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PartⅠ:The Patient Presents With1

1.Acute Abdominal Pain3

Differential diagnosis of acute abdominal pain3

History to focus on the difierential diagnosis of acute abdominal pain3

Examination of patients who have acute abdominal pain5

Investigation of patients who have acute abdominal pain6

Differential diagnosis of dyspepsia9

History to focus on the differential diagnosis of dyspepsia9

2.Dyspepsia9

Examination of patients who have dyspepsia10

Investigation of patients who have dyspepsia10

3.Vomiting,Haematemesis,and Melaena13

Differential diagnosis of vomiting,haematemesis,and melaena13

History to focus on the differential diagnosis of vomiting,haematemesis,and melaena13

Examination of patients who have vomiting,haematemesis,and melaena14

Investigation of patients who have vomiting,haematemesis,and melaena15

Differential diagnosis of a change in bowel habit17

History to focus on the differential diagnosis of a change in bowel habit17

4.Change in Bowel Habit17

Examination of patients who have a change in bowel habit18

Investigation of patients who have a change in bowel habit19

5.Abdominal Mass and Distension21

Differential diagnosis of abdominal mass or distension21

History to focus on the differential diagnosis of abdominal mass or distension21

Examination of patients who have abdominal mass or distension22

Investigation of patients who have abdominal mass or distension23

History to focus on the differential diagnosis of rectal bleeding25

Differential diagnosis of rectal bleeding25

6.Rectal Bleeding25

Examination of patients who have rectal bleeding26

Investigation of patients who have rectal bleeding27

7.Anorectal Pain29

Differential diagnosis of anorectal pain29

History to focus on the difierential diagnosis of anorectal pain29

Examination of patients who have anorectal pain29

Investigation of patients who have anorectal pain30

Differential diagnosis of iaundice33

History to focus on the differential diagnosis of iaundice33

8.Jaundice33

Examination of patients who have iaundice34

Investigation of patients who have iaundice34

9.Dysphagia37

Differential diagnosis of dysphagia37

History to focus on the differential diagnosis of dysphagia37

Examination of patients who have dysphagia38

Investigation of patients who have dysphagia38

History to focus on the differential diagnosis of a breast lump41

Differential diagnosis of a breast lump41

10.Breast Lump41

Examination of patients who have a breast lump42

Investigation of patients who have a breastlump43

11.Neck Lump45

Differential diagnosis of a neck lump45

History to focus on the differential diagnosis of a neck lump45

Examination of patients who have a neck lump46

lnvestigation of patients who have a neck lump46

History to focus on the differential diagnosis of an ischaemic limb49

Differential diagnosis of an ischaemic limb49

12.Ischaemic Limb49

Examination of patients who have an ischaemic limb50

Investiggation of patients who have an ischaemic limb51

13.Leg Ulcer53

Differential diagnosis of a leg ulcer53

History to focus on the differential diagnosis of a leg ulcer53

Examination of patients who have a leg ulcer53

Investigation of patients who have a leg ulcer54

History to focus on the differential diagnosis of a groin swelling57

Differential diagnosis of a groin swelling57

14.Groin Swelling57

Examination of patients who have a groin swelling58

Investigation of patients who have a groin swelling58

15.Scrotat Swelling61

Differential diagnosis of a scrotal swelling61

History to focus on the differential diagnosis of a scrotal swelling61

Examination of patients who have a scrotal swelling62

Investigation of patients who have a scrotal swelling62

Differential diagnosis of haematuria65

16.Haematuria65

Examination of patients who have haematuria66

History to focus on the differential diagnosis of haematuria66

Investigation of patients who have haematuria67

17.Urinary Difficulty69

Differential diagnosis of urinary difficulty69

History to focus on the differential diagnosis of urinary difficulty69

Examination of patients who have urinary difficulty70

Investigation of patients who have urinary difficulty70

History to focus on the differential diagnosis of a skin lesion73

Examination of patients who have a skin lesion73

18.Skin Lesion73

Differential diagnosis of a skin lesion73

lnvestigation of patients who have a skin lesion74

19.Anaemia77

Differential diagnosis of anaemia77

History to focus on the differential diagnosis of anaemia77

Examination of patients who have anaemia78

Investigation of patients who have anaemia79

Differential diagnosis of postoperative pyrexia81

History to focus on the differential diagnosis of postoperative pyrexia81

Examination of patients who have postoperative pyrexia81

20.Postoperative Pyrexia81

Investigation of patients who have postoperative pyrexia82

Part Ⅱ:History,Examination,and Common Investigations85

Introduclion87

History87

21.Clerking a Surgical Patient87

Influence of coexisting disease on operative intervention89

Important medical conditions89

Common presentina symptoms91

22.Examination of a Surggical Patient95

Examination of specific surgical conditions95

General examination of the patient95

Examination of the breast95

Examination of the neck and thyroid98

Examination of the abdomen98

Examination of a scrotal swelling100

Examination of a hernia100

Examination of peripheral vasculature101

Examination of varicose veins101

Examination at a patient who has multiple iniuries102

23.Writing Up a Surgical Clerking105

Sample clerking105

24.Investigation of a Surgical Patient109

Assessment before general anaesthesia109

Investigation of the gastrointestinal tract111

Investigation of breast problems114

Investigation of thyroid disease115

Vascular investigations115

Urological investigations115

Part Ⅲ:Background Information and Management Plans117

25.Oesophageal Disorders119

Gastro-oesophageal reflux119

Benign tumours of the oesophagus120

Oesophageal cancer120

Achalasia121

Pharyngeal pouch122

Plummer-Vinson syndrome123

Perforation of the oesophagus123

Dysphagia123

26.Gastric and Duodenal Disorders125

Peptic ulceration125

Erosive gastritis126

Chronic atrophic gastritis126

Zollinger-Ellison syndrome127

Gastric cancer128

Gastric lymphoma129

27.Disorders of Small Intestine131

Obstruction of the small intestine131

Crohn's disease131

Short gut syndrome133

Intestinal ischaemia133

Chronic ischaemia133

Radiation enteropathy134

Meckel's diverticulum134

Intussusception134

Carcinoid tumours135

Tumours of the small intestine135

28.Colonic Disorders137

Acute appendicitis137

Appendix tumours138

Inflammatory bowel diseases138

Ulcerative colitis138

Crohn's disease of the colon139

Diverticulosis139

Caecal volvulus140

Volvulus140

Pseudo-obstruction141

Colonic polyps141

Villous adenoma142

Colonic carcinoma142

Vascular disorders144

Ischaemic colitis144

Colonic obstruction144

Anal fissure147

Haemorrhoids147

29.Anorectal Disorders147

Perianal haematoma148

Rectal prolapse148

Perianal abscess148

Anal fistula149

Pruritus ani149

Anal carcinoma149

Acute liver damage151

Portal hypertension151

Normal liver function151

30.Hepatobiliary Disorders151

Hepatic cysts153

Hepatic abscesses153

Hepatic tumours153

Chronic liver disease154

Gall bladder disease154

Acalculous cholecystitis157

Pancreatitis157

Pancreatic tumours158

Chronic pancreatitis158

Endocrine tumours of the pancreas159

Obstructive iaundice160

31.Gynaecological Disorders163

Ovarian cysts and neoplasms163

Ovarian tumours163

Pelvic inflammatory disease164

Ectopic pregnancy164

Leiomyoma165

Endometriosis165

32.Abdominal Hernias167

Types of hernia167

Inguinal hernia167

Femoral hernia169

Umbilical hernia169

Poraumbilical hernia170

Epigastric hernia170

Incisional hernia170

Uncommon hernias170

Desmoid tumour171

Rectus haematoma171

Diaphragmatic hernia171

Obturator hernia171

33.Thyroid and Parathyroid Disorders173

Thyroid gland173

Thyroglossal cyst173

Thyroid goitre173

Solitary thyroid nodule174

Thyroiditis174

Thyroid carcinomas174

Thyroid operations175

Parathyroid disorders176

Hyperparathyroidism176

34.Neck Swellings179

Cervical lymphadenopthy179

Other cervical swellings180

Salivary gland disorders181

Salivary gland tumours181

Benign breast disorders183

Breast development183

35.Breast Disorders183

Benign breast lumps184

Breast cancer185

Gynaecomastia and male breast cancer188

36.Vascular Disorders189

Chronic limb ischaemia189

Acute limb ischaemia190

Compartment syndrome191

Aneurysm192

Abdominal aortic aneurysm192

Thoracoabdominal aneurysm193

Diabetic foot problems193

Amputation194

Carotid artery disease194

Coronary artery disease194

Raynaud's phenomenon195

Varicose veins195

Raynaud's disease195

Thromboangiitis obiiterans195

Superficial thrombophlebitis196

Subclavian or axillary vein thrombosis196

Lymphatic disorders197

37.Urological Disorders199

Urinary tract infection199

Renal tract calculi200

Bladder cancer201

Tumours of the renal pelvis and ureter201

Nephroblastoma(Wilms'tumour)201

Renal carcinoma201

Prostatic cancer202

Testicular cancer203

Penile cancer204

Lower urinary tract obstruction204

Upper urinary tract obstruction205

Renal transplantation205

Urinary incontinence206

Testicular problems207

Scrotal problems207

Disorders of the perineum208

38.Skin Lesions209

Benign conditions209

Benign skin tumours210

Vascular lesions210

Malignant skin lesions211

Pigmented lesions212

39.Soft Tissue Disorders215

Hand and nail problems215

Soft tissue tumours216

Pilonidal sinus216

40.Trauma217

Chest iniuries217

Abdominal trauma220

Head iniury221

Limb iniuries223

Burns223

41.Postoperattve care and complications225

Postoperative fluid management225

Shock225

Prevention of complications227

Postoperative nutrition228

Postoperative analgesia228

42.Principles of Cancer Management231

Cancer231

Screening for cancer231

Spread of cancer232

Staging of cancer232

Operations for malignant disease233

Radiotherapy for malignant disease233

Palliative care234

Chemotherapy for malignant disease234

Hormonal therapy for malignant disease234

Part Ⅳ:Self-assessment235

Multiple-choice questions237

Short-answer questions241

Patient management problems242

MCQ answers243

SAQ answers244

Index247