Acute abdomen, hernias, breast disease, vascular surgery, trauma, and perioperative care — key surgical principles.
AAA is a focal dilatation of the abdominal aorta to ≥3cm. It affects ~5% of men aged 65-74. Rupture carries ~80% overall mortality. NHS screening programme targets men aged 65.
Acute abdomen refers to sudden-onset severe abdominal pain requiring urgent surgical assessment. Causes include appendicitis, bowel obstruction, perforation, and vascular emergencies.
Acute pancreatitis is acute inflammation of the pancreas, most commonly caused by gallstones (50%) and alcohol (25%). Severity ranges from mild self-limiting to severe necrotising disease with high mortality.
Appendicitis is acute inflammation of the vermiform appendix, the most common surgical emergency. Lifetime risk is approximately 7-8% with peak incidence in the 10-30 age group.
Bariatric surgery is the most effective long-term treatment for severe obesity, offering significant weight loss and resolution of obesity-related comorbidities including type 2 diabetes.
Benign prostatic hyperplasia is the most common cause of LUTS in men over 50, characterised by non-malignant proliferation of the prostatic transition zone causing bladder outflow obstruction.
Bladder cancer is the 10th most common cancer in the UK, predominantly transitional cell carcinoma, typically presenting with painless visible haematuria. Smoking is the leading risk factor.
Bowel obstruction is a mechanical or functional blockage of the intestinal lumen preventing normal passage of contents. Adhesions are the commonest cause of small bowel obstruction (SBO).
Breast cancer is the most common cancer in the UK, affecting approximately 1 in 7 women. Early detection through screening and multidisciplinary management have significantly improved outcomes.
Breast lumps are extremely common, with most being benign. Triple assessment (clinical, imaging, tissue diagnosis) at a one-stop breast clinic is the standard approach for evaluation.
Burns are tissue injuries caused by thermal, chemical, electrical, or radiation exposure. Assessment of burn depth and total body surface area (TBSA) guides fluid resuscitation and specialist referral.
Carotid artery disease is atherosclerotic stenosis of the carotid arteries, a major cause of ischaemic stroke and TIA. Carotid endarterectomy is indicated for symptomatic stenosis ≥50%.
Colorectal cancer is the 4th most common cancer and 2nd leading cause of cancer death in the UK. Screening with FIT has improved early detection; 5-year survival is approximately 60%.
Compartment syndrome is a surgical emergency caused by raised pressure within a closed fascial compartment, compromising tissue perfusion. The anterior compartment of the leg is most commonly affected.
Valid surgical consent requires capacity, voluntariness, and adequate information. The Montgomery ruling (2015) established that patients must be informed of all material risks.
Femoral hernia passes through the femoral canal below and lateral to the pubic tubercle. It has a high strangulation risk (~30%) and requires urgent surgical repair.
Appropriate fluid management is essential in surgical patients. NICE CG174 recommends individualised, goal-directed fluid therapy using balanced crystalloids as first-line for replacement.
Fractures are breaks in bone continuity caused by trauma or pathological processes. Classification, assessment, and management follow systematic principles including reduction, immobilisation, and rehabilitation.
Head injury is a leading cause of death and disability in young adults. CT head criteria (NICE NG232), GCS monitoring, and recognition of intracranial complications are essential management skills.
Hepatobiliary surgery encompasses the surgical management of liver, biliary, and pancreatic conditions including malignancy, gallstone disease, and hepatic trauma.
Hip fractures affect ~80,000 people annually in the UK, predominantly elderly osteoporotic patients. Prompt surgical fixation within 36 hours and comprehensive orthogeriatric care reduce mortality.
Incisional hernia occurs through a previous surgical incision site. It affects approximately 10-15% of laparotomy wounds and is a common late surgical complication.
Inguinal hernia is the commonest hernia (~75% of all hernias). It presents as a groin lump that increases with coughing or straining. Surgical repair is definitive treatment.
Necrotising fasciitis is a rapidly progressive, life-threatening soft tissue infection spreading along fascial planes. It requires emergency surgical debridement and carries mortality of 20-40%.
Malnutrition affects approximately 30-40% of surgical patients and is associated with increased complications, impaired wound healing, prolonged hospital stay, and increased mortality.
Pancreatic cancer has the worst prognosis of any common cancer, with 5-year survival approximately 7%. It typically presents late with painless obstructive jaundice, weight loss, and back pain.
Perioperative care encompasses pre-operative assessment, intraoperative management, and post-operative care. Systematic optimisation reduces complications, mortality, and length of stay.
PAD is atherosclerotic narrowing of peripheral arteries, most commonly affecting the lower limbs. It presents as intermittent claudication or critical limb ischaemia and indicates high cardiovascular risk.
Peritonitis is inflammation of the peritoneum, most commonly secondary to perforation of a hollow viscus. It is a surgical emergency with high mortality if untreated.
Prostate cancer is the most common cancer in men in the UK, with ~52,000 new cases/year. Management ranges from active surveillance to radical treatment, guided by risk stratification.
Rectal cancer (within 15cm of anal verge) requires specialised staging and management including MRI pelvis for local staging, neoadjuvant chemoradiotherapy, and total mesorectal excision (TME).
Renal stones (nephrolithiasis) cause acute loin-to-groin pain and affect 10-15% of the UK population. Management depends on stone size, location, and composition.
Spinal injuries encompass fractures and dislocations of the vertebral column with or without spinal cord injury, requiring urgent immobilisation and assessment to prevent secondary neurological damage.
SSI is an infection occurring within 30 days of surgery (or 1 year if an implant is placed). It is the most common healthcare-associated infection in surgical patients, affecting 3-5% of operations.
Testicular torsion is a urological emergency caused by twisting of the spermatic cord, leading to ischaemia. Surgical exploration within 6 hours is critical to save the testis.
Thyroid nodules are extremely common (palpable in ~5%, incidental on US in ~50%). The key clinical question is excluding malignancy, which accounts for approximately 5% of thyroid nodules.
Thyroid surgery (thyroidectomy) is performed for malignancy, compressive goitre, hyperthyroidism refractory to medical therapy, and cosmesis. Key complications include recurrent laryngeal nerve injury and hypoparathyroidism.
ATLS provides a systematic approach to trauma management prioritising life-threatening injuries. The ABCDE approach ensures structured assessment and simultaneous resuscitation.
Upper GI surgery encompasses surgical management of oesophageal and gastric conditions including cancer, GORD, peptic ulcer complications, and hiatus hernia.
Urology encompasses the surgical management of diseases of the male and female urinary tract and the male reproductive system, including malignancy, stones, and functional disorders.