General Surgery
Browse 79 topics in general surgery.
Abdominal Aortic Aneurysm (AAA) in Adults
An Abdominal Aortic Aneurysm (AAA) is defined as a permanent, localised dilatation of the abdominal aorta having a diameter greater than 3.0 cm or exceeding the normal diameter by more than 50%. It is a critical...
Abdominal Trauma
The management of abdominal trauma has undergone a paradigm shift over the last three decades, moving away from "mandatory laparotomy" for all penetrating wounds toward a sophisticated approach of Selective...
Acute Appendicitis
Acute Appendicitis is the most common non-traumatic surgical emergency worldwide, characterized by the acute inflammatio... MRCS exam preparation.
Acute Appendicitis
Acute appendicitis is the most common surgical emergency worldwide, with a lifetime risk of 7-8% and an incidence of app... MRCS exam preparation.
Acute Cholecystitis
The modern management of acute cholecystitis is defined by the Tokyo Guidelines (TG18) , which provide a standardized framework for diagnosis and severity grading. The historical "cool it off" approach with...
Acute Cholecystitis
Acute cholecystitis is an acute inflammatory condition of the gallbladder, most commonly resulting from cystic duct obst... MRCS exam preparation.
Acute Diverticulitis
Diagnosis is primarily confirmed by CT abdomen/pelvis with intravenous contrast, which demonstrates pericolic fat stranding, bowel wall thickening, and complications such as abscess or perforation. The modified...
Acute Lower GI Bleeding
Acute lower gastrointestinal bleeding (LGIB) is a medical emergency characterized by bleeding from the gastrointestinal tract distal to the ligament of Treitz, presenting as hematochezia (bright red or maroon blood...
Acute Post-Operative Bleeding
Post-operative bleeding (POB) is a potentially life-threatening surgical complication characterized by excessive hemorrh... MRCS exam preparation.
Acute Severe Ulcerative Colitis (ASUC)
The management of ASUC is a race against time. The "Three-Day Rule" is the cornerstone of modern care: failure to demonstrate a significant biological response to high-dose intravenous corticosteroids by Day 3...
Acute Soft Tissue Infection
Acute soft tissue infections (SSTIs) represent a spectrum of bacterial infections affecting the skin, subcutaneous tissu... MRCS exam preparation.
Acute Vascular Injury
Acute vascular injury encompasses traumatic damage to arteries or veins resulting from penetrating or blunt mechanisms. ... FRCS exam preparation.
Acute Wound Dehiscence
Wound dehiscence is the partial or complete separation of the layers of a surgical wound following closure. It represents a spectrum from superficial skin separation to complete fascial disruption with evisceration...
Anaesthesia for Laparoscopic Surgery
Laparoscopic surgery presents unique physiological challenges: pneumoperitoneum (CO₂ insufflation 12-15 mmHg) increases intra-abdominal pressure causing cardiovascular effects (↓venous return initially, then ↑SVR and...
Anal Fissure
An anal fissure is a longitudinal tear in the squamous epithelium (anoderm) of the anal canal, extending from the dentat... FRCS exam preparation.
Anastomotic Leak
Anastomotic leak (AL) is the breakdown or failure of a surgical connection (anastomosis) between two segments of bowel o... FRCS exam preparation.
Barrett's Oesophagus
It represents an adaptive response to chronic gastro-oesophageal reflux disease (GORD) and is the single most important precursor lesion for oesophageal adenocarcinoma (OAC), which has shown a dramatic increase in...
Benign Breast Disease
Benign Breast Disease encompasses a heterogeneous spectrum of non-malignant conditions affecting the breast, accounting ... MRCS, MRCOG exam preparation.
Biliary Colic & Acute Cholecystitis
Biliary colic and acute cholecystitis represent a clinical spectrum of gallstone-related disease affecting the gallbladder. Biliary colic is transient right upper quadrant (RUQ) pain caused by temporary cystic duct...
Burns Assessment and Management
Burns are tissue injuries caused by heat (thermal), chemicals, electricity, radiation, or friction, representing one of ... MRCS, FRACS exam preparation.
Chronic Pancreatitis
The clinical hallmark is chronic abdominal pain, which affects 80-90% of patients and significantly impairs quality of life. As the disease progresses, patients develop exocrine pancreatic insufficiency (EPI)...
Clostridioides difficile Infection
Key Facts Pathogen : Toxin-producing Clostridioides difficile (formerly Clostridium difficile) Toxins : Toxin A (enterotoxin), Toxin B (cytotoxin, 10-100x more potent), Binary toxin CDT (hypervirulent strains)...
Colonic Polyps
Colonic polyps are abnormal tissue growths that protrude from the colonic mucosa into the bowel lumen. They represent a ... MRCP exam preparation.
Cryotherapy (Liquid Nitrogen Treatment)
Cryotherapy is one of the most commonly performed dermatological procedures worldwide, utilizing extreme cold—most frequently liquid nitrogen at -196°C—to selectively destroy abnormal or unwanted tissue through...
Epidermoid & Pilar Cysts
Epidermoid and pilar (trichilemmal) cysts are the most common cutaneous cysts encountered in clinical practice, often incorrectly termed "sebaceous cysts." This terminology is a misnomer because these cysts contain...
Femoral Hernia
The clinical presentation ranges from asymptomatic groin swelling detected incidentally to acute surgical emergencies with bowel obstruction and peritonitis. Physical examination revealing a lump below and lateral to...
Fournier's Gangrene
Fournier's gangrene is a rare but life-threatening form of necrotising fasciitis affecting the perineum, genitalia, and ... MRCS, MRCP exam preparation.
Fournier's Gangrene
Fournier's Gangrene is a fulminant, life-threatening necrotising fasciitis of the perineum, genitalia, and perianal regi... FRCS exam preparation.
Gallstones (Cholelithiasis)
The pathophysiology centres on supersaturation of bile with cholesterol or bilirubin, leading to nucleation and crystal aggregation. Approximately 75-80% of gallstones are cholesterol stones, while 15-20% are pigment...
Gastric Cancer
The strongest modifiable risk factor is chronic infection with Helicobacter pylori , classified as a Group 1 carcinogen by the International Agency for Research on Cancer (IARC). Other significant risk factors include...
Gastro-Oesophageal Reflux Disease (GORD)
GORD represents one of the most common gastrointestinal disorders in Western populations, with significant impact on quality of life and healthcare costs. The condition exists on a spectrum from Non-Erosive Reflux...
Glucagonoma
Dermatosis – Necrolytic Migratory Erythema (NME) Diabetes Mellitus – usually mild to moderate Deep Vein Thrombosis – hypercoagulable state Depression – neuropsychiatric manifestations
Haemorrhoids (Adult)
A comprehensive, evidence-based clinical guide to haemorrhoids (piles) for postgraduate surgical training. Covers anatomy, Goligher classification, office-based treatments (rubber band ligation, sclerotherapy),...
Hepatocellular Carcinoma (HCC)
The major risk factors are chronic viral hepatitis (hepatitis B virus [HBV] and hepatitis C virus [HCV]), alcohol-related liver disease, and increasingly non-alcoholic steatohepatitis (NASH), now termed metabolic...
Hiatus Hernia
The condition exists on a spectrum from incidental radiological findings to symptomatic disease requiring surgical correction. Type I (sliding) hernias account for approximately 95% of cases and are primarily...
Hidradenitis Suppurativa
The disease manifests predominantly in areas with high concentrations of apocrine glands: axillae, groin, perineum, inframammary regions, and buttocks. It presents after puberty (typically second to third decade) and...
Incarcerated Hernia in Adults: The Definitive Gold Standard Reference
1.1 Summary An incarcerated hernia occurs when the contents of a hernia sac—be it omentum, small bowel, large bowel, or other viscera—become trapped outside their native cavity and cannot be manually reduced. This...
Inflammatory Bowel Disease (IBD) in Adults
Inflammatory Bowel Disease (IBD) comprises a group of chronic, immune-mediated inflammatory conditions of the gastrointe... MRCP exam preparation.
Inguinal Hernia
An inguinal hernia is the abnormal protrusion of abdominal contents (most commonly omentum or small bowel) through a defect in the inguinal canal. Inguinal hernias represent the most common type of abdominal wall...
Insulinoma
Over 90% of insulinomas are benign, solitary, and less than 2 cm in diameter . Approximately 5-10% are associated with Multiple Endocrine Neoplasia Type 1 (MEN1) , where they may be multiple. Malignancy occurs in...
Intestinal Obstruction
Intestinal Obstruction represents a mechanical or functional blockage preventing the normal transit of intestinal conten... MRCS exam preparation.
Intussusception - Adult
Adult intussusception is rare (5% of intestinal obstructions, 2-3 cases per million adults/year) and has a lead point... ACEM Fellowship Written, ACEM Fellow
Keloid & Hypertrophic Scars
Keloid and hypertrophic scars represent aberrant wound healing characterized by excessive fibroproliferative responses and abnormal collagen deposition . These pathological scars arise from dysregulation of the normal...
Lipoma
A lipoma is a benign mesenchymal tumour composed of mature adipose tissue, representing the most common soft tissue neoplasm in adults with an estimated prevalence of 1-2% in the general population. These tumours are...
Lower Gastrointestinal Bleeding
Lower gastrointestinal bleeding (LGIB) refers to bleeding originating from a source distal to the ligament of Treitz, en... MRCP, FRCS exam preparation.
Mallory-Weiss Tear
A Mallory-Weiss tear is a longitudinal mucosal or submucosal laceration occurring at or near the gastro-oesophageal junction (GOJ), typically caused by a sudden and forceful increase in intra-abdominal pressure...
McBurney's Point (Acute Appendicitis)
Comprehensive evidence-based guide to McBurney's Point, acute appendicitis diagnosis, clinical examination techniques, anatomical variations, surgical approaches, and management protocols for postgraduate medical and...
Mesenteric Ischaemia
Key Facts Incidence : Acute: 0.1-0.2% of acute surgical admissions; Chronic: Rare (less than 1 per 100,000). Mortality : Acute: 30-90% (highest of abdominal emergencies); Chronic: less than 5% with treatment. Age...
Multiple Endocrine Neoplasia Type 2 (MEN 2)
A comprehensive, evidence-based guide to Multiple Endocrine Neoplasia Type 2 syndromes (MEN 2A and 2B), focusing on RET proto-oncogene mutations, genotype-phenotype correlations, prophylactic thyroidectomy timing,...
Murphy's Sign (Acute Cholecystitis)
Comprehensive guide to Murphy's Sign: examination technique, diagnostic accuracy, pathophysiology, and clinical application in acute cholecystitis diagnosis. Evidence-based approach to right upper quadrant pain...
Necrotising Fasciitis
The hallmark clinical feature is severe pain that appears disproportionate to the physical examination findings—a result of deep fascial involvement and nerve ischaemia occurring before significant skin changes become...
Oesophageal Varices
Approximately 50% of patients with cirrhosis have varices at the time of diagnosis , with the prevalence increasing to 60-80% in those with decompensated cirrhosis. The annual incidence of new varix formation is 5-8%...
Ovarian Cancer (Adult)
Ovarian cancer is the deadliest gynaecological malignancy and the fifth leading cause of cancer death in women in developed countries. Despite accounting for only 3% of all female cancers, it causes more deaths than...
Ovarian Torsion
The condition predominantly affects women of reproductive age (20-40 years) but can occur at any age from infancy to post-menopause. The presence of an ovarian mass—particularly cysts or tumours exceeding 5cm in...
Paraphimosis
Pearl 1 : Prevention is paramount — ALL healthcare staff performing catheterisation must be trained to replace the foreskin after the procedure. Failure to do so accounts for the majority of paraphimosis cases.
Perianal Abscess and Fistula-in-Ano
This condition represents one of the most common anorectal emergencies encountered in surgical practice, with significant implications for patient quality of life and functional outcomes. The fundamental surgical...
Periductal Mastitis (Non-Lactational)
Periductal Mastitis (PDM) is a chronic inflammatory condition of the subareolar ducts, predominantly affecting women of reproductive age, with a strong association with cigarette smoking ( 90% of cases). It is...
Peritonitis in Adults
Comprehensive evidence-based guide to diagnosis and management of peritonitis including spontaneous bacterial peritonitis (SBP), secondary peritonitis from perforation, and emergency surgical intervention
Phaeochromocytoma and Paraganglioma
Phaeochromocytoma is a rare catecholamine-secreting tumour arising from chromaffin cells of the adrenal medulla. When arising from extra-adrenal sympathetic ganglia (paraganglia), the tumour is termed paraganglioma....
Pilonidal Sinus (Adult)
Pilonidal sinus disease (PSD) is a chronic inflammatory condition affecting the natal cleft (intergluteal region), characterised by midline pits, subcutaneous sinus tracts containing hair and keratin debris, and a...
Portal Hypertension
Key Facts Definition : HVPG greater than 5 mmHg. Clinically Significant : HVPG greater than or equal to 10 mmHg (varices start forming). Bleeding Risk : HVPG greater than or equal to 12 mmHg (varices can bleed)....
Rectal Prolapse
Full-thickness rectal prolapse predominantly affects elderly women (6:1 female:male ratio), with peak incidence in the 7th-8th decades. Key risk factors include chronic constipation with straining , multiparity...
Rectus Sheath Block
Formation: The rectus sheath is a fibrous compartment formed by the aponeuroses of the three lateral abdominal wall muscles (external oblique, internal oblique, transversus abdominis) as they envelop the rectus...
Renal Abscess
A renal abscess is a focal collection of purulent material within or around the kidney parenchyma, representing a severe and potentially life-threatening complication of upper urinary tract infection. Renal abscesses...
Rovsing's Sign
Rovsing's sign is a clinical examination finding used in the assessment of acute appendicitis, characterized by pain eli... MRCS exam preparation.
Skin Grafts
A skin graft is the transfer of epidermis and variable amounts of dermis from a donor site to a recipient wound bed, where it survives by developing a new blood supply from the underlying tissue. Unlike flaps (which...
Small Bowel Obstruction (SBO)
The pathophysiology involves mechanical occlusion of the intestinal lumen, leading to proximal bowel dilatation, fluid sequestration, electrolyte derangements, and potential vascular compromise. The classic clinical...
Surgical Site Infection in Adults
Surgical site infection (SSI) remains the most common healthcare-associated infection (HAI) in surgical patients, accounting for nearly 20% of all HAIs. Defined by the Centers for Disease Control and Prevention (CDC)...
Testicular Torsion
The classic presentation comprises sudden-onset severe unilateral scrotal pain, a high-riding testis with horizontal lie, and an absent cremasteric reflex. The condition is primarily a clinical diagnosis and should...
The Acute Abdomen
The "Acute Abdomen" is a clinical syndrome characterized by sudden, severe abdominal pain that typically develops over a period of hours and may require urgent surgical intervention. It is a working diagnosis that...
The Mental Capacity Act (MCA) 2005
The Mental Capacity Act 2005 (MCA) is the primary legislation in England and Wales governing decision-making for adults (aged 16+) who lack mental capacity. It provides a comprehensive statutory framework that...
Thyroid Cancer
The vast majority ( 90%) of thyroid cancers are differentiated thyroid cancers (DTC) , comprising papillary and follicular subtypes, which originate from thyroid follicular epithelial cells and retain the ability to...
Thyroid Nodules & Goitre
Thyroid nodules are discrete lesions within the thyroid gland that are palpably or radiologically distinct from surrounding thyroid parenchyma. They represent one of the most common endocrine disorders, with a...
Ulcerative Colitis (Adult)
Ulcerative colitis (UC) is a chronic, idiopathic inflammatory bowel disease (IBD) characterized by continuous mucosal inflammation of the colon, always involving the rectum and extending proximally to varying degrees....
Umbilical & Paraumbilical Hernia (Adult)
An umbilical hernia is a protrusion of abdominal contents through a defect in the linea alba at or adjacent to the umbil... MRCS, FRCS, FRACS exam preparation.
Upper Gastrointestinal Bleeding (Adult)
Upper gastrointestinal bleeding (UGIB) is a common and potentially life-threatening medical emergency defined as bleedin... MRCP exam preparation.
Ventral Hernias (Incisional & Umbilical)
Ventral hernias encompass all anterior abdominal wall defects, primarily classified into three major subtypes: incisiona... MRCS, FRACS exam preparation.
Volvulus (Adult)
Volvulus is the twisting of a segment of bowel around its mesentery , causing closed-loop obstruction and vascular compromise with risk of ischaemia, gangrene, and perforation . It accounts for 3-5% of large bowel...
Zollinger-Ellison Syndrome
Key Features : Sporadic : 75–80% of cases. Usually solitary pancreatic or duodenal tumours, potentially curable with surgical resection. MEN1-Associated : 20–25% of cases. Multiple gastrinomas, often microadenomas,...