly/Partial selective
vagotomy,
 SxRx - Remove ulcer bearing part
Gastric ulcer “ RxOC - Roux en y gastrojejunostomy
Bilroth I - GD, Bilroth II - GJ
Cardboard Like rigidity in Laparotomy + Peritoneal lavage +
Clinical Ex
Peritonitis a)< 24 - 48 hrs - Minimal contamination - Closure
Complication of PU
Chest X Ray Pneumoperitoneum of perforation Omental patch - Graham's patch
( Perforation)
b)> 24 - 48 hrs - Gross contamination - Leave the
In Supine Left Lateral decubitus
drain
Stone- hyperechoic Postr
Cholelithiasis USG Abdomen Laparoscopic Cholecystectomy
acoustic shadow
Rx - Conservative IVF, IV Ab 5 - 7 days -
large stone Obstruction in Clinical Ex - Murphys
USG Abdomen Discharges advice - Interval
mouth of GB / Cystic Duct Sign
cholecystectomy after 3- 6 weeks
Complications of Lap Bile leak ERCP Stump-Resolve with Endobiliay Stenting
chole Bile obstruction ECRP US guided Catheter Drainage
Cholesterolerosis Yellow flakes on the mucosal surface of GB Strawberry GB
Multiple Air fluid levels, Air
GB Fistula X - Ray - Rigglar’s Triad Removal of Obstruction
in GB, Stone in intestine
ERCP + Sphincterotomy + CBD Stone
Choledocholithiasis LFT, USD Abdomen ERCP, MRCP
extraction with Dormia Basket
Basic Resc + IVF, IVAb — >
Cholangitis Charcot’s Triad, Reynolds’s Pentad Endobiliary stenting ( ERCP + stenting)
LFT + USD Abd.
Pancreatic enzymes X- Ray - 1. Colon cut off sign
Radiological IOC - ERCP, Sphincterotomy, stone extraction
Acute Pancreatitis 2. Sentinel loop sign 3. Renal
X - Ray CT Scan with Dormia basket
halo sign
Rx - a) - If Asymp - No Rx
Pancreas Pseudocyst CT scan Pseudocyst b) - If Symp, Compli > 12 weeks old —>
Cystoenterostomy (CJ**, CG, CD)
Malabsorption- Pancreatic enzyme
supplements, DM - Insulin, Pain - xxx
Chronic Pancreatitis MRCP/ ERCP Chain of lakes Alcohol, Analgesics, Small frequent meals,
Octreotide, Sx - Side to side Pancreato
Jejunostomy
 Cephalosporins (Penicillin) +
US abdomen Streptococcusmilleri
Liver Abscess - Pyogenic Best - CECT Aminoglycosides + Metronidazole US
Blood, Pus Culture E. coli
guided percut. catheter drainage
Metronidazole 400-800 mg TDS
US Abdomen inverted Flask shaped ulcers in x 14 days
Amoebic Best - CECT
Stool Culture sigmoid colon, Caecum US guided percut Cath. drainage, Anchovy
Sauce , Pus (Chocolate)
Albendozole / Mebendazole
US Abdomen
Hydatid Cyst Best - CECT Water lily Sign PAIR - Percut. Aspiration + Instillation of
ELISA
hypertonic saline + Reaspiration
a) - Leave a Flatus tube in Sigmoid
Coffee bean sign / Bird of Prey
Sigmoid Volvulus X - Ray colon (24 hrs)
sign
b) - If stranguln - Resection & anastomosis
1st - Pain relief -
Diclofenac, Tamsulosin
Kidney Stones NCCT “Refer WB Pg. 71,72”
then Plain X - Ray - KUB
US - KUB
Renal TB 1. (Early) - Moth
eaten calyces. 2.(Late) -
Urine examination - Mild
Pseudo calculus appearance
Urinary Tuberculosis steam early morning urine CECT Rx - ATT
Bladder TB 1. (Early) - Golf
sample.
hole ureteric orifice. 2.(Late) -
Thimble bladder.
Basic Invn - TLC -
Mc burney’s , Rovsing’s, Ultrasound showing blind
11000 - 14000/cu.mm (4 - Mild - Conservative c Ab
Obturator’s, Psoas’s, ending tubular appendix with
Acute Appendicitis 11)- DLC - Nphs (incr) Severe - Operative - Emergency
Dunphy’s sign. a transverse diameter more
Best Inv - CECT Appendicectomy
NO invn required. than 6mm
Abdomen
Ba meal follow thr- String sign Main stay - Steroids
Crohn’s disease CECT Abdomen of kantor (String Sign - TB of 5 - Aminosalicylates in Infln, Levamisole,
Inflammatory bowel
Ileum) Infliximab, Rituximab
disease
Ba enema- Lead Pipe app. Sx - Rarely done in Crohn’s,
Ulcerative colitis Colonoscopy
(Loss of haustral folds) can be done in UC
 Initially high fiber diet
Diverticulosis of Colon Ba enema CT Scan Saw Tooth Appearance
Later - Resection & anastomosis
Intraperitoneal Bladder Bed side Test -Peritoneal Laparotomy, Peritoneal lavage, Bladder
rupture (20%) Tap Cystogram repair Foley’s catheter for 7-10 days.
Bladder Trauma
Extraperitoneal bladder
Tear drop Bladder Repair (Pfannestiel incision)
rupture (80%)
Rup.of post. Urethra RGU ( Retrograde
Pelvic hematoma Suprapubic Cystostomy ( Supra Catheter )
( Membraneous urethra) Urethrogram)
Urethra Trauma
Rup. of Ant. Urethra RGU ( Retrograde
Perineal hematoma Suprapubic Cystostomy ( Supra Catheter )
( Bulbar) Urethrogram)
Mild Symp (No Complicn) Medical Rx
Benign Prostatic US Abdomen (Vol of Narrowing & Lengthening of
DRE Severe Symp, Compln - SxRxOC - TURP
Hyperplasia prostate) Prostatic urethra
(Transurethral resection of prostate)
Rx : Aim- Reduce cnts, apply a barrier - Open Sx- Hernioplasty ( Tension
Inguinoscrotal Swelling
Hernia ( Umbilical, free repair, Liechtenstein Opn). (Earlier - Bassini's / Shouldice / Stoppa's
Cl. examn - Supine
Femoral, inquinal, operation)- Lap. Sx - TEP - Totally Extraperitoneal Repair TAPP - Transabd
- Standing
Paraumb, spigelian) Preperitoneal Repair. Rx OC for Cong hernia - Herniotomy, RxOC for
- 3 Finger Test - Zieman’s Test
hydrocele - Herniotomy/ Age of Opn > 3 yrs.
Clinical Test to DD from Epididymo orchitis - Best - Immediate Scrotal Exploration
Prehn’s Test a) If Testis - Viable (< 12 - 24 hrs) - Derotation, Orchidophexy, Contralateral
Testicular Torsion
Prehn’s Test - (+) in Epididymo orchitis (-) in Orchidopexy. b) If Testis - Non viable (> 12 - 24 hrs)-
Torsion. Orchidectomy, Contralateral Orchidopexy
If in doubt - US scrotum
Scrotal Swelling RxOC - Eversion of sac (Jaboulay’s operation).
Hydrocele (Trans Scrotal FNAC is
Transillumination (+) Lord's opn, Congenital hydrocele - Herniotomy > 3 yrs age.
C/I)
Bleeding PR ( Splash in Rx— 1° - Sclerotherapy 5% Phenol in Almond oil, 2°- Banding -Mass falls
Hemorrhoids(Piles) Proctoscopy
the pan) off in 5-10 days. 3°/4° - Sx - Hemorrhoidectomy
 PEDIATRIC SURGERY

Disease 1st INV/ Dx IOC Appearance/ sign Treatment Rx/ Rxoc

CL - Antenatal USG Plastic Sx Reconstruction CL - 3 months (Millard’s Opn/ Wardil’s Opn)

Cleft Lip & Palate
after 18 Wks of Pregn CP - Soft P (6 months), Hard P (12-15 months).
Always in midline, except Mc - Beneath hyoid Sx - Sistrunk’s Opn (Excision of cyst + Thy. Tract). Include central portion of hyoid
Thyroglossal cyst
in region of Thy. Cartilag bone (Subhyoid). bone.
Remenent of 2nd Ant bord of SCM m/s Lined by squamous
Bronchial Cyst Excision
bronchial cleft Mc @Jn of U1/3, M1/3 Epithelium
Remenent of 2nd Ant bord of SCM m/s Lined by Ciliated Columnar
Bronchial Fistula Complete Excision
bronchial cleft Mc @Lower Neck Epithelium
Most Brilliantly Complete Excision, Sclerotherapy
Cystic Hydroma Post Triangle of Neck Lined by Endothelium
Transilluminate swelling (Picibanil OK 432)
Coiling of NG tube in upper Sx correction on Day 1/2 after Birth —
Esophageal Atresia Initially Bed Side test.
CTScan (Best) eso, distended stomach with Thoracotomy — Division of fistula + Eso-Eso
(VACTERL) 1st IVN - CXR
gas indicate type 3,4,5 Eso A. stomy ( Far/close) Eso reconstruction (ref WB)
Within few hrs after Birth Sx - D-D (Duodeno-duodenostomy)
X-Ray Double bubble sign
(with Bilious Vomiting) Alternative Rx - D-J ( Duodenojejunostomy)
Duodenal Atresia SBS - Pyloric obs. DBS - Duodenal obsn MBS -
TBS - Jejunal obsn (Jejunal
(Cong./Infantile hypertrophic (Duodenal atresia Central - Small Intestinal obsn -
atresia)
Pyloric Stenosis) /Annular Pancr.) Peripheral - Large Intestinal obsn
Ring of Pancreas tissue Rx - D-D,
Annular Pancreas X-Ray DBS
surrounds Duodenum Alternative Rx- D-J
Thick Pyloric ms (> 3 - 4 mm), Rx - Initially - Pneumatic balloon
Congenital Hypertrophic Emerg 1st Rehydration & 1st Inv (IOC) - US
Lengthening of Pyloric canal dilatation
Pyloric stenosis Electrolyte correction Abdomen
(> 16 - 17 mm) RxOC - Ramstedt’s Seromyotomy
I - Roux en y hepaticojejunostomy
Jaundice - 1st (LFT)
Biliary Atresia HIDA Scan Absence of biliary Channel II, III - Kasai’s Opn
2nd (US Abdomen)
Hepaticocporto enterostomy - Transplant
 OPD - LFT, US abdomen ERCP Mass in RHC Cyst Excision + Roux en y hepatojejunostomy
Choledochal Cyst
Cholangitis ( Charcot’s Basic Resuscitation Endobiliary Stenting or
Emerg - LFT, US Abd.
Traid) + Reynold’ Pentad IVF , IV Ab ERCP + Stenting
DRE, US Abd - Doughnut Sign RxOC - Hydrostatic Reduction ( Air, Saline,
Best Inv - CECT
Intussusception 1st Inv - US Abdomen X -Ray - cresent Sign Barium Enema) — If Fails - Op. reduction
Abdomen
X-Ray, Ba -Enema Ba E - Claw, Coil spring sign If Gangrenous - Resection + end-end ANMs
IVU (IVP) - Spider Leg Initially - Deroofing of cyst
Polycystic Kidney US Abdomen CECT Abdomen
Appearance Eventually - Renal Transplant
IVP - Flower Vase Ureters UTI - Antibiotics, If Stones - Removal
Horse shoe Kidney US Abdomen Best - CECT Abdomen
Hand Joining Sign (Division of Isthumus is not the Rx OC)
Meckel’s Scan - Radioisotope Scan, Technetium If Asymp - No Rx
Meckel’s Diverticulum pertechnetate scan If Symp/Compli - Diverticulectomy (Narrow Mouth), Wide Mouth ( Resect.
Ba meal follow through Video Capsule Endoscopy of segment of intestine bearing Meckels with end to end anastomasis
IOC - Suction Rectal 1st - IOC for Extent of disease - Ba Enema Rx- Duhamel (Soave) /Swenson’s opn
Hirschsprung’s Disease
Biopsy 2nd - Ano Rectal Manometry Emerg - Proximal Colostomy

Renal pelvis - Drooping Ureter - Meyer Weigert Ectopic Ureter - IOC -

Duplication Ureteric Reimplementation.
lily sign (water lily S) Law CECT/ IVU
Cobra head or Adder head Sx excision and reimplantation of ureter
Uretrocele Male, childhood, UTI IVU
Appearance Rare - Endosc Long. Inci. of ureteric orifi.
Incomplete Valves - Incomplete Valves -
OPD, Childhood,
Posterior Urethra valves MCU Transurethral Resection of Emerg— Neonate —Retention of urine
Recurrent UTI
valves/Fulguration. Suprapub Cystostomy / Urethral Catheteriz
Inspection, Palpation Orchidopexy
Undescended Testis Diagnostic Laproscopy
US Abdomen & Scrotum Age of Opn - 6 months - 18 months
24 hrs - Air indicate dist. b/w Low Anoplasty, High Plastic Sx - PSARP
Imperforate Anus X-Ray in lateral Prone (Invertogram)
Rectum and Perineum (coin) Postr Sogiltal Anorectoplasty
Urethral Opening in Sx - Chordae Correction + Urethroplaty.
Hypospadias MC - Glanular, LC - Perineal (Severe)
Undersurface of Penis Age of Opn - 10 months (6 -18 months)