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