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PartⅠ:The Patient Presents With 1

1.Acute Abdominal Pain 3

Differential diagnosis of acute abdominal pain 3

History to focus on the difierential diagnosis of acute abdominal pain 3

Examination of patients who have acute abdominal pain 5

Investigation of patients who have acute abdominal pain 6

Differential diagnosis of dyspepsia 9

History to focus on the differential diagnosis of dyspepsia 9

2.Dyspepsia 9

Examination of patients who have dyspepsia 10

Investigation of patients who have dyspepsia 10

3.Vomiting,Haematemesis,and Melaena 13

Differential diagnosis of vomiting,haematemesis,and melaena 13

History to focus on the differential diagnosis of vomiting,haematemesis,and melaena 13

Examination of patients who have vomiting,haematemesis,and melaena 14

Investigation of patients who have vomiting,haematemesis,and melaena 15

Differential diagnosis of a change in bowel habit 17

History to focus on the differential diagnosis of a change in bowel habit 17

4.Change in Bowel Habit 17

Examination of patients who have a change in bowel habit 18

Investigation of patients who have a change in bowel habit 19

5.Abdominal Mass and Distension 21

Differential diagnosis of abdominal mass or distension 21

History to focus on the differential diagnosis of abdominal mass or distension 21

Examination of patients who have abdominal mass or distension 22

Investigation of patients who have abdominal mass or distension 23

History to focus on the differential diagnosis of rectal bleeding 25

Differential diagnosis of rectal bleeding 25

6.Rectal Bleeding 25

Examination of patients who have rectal bleeding 26

Investigation of patients who have rectal bleeding 27

7.Anorectal Pain 29

Differential diagnosis of anorectal pain 29

History to focus on the difierential diagnosis of anorectal pain 29

Examination of patients who have anorectal pain 29

Investigation of patients who have anorectal pain 30

Differential diagnosis of iaundice 33

History to focus on the differential diagnosis of iaundice 33

8.Jaundice 33

Examination of patients who have iaundice 34

Investigation of patients who have iaundice 34

9.Dysphagia 37

Differential diagnosis of dysphagia 37

History to focus on the differential diagnosis of dysphagia 37

Examination of patients who have dysphagia 38

Investigation of patients who have dysphagia 38

History to focus on the differential diagnosis of a breast lump 41

Differential diagnosis of a breast lump 41

10.Breast Lump 41

Examination of patients who have a breast lump 42

Investigation of patients who have a breastlump 43

11.Neck Lump 45

Differential diagnosis of a neck lump 45

History to focus on the differential diagnosis of a neck lump 45

Examination of patients who have a neck lump 46

lnvestigation of patients who have a neck lump 46

History to focus on the differential diagnosis of an ischaemic limb 49

Differential diagnosis of an ischaemic limb 49

12.Ischaemic Limb 49

Examination of patients who have an ischaemic limb 50

Investiggation of patients who have an ischaemic limb 51

13.Leg Ulcer 53

Differential diagnosis of a leg ulcer 53

History to focus on the differential diagnosis of a leg ulcer 53

Examination of patients who have a leg ulcer 53

Investigation of patients who have a leg ulcer 54

History to focus on the differential diagnosis of a groin swelling 57

Differential diagnosis of a groin swelling 57

14.Groin Swelling 57

Examination of patients who have a groin swelling 58

Investigation of patients who have a groin swelling 58

15.Scrotat Swelling 61

Differential diagnosis of a scrotal swelling 61

History to focus on the differential diagnosis of a scrotal swelling 61

Examination of patients who have a scrotal swelling 62

Investigation of patients who have a scrotal swelling 62

Differential diagnosis of haematuria 65

16.Haematuria 65

Examination of patients who have haematuria 66

History to focus on the differential diagnosis of haematuria 66

Investigation of patients who have haematuria 67

17.Urinary Difficulty 69

Differential diagnosis of urinary difficulty 69

History to focus on the differential diagnosis of urinary difficulty 69

Examination of patients who have urinary difficulty 70

Investigation of patients who have urinary difficulty 70

History to focus on the differential diagnosis of a skin lesion 73

Examination of patients who have a skin lesion 73

18.Skin Lesion 73

Differential diagnosis of a skin lesion 73

lnvestigation of patients who have a skin lesion 74

19.Anaemia 77

Differential diagnosis of anaemia 77

History to focus on the differential diagnosis of anaemia 77

Examination of patients who have anaemia 78

Investigation of patients who have anaemia 79

Differential diagnosis of postoperative pyrexia 81

History to focus on the differential diagnosis of postoperative pyrexia 81

Examination of patients who have postoperative pyrexia 81

20.Postoperative Pyrexia 81

Investigation of patients who have postoperative pyrexia 82

Part Ⅱ:History,Examination,and Common Investigations 85

Introduclion 87

History 87

21.Clerking a Surgical Patient 87

Influence of coexisting disease on operative intervention 89

Important medical conditions 89

Common presentina symptoms 91

22.Examination of a Surggical Patient 95

Examination of specific surgical conditions 95

General examination of the patient 95

Examination of the breast 95

Examination of the neck and thyroid 98

Examination of the abdomen 98

Examination of a scrotal swelling 100

Examination of a hernia 100

Examination of peripheral vasculature 101

Examination of varicose veins 101

Examination at a patient who has multiple iniuries 102

23.Writing Up a Surgical Clerking 105

Sample clerking 105

24.Investigation of a Surgical Patient 109

Assessment before general anaesthesia 109

Investigation of the gastrointestinal tract 111

Investigation of breast problems 114

Investigation of thyroid disease 115

Vascular investigations 115

Urological investigations 115

Part Ⅲ:Background Information and Management Plans 117

25.Oesophageal Disorders 119

Gastro-oesophageal reflux 119

Benign tumours of the oesophagus 120

Oesophageal cancer 120

Achalasia 121

Pharyngeal pouch 122

Plummer-Vinson syndrome 123

Perforation of the oesophagus 123

Dysphagia 123

26.Gastric and Duodenal Disorders 125

Peptic ulceration 125

Erosive gastritis 126

Chronic atrophic gastritis 126

Zollinger-Ellison syndrome 127

Gastric cancer 128

Gastric lymphoma 129

27.Disorders of Small Intestine 131

Obstruction of the small intestine 131

Crohn's disease 131

Short gut syndrome 133

Intestinal ischaemia 133

Chronic ischaemia 133

Radiation enteropathy 134

Meckel's diverticulum 134

Intussusception 134

Carcinoid tumours 135

Tumours of the small intestine 135

28.Colonic Disorders 137

Acute appendicitis 137

Appendix tumours 138

Inflammatory bowel diseases 138

Ulcerative colitis 138

Crohn's disease of the colon 139

Diverticulosis 139

Caecal volvulus 140

Volvulus 140

Pseudo-obstruction 141

Colonic polyps 141

Villous adenoma 142

Colonic carcinoma 142

Vascular disorders 144

Ischaemic colitis 144

Colonic obstruction 144

Anal fissure 147

Haemorrhoids 147

29.Anorectal Disorders 147

Perianal haematoma 148

Rectal prolapse 148

Perianal abscess 148

Anal fistula 149

Pruritus ani 149

Anal carcinoma 149

Acute liver damage 151

Portal hypertension 151

Normal liver function 151

30.Hepatobiliary Disorders 151

Hepatic cysts 153

Hepatic abscesses 153

Hepatic tumours 153

Chronic liver disease 154

Gall bladder disease 154

Acalculous cholecystitis 157

Pancreatitis 157

Pancreatic tumours 158

Chronic pancreatitis 158

Endocrine tumours of the pancreas 159

Obstructive iaundice 160

31.Gynaecological Disorders 163

Ovarian cysts and neoplasms 163

Ovarian tumours 163

Pelvic inflammatory disease 164

Ectopic pregnancy 164

Leiomyoma 165

Endometriosis 165

32.Abdominal Hernias 167

Types of hernia 167

Inguinal hernia 167

Femoral hernia 169

Umbilical hernia 169

Poraumbilical hernia 170

Epigastric hernia 170

Incisional hernia 170

Uncommon hernias 170

Desmoid tumour 171

Rectus haematoma 171

Diaphragmatic hernia 171

Obturator hernia 171

33.Thyroid and Parathyroid Disorders 173

Thyroid gland 173

Thyroglossal cyst 173

Thyroid goitre 173

Solitary thyroid nodule 174

Thyroiditis 174

Thyroid carcinomas 174

Thyroid operations 175

Parathyroid disorders 176

Hyperparathyroidism 176

34.Neck Swellings 179

Cervical lymphadenopthy 179

Other cervical swellings 180

Salivary gland disorders 181

Salivary gland tumours 181

Benign breast disorders 183

Breast development 183

35.Breast Disorders 183

Benign breast lumps 184

Breast cancer 185

Gynaecomastia and male breast cancer 188

36.Vascular Disorders 189

Chronic limb ischaemia 189

Acute limb ischaemia 190

Compartment syndrome 191

Aneurysm 192

Abdominal aortic aneurysm 192

Thoracoabdominal aneurysm 193

Diabetic foot problems 193

Amputation 194

Carotid artery disease 194

Coronary artery disease 194

Raynaud's phenomenon 195

Varicose veins 195

Raynaud's disease 195

Thromboangiitis obiiterans 195

Superficial thrombophlebitis 196

Subclavian or axillary vein thrombosis 196

Lymphatic disorders 197

37.Urological Disorders 199

Urinary tract infection 199

Renal tract calculi 200

Bladder cancer 201

Tumours of the renal pelvis and ureter 201

Nephroblastoma(Wilms'tumour) 201

Renal carcinoma 201

Prostatic cancer 202

Testicular cancer 203

Penile cancer 204

Lower urinary tract obstruction 204

Upper urinary tract obstruction 205

Renal transplantation 205

Urinary incontinence 206

Testicular problems 207

Scrotal problems 207

Disorders of the perineum 208

38.Skin Lesions 209

Benign conditions 209

Benign skin tumours 210

Vascular lesions 210

Malignant skin lesions 211

Pigmented lesions 212

39.Soft Tissue Disorders 215

Hand and nail problems 215

Soft tissue tumours 216

Pilonidal sinus 216

40.Trauma 217

Chest iniuries 217

Abdominal trauma 220

Head iniury 221

Limb iniuries 223

Burns 223

41.Postoperattve care and complications 225

Postoperative fluid management 225

Shock 225

Prevention of complications 227

Postoperative nutrition 228

Postoperative analgesia 228

42.Principles of Cancer Management 231

Cancer 231

Screening for cancer 231

Spread of cancer 232

Staging of cancer 232

Operations for malignant disease 233

Radiotherapy for malignant disease 233

Palliative care 234

Chemotherapy for malignant disease 234

Hormonal therapy for malignant disease 234

Part Ⅳ:Self-assessment 235

Multiple-choice questions 237

Short-answer questions 241

Patient management problems 242

MCQ answers 243

SAQ answers 244

Index 247