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Summary MBBS Surgery All in One
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  • Course
  • MBBS
  • Institution
  • National University Of Singapore

A guide to success in MBBS study! Self-written notes based on lecture notes and Uptodate. The notes cover all materials medical student need to know about surgery before they graduate. Detailed coverage on common surgical diseases (signs and symptoms, investigations, treatment) with convenient ta...

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Document information

  • October 18, 2022
  • 1185
  • 2022/2023
  • Summary

Subjects

  • mbbs
  • medicine
  • surgery
  • final year
  • disease
  • treatment
  • exam

Written for

  • National University Of Singapore
  • MBBS
All documents for this subject (5)

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TABLE OF CONTENTS

Chapter 1: Basic Surgical Principles 8 – 45

LABORATORY REFERENCE VALUE 8 – 10
SUTURE MATERIAL 11 – 15
NUTRITION 16 – 23
CRYSTALLOIDS VS COLLOIDS 24
FLUID REPLACEMENT 25 – 28
SHOCK 29 – 33
SEPSIS 34 – 42
DISSEMINATED INTRAVASCULAR COAGULOPATHY (DIC) 43 – 45


Chapter 2: Tubes And Drains 46 – 75

GENERAL TUBES AND DRAINS 46 – 51
NASOGASTRIC (NG) TUBE 52 – 54
ENDOTRACHEAL (ET) TUBE 55 – 59
TRACHEOSTOMY 60 – 63
STOMA PRINCIPLES 64 – 70
URINARY CATHETERIZATION 71 – 75


Chapter 3: Procedures 76 – 89

ESOPHAGOGASTRODUODENOSCOPY (OGD) 76 – 80
COLONOSCOPY 81 – 86
ERCP 87 – 89


Chapter 4: Anesthesia 90 – 114

ANALGESIA 90 – 96
GENERAL ANESTHESIA (GA) 97 – 107
REGIONAL ANESTHESIA (RA) 108 – 114

,Chapter 5: Clinical Examination 115 – 139

LUMPS AND BUMPS EXAMINATION 115 – 119
NECK EXAMINATION 120 – 122
BREAST EXAMINATION 123 – 124
ABDOMINAL EXAMINATION 125 – 131
VASCULAR EXAMINATION 132 – 139


Chapter 6: Lumps And Bumps 140 – 196

BENIGN SKIN LESIONS 140 – 161
KELOIDS AND HYPERTROPHIC SCARS 162
HEMANGIOMAS 163 – 167
VASCULAR MALFORMATIONS 168 – 172
LIPOMA 173 – 176
SEBACEOUS CYSTS 177 – 180
SQUAMOUS CELL CARCINOMA (SCC) 181 – 186
BASAL CELL CARCINOMA (BCC) 187 – 190
MELANOMA 191 – 196


Chapter 7: Head And Neck/ ENT System 197 - 268

NECK MASS 197 – 207
FACIAL NERVE PALSY 208 – 214
BENIGN LESIONS OF VOCAL CORD 215 – 219
PAROTITIS 220 – 223
SIALOLITHIASIS 224 – 228
SALIVARY GLAND TUMOURS 229 – 236
HEAD AND NECK CANCER 237 – 247
NASOPHARYNGEAL CARCINOMA (NPC) 248 – 253
OROPHARYNGEAL CARCINOMA 254 – 258
LARYNGEAL CARCINOMA 259 – 268

,Chapter 8: Breast System 269 – 321

NIPPLE DISCHARGE OR INVERSION 269 – 271
BENIGN BREAST DISEASE 272 – 283
BREAST CANCER 284 – 321


Chapter 9: EGI (Esophago-gastrointestinal) System 322 – 425

DYSPHAGIA 322 – 326
DYSPEPSIA 327 – 333
UPPER GI BLEEDING 334 – 342
LOWER GI BLEEDING 343 – 348
GERD 349 – 359
ACHALASIA 360 – 364
BARRETT’S ESOPHAGUS 365 – 369
ESOPHAGEAL CANCER 370 – 385
PEPTIC ULCER DISEASE 386 – 399
GASTRIC CANCER 400 – 420
GASTROINTESTINAL STROMAL TUMOUR (GIST) 421 – 425


Chapter 10: HBP (Hepato-biliary-pancreatic) System 426 – 602

JAUNDICE 426 – 435
LIVER ABSCESS 436 – 439
LIVER CIRRHOSIS 440 – 472
HEPATOCELLULAR CARCINOMA (HCC) 473 – 497
MALIGNANT BILIARY OBSTRUCTION (MBO) 498 – 507
GALLSTONES 508 – 519
ACUTE CHOLANGITIS 520 – 525
RECURRENT PYOGENIC CHOLANGITIS 526 – 528
PRIMARY SCLEROSING CHOLANGITIS 529 – 532
PRIMARY BILIARY CIRRHOSIS 533 – 540
BILIARY CYSTS 541 – 544
CHOLANGIOCARCINOMA 545 – 552
ACUTE CHOLECYSTITIS 553 – 562
GALLBLADDER CANCER 563 – 571
MIRIZZI SYNDROME 572 – 575
ACUTE PANCREATITIS 576 – 590
PANCREATIC CANCER 591 – 602

,Chapter 11: CRS (Colorectal) System 603 – 763

INTESTINAL OBSTRUCTION 603 – 615
HERNIA 616 – 636
DIVERTICULAR DISEASE 637 – 647
INFLAMMATORY BOWEL DISEASE (CROHN’S DISEASE) 648 – 659
INFLAMMATORY BOWEL DISEASE (ULCERATIVE COLITIS) 660 – 674
COLORECTAL CANCER (CRC) 675 – 712
INTESTINAL ISCHEMIA 713 – 720
VOLVULUS 721 – 726
ACUTE APPENDICITIS 727 – 737
PERITONITIS 738 – 744
HEMORRHOIDS 745 – 750
ANAL FISSURE 751 – 753
ANORECTAL ABSCESS 754 – 755
ANORECTAL FISTULA 756 – 760
RECTAL PROLAPSE 761 – 763


Chapter 12: Urological System 764 – 891

HEMATURIA 764 – 769
ACUTE RETENTION OF URINE (AROU) 770 – 774
URINARY TRACT INFECTION (UTI) 775 – 787
URINARY STONES (NEPHROLITHIASIS) 788 – 798
POLYCYSTIC KIDNEY DISEASE (PKD) 799 – 805
RENAL CELL CARCINOMA (RCC) 806 – 815
BLADDER CANCER 816 – 825
BENIGN PROSTATIC HYPERPLASIA (BPH) 826 – 834
PROSTATE CANCER 835 – 850
TESTICULAR CANCER 851 – 859
PERITONEAL DIALYSIS 860 – 867
HEMODIALYSIS VASCULAR ACCESS 868 – 875
RENAL TRANSPLANTATION 876 – 891

,Chapter 13: Vascular System 892 – 972

CAROTID ARTERY STENOSIS 892 – 900
AORTIC DISSECTION 901 – 907
ABDOMINAL AORTIC ANEURYSM (AAA) 908 – 916
ACUTE ARTERIAL INSUFFICIENCY 917 – 927
CHRONIC ARTERIAL INSUFFICIENCY 928 – 940
CHRONIC VENOUS DISEASE 941 – 949
VARICOSE VEINS 950 – 972
DEEP VEIN THROMBOSIS AND PULMONARY EMBOLISM



Chapter 14: Endocrine System 973 – 1035

HYPERTHYROIDISM AND HYPOTHYROIDISM 973 – 990
THYROID CANCER 991 – 1014
HYPERPARATHYROIDISM 1015 – 1025
PITUITARY ADENOMA 1026 – 1031
PHAEOCHROMOCYTOMA 1032 – 1035


Chapter 15: Pediatrics Surgery 1036 – 1110

TRACHEOESOPHAGEAL FISTULA AND ESOPHAGEAL ATRESIA 1036 – 1037
MECKEL’S DIVERTICULUM 1038 – 1042
INTUSSUSCEPTION 1043 – 1046
INTESTINAL ATRESIA 1047 – 1051
INTESTINAL MALROTATION 1052 – 1057
HIRSCHSPRUNG DISEASE 1058 – 1063
GASTROSCHISIS AND OMPHALOCELE 1064 – 1068
SHORT GUT SYNDROME 1069 – 1074
HEPATOBLASTOMA 1075 – 1077
WILM’S TUMOUR 1078 – 1081
PHIMOSIS AND PARAPHIMOSIS 1082 – 1085
HYPOSPADIAS 1086 – 1090
UNDESCENDED TESTES 1091 – 1096
HYDROCELE/ VARICOCELE/ SPERMATOCELE 1097 – 1103
TESTICULAR TORSION 1104 – 1110

,Chapter 16: Neurosurgery 1111 – 1167

INCREASED ICP 1111 – 1119
HEAD INJURY 1120 – 1128
EPIDURAL/ SUBDURAL/ SUBARACHNOID HEMORRHAGE 1129 – 1134
STROKE 1135 – 1167

Chapter 17: Cardiothoracic Surgery 1068 – 1071

VALVULAR HEART SURGERY 1068 – 1071


Chapter 18: Plastic Surgery 1072 – 1184

SKIN GRAFTS AND FLAPS 1072 – 1176
BURNS 1177 – 1184

, Laboratory reference value
Complete blood count (CBC)
Red blood cells (RBC)
Haemoglobin (Hb) ♂ 13.5 – 16.5 g/dL
♀ 12.0 – 16.0 g/dL
MCV 80 - 96 fL
MCH 26 – 33 pg
Hematocrit 0.4 – 0.5 L/L
RBC 4.4 – 5.8 x 1012 /L
RDW 11.8 – 15.8 %
Reticulocytes 0.2 – 2.0 %
White blood cells (WBC)
WBC 3.7 – 9.3 x 109 /L
Neutrophils 1.8 – 6.2 x 109 (40 – 80%) /L
9
Lymphocytes 1.0 – 3.2 x 10 (20 – 40%) /L
Monocytes 0.2 – 0.7 x 109 (< 10%) /L
9
Eosinophils 0.0 – 0.5 x 10 (< 5%) /L
9
Basophils 0.0 – 0.2 x 10 (< 1 - 2%) /L
Platelets
Platelet 150 – 450 x 109 /L
*: Values that are bolded are reviewed according to the newest definition in uptodate


Clotting profile
PT 9.3 – 12.1 s
APTT 25.0 – 31.3 s
INR < 1.0
D-dimer < 0.5 mg/L
Fibrinogen 2–4 g/dL


Electrolyte profile
+
Na 136 – 148 mmol/L
K+ 3.6 – 5.0 mmol/L
Cl- 100 - 109 mmol/L
Ca2+ 2.11 – 2.55 mmol/L
PO 4 3- 0.89 – 1.45 mmol/L




8

, Lipid profile
Total cholesterol Desirable < 5.2 mmol/L
Borderline high 5.2 – 6.1 mmol/L
High ≥ 6.2 mmol/L
LDL Optimal < 2.6 mmol/L
Near optimal 2.6 – 3.3 mmol/L
Borderline high 3.4 – 4.0 mmol/L
High 4.1 – 4.8 mmol/L
Very high ≥ 4.9 mmol/L
Triglycerides Normal < 1.7 mmol/L
Borderline high 1.7 – 2.2 mmol/L
High 2.3 – 5.5 mmol/L
Very high ≥ 5.6 mmol/L
HDL Low < 1.0 mmol/L
High ≥ 1.6 mmol/L




Liver function test (LFT)
AST 15 – 38 U/L
ALT 8 – 58 U/L
ALP 42 – 110 U/L
GGT 11 – 62 U/L
Total bilirubin 4 – 23 μmol/L
Conjugated bilirubin <6 μmol/L
Albumin 39 – 50 g/L




Renal function test (RFT)
Urea 3.1 – 7.7 mmol/L
Creatinine 67 - 109 μmol/L
GFR ≥ 90 (90 – 120) mL/min/1.73m2




Thyroid function test (TFT)
TSH 0.35 – 4.80 mIU/L
fT 4 12 – 23 mmol/L




9

, Arterial blood gas
pH 7.35 – 7.45
PO 2 10.6 – 14.0 kPa
PCO 2 4.7 – 6.0 kPa
HCO 3 - 22 – 26 mmol/L
Base excess -4 - +2 mmol/L




Others
Total protein 68 – 84 g/L
Globulin 24 – 36 g/L
CK 260 – 530 U/L
LDH 118 – 221 U/L
ESR ♂ Age / 2 mm/hr
♀ (Age + 10) / 2 mm/hr




10

, General Surgical Diseases
Suture material
I. Overview
1. Suture size
 Size refers to the diameter of suture strand
 The more “0”, the small the strand diameter
• 2-0 or 00 is larger than (粗過) 4-0 or 0000
• “細 number 粗 D”

2. Characteristics of an ideal sutures
 Minimal tissue reaction
 Smoothness (minimum tissue drag)
 Low capillarity (ability to fluid to travel along sutures)
 Maximum tensile strength
 Ease of handling (minimum memory)
 Knot security
 Consistency of performance
 Predictable performance
 Cost-effectiveness




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