Table Of Contents
SL No. Chapter Page No
A GENERAL SURGERY
I General
1 Nutrition 5
2 Shock 8
3 BloodTransfusion 12
4 Sutures 16
5 Energy device used in theater 23
6 Surgical Blades 26
7 Wound 28
8 PPE 30
9 WHO Safety Guidelines 31
10 Instruments 32
11 Surgical Technique & Positions 34
12 Laparoscopy 36
II TRAUMA
14 Brain Haematoma 38
15 GCS Score 41
16 Brain Herniation 42
17 Base Of Skull fractures 43
18 Abdominal Trauma 44
19 E Fast 46
20 Liver Injury 48
21 Pancreatic Injury 49
22 Retroperitoneal Injury 50
23 Abdominal Compartment Syndrome 51
III BURNS
24 % Calculate Burns 53
25 Fluid calculation fro burns 53
26 Degree of Burns 54
IV TRANSPLANT SURGERY
27 Basics 57
28 Types of Grafts 58
29 Graft Rejection 60
30 Renal Transplant 61
31 Firsts in transplant 62
B HEAD AND NECK
1
SL No. Chapter Page No
32 Level of Neck nodes 62
33 Neck dissection operations 63
34 Oral Carcinoma 64
35 Neck Dissection incisions 66
36 Dentigenrous cyst and Dental cyst 67
37 Cervical Rib 69
38 Subclavian Steel Syndrome 70
39 Branchial Fistula 71
40 Parotid Glands 72
41 Thyroid Surgery 75
42 Thyroid Cancer 77
43 MEN Syndromes 81
C THORAX
44 Breast Cancer 83
45 Mastectomy 90
46 Breast Reconstruction 91
D GIT
I OESOPHAGUS
47 Motility Disorders 94
48 Esophageal perforations 97
49 Malignant Tumors in Esophagus 100
50 Esophagitis Types 103
II STOMACH AND DUODENUM
51 Vagotomy 105
52 Complications of GJ 106
53 H.Pylori 108
54 Peptic Ulcer 109
55 Duodenal Ulcer 111
56 GOO 113
57 Congenital Hypertrophic Pyloric Stenosis 115
58 Duodenal Atresia 116
59 Jejunal Atresia 117
60 Upper GI Bleed 118
61 Menetriers Disease 119
III BARIARTIC SURGERY
62 Introduction 120
63 Types 121
2
SL No. Chapter Page No
64 Complications 122
IV SMALL BOWEL AND LARGE BOWEL
65 Capsule Endoscopy 123
66 Double Balloon Endoscopy 125
67 Meckels diverticulum 125
68 Sigmoid Diverticulum 126
69 Short Bowel Syndrome 127
70 Hirshsprung Disease 128
71 Small Intestine Tumor 130
72 Inflammatory Bowel Disease 132
73 Intestinal Obstruction 136
V RECTUM AND ANUS
74 Hemorrhoids 138
VI HERNIA
75 Techniques 138
76 NYHUS Classification 140
VI HEPATOBILLIARY AND PANCREATIC SYSTEM
77 ERCP and Sphicturotomy 141
78 Gall stones 141
79 Choledochal Cyst 148
80 Pancreas Tumor 151
81 Neuroendocrine Tumors of Pancreas 153
83 Acute Pancreatitis 156
84 Portal HTN 156
85 Budd Chiari Syndrome 160
86 Infections in Liver 161
87 Hydatid Cyst 162
88 Splenectomy 164
E KIDNEYS AND GENITO URINARY SYSTEM
89 Renal Stones 166
90 Urinary tract injuries 170
91 Benign Prostatic HTN 171
92 Hypospadias 172
93 Peyronie’s disease 173
94 Priapism 173
95 Torsion Testes 174
F VASCULAR SURGERY
3
SL No. Chapter Page No
96 Arterial Lesion 176
97 Klippel Trenany Syndrome 179
98 Lymphoedema 180
G PLASTIC SURGERY
99 Flaps 181
100 Reimplantation Of Digits 183
H MISCELLANEOUS
101 Intestinal Atresia 184
102 Skin Cancer 185
103 Cardio thoracic Surgery 187
104 Phaeochromocytoma 187
105 Neurosurgery 188
106 Tearson Syndrome 189
GENERAL SURGERY
Nutrition
mm
TPNdGiversthrong veins
to
peripheral Vein central vein
Zwk HeckmannLINE 2wks
Pice
peripherallyinserted
centralcatheter
1
isu only for traumacourses
subclavian vein easyto use for longterm
More patientcompliant
50
251 75ns
25 251 AA Dextran
l t to
Eat Free TPN
lipids A A Dextran
12 bag with all essential f for
vitamins mineral Nutrient Fatty lives
Steatosis
Liver failure
e
a
Catheter Related Complications
I
la la
procedure catheter Related catheter
Related Blockage Related
Tension pneumothorax IQmplication sepsis
s.bgfoelzfeedd
Tip of catheter should be
in Svc if it is accidently
in atrium to Atrium If both culture Tip 45
Thrombus come to be same BloodCB
4 organism catheter
Xray Chest is mandatory Related sepsis confirmed
Mx Put new catheter
on otherside
Other complications
mum
ofme
TPN
MOSTDREADED
Complies
to be
Elevation ofBlood 9 LET Liverfailure
sugar Central vein
Electrolyte imbalance to kliver thrombosis
stealosis
also 1stsign of sepsis
overfeed
sat me I
f Small bowel
Mex transplantation
stopTPN Liver transplant
restart ratios
Fat freeTPN
Refeeding Syndrome
Condition Hi ppl who are starved and not on nutrition for dong
period
once nutrition is started severe hyperglycemia and there will
be so much of Insulin release
Insulin drive e pottasium
calcium
µq Magnesium into the cell
phosphate
Hypokalemia
Hypercalcemia
Hypomoynesemia
Hypophosphatemia
indications of TPM Enteralnutrition is always best3
GIT is not good
Enter cutaneous fistula
Short Bowel Syndrome
poor Crohn dis
Radiation Enteritis
2 BP is not good chances of mesentrial ischemia in enteral nutrition
shock
Burns
severe
Atcpancreatitis
Monitor in TPN
CHATHETER change
a onlyfor
is
Twice wkly weekly once catheter related
f f sepsis
Bloodsugar LET
RFT
Electrolytes
must Malnutrition Universal screening tool
based wghtloss Tool 1 calculate malnutrition
on Body mass Index
Aledisease effect
Best method to calculate the nutrition in a surgical patient s Alburnin
Rolling the bag helps in mixing the three compartments
Post canulation CXR mandatory to check the catheter tip is placed
in SVC
also look for pneumothorax
SCHOCK E cause of death in surgical patient3
cardiac output
rTZE
Peripheral Arterial PAR
Resistance
1 1
py
j sum.pt
measure Mixed venous 02
saturation CMvos
when root Oz is given to pt
the of blood returning back
to heart after reaching
Wires
S in
50 70
SHOCK
I
f to
Haemorh
agic septic
e o tese c OP
peripheral vasoconstriction peripheralartery dilatation
Pse PAR tase PAR
9Ozconsumption Ozconsumption lose
I Vensuse Resistance lose venouse resistance
Mvos 50 MVOS 370 1
Peripheries will be Peripheries will be
COOL GCLAMY
WARM 9 HOT
8
HEMORRHAGIC SCHOCK
Based on blood loss
la I b t
I I 11 I
O 15 15 30 s 30 40s 740
pppp.NET Blood loss Bloodloss Bloodloss Bloodloss
750mL 750 1500mi 1800 2000mi 2L
PR Tse Tse Tse
pp tase f se lase
NORMAL
RR Tse Tse Tse
Bop lose lose
urineoutput
Mentalstatus
Basedeficit Recentoutput
ATLS PROTOCOL for H'magic shock CATLS10thEdition
STEP't cannulate the patient
pv 2 GREEN CANNULA 18Guage
1
FLUID OFCHOICE 75 Hypertonic 85mL minute
saline
old GREY CANNULA
now notadvisedinTrauma
E Alim's19
AIIMS
MAY 9
Patient with Diarrhoea and severe Dehydration presenting in
OPD for Rapid infusion of fluid choice will be
rey
b Pink
Blue
d Green
1
1
Emergency
I cytotoxicdrug
fluid
Bg1nF a
Antibiotics
replacement
STEP2 BLOOD TRANSFUSION
aegis's Immediately done
Blood is the ideal replacement fluid
Newupdate BT 9 E I No coagalopathy
to pfasmatplatelets happens
PRC
Emergency B T uncross match
Blood group used O ve To prevent
Rhincompat
o_0
Postreproductive One can
be given
female
Plasma AB Bloodgroup
update
new BALANCED RESISTATION
2
B Pshould not be High above
me
because previously vasoconstricted
to vessels start bleeding
M A P 90mmHg
meanatrial Bpshould not be very low
pressure becoz Brain will not recieve
blood to Hypoxia
10
SEPTICSHOCK
SIS systemicInflammatory response syndrome 22
c Temperature 35 C or 380
2 Heart Rate Pse Each is given 1 point
3 Respiratory Rate Paco_P
4 Leukocyte count 4000 or 212,000
Aum'smaguey
orSOFA
I t
RR confused BPC 90
inference
mm
each 9 point Zz lo g mortality
Mj
IVE
2 Inj Noradregnaline fluid of choice in septicshock
DeadlyTriad
Hypothermia
Coagulopathy Acidosis
Avoid by
DAMAGECONTROL
RESUSUTATION
Aim i stopbleeding
ii stop contamination
ta t t
Phase I phase II Phase
Emergency 0T ICU Elective 0T
I B O 48hr FH T 48ns
Packing the bleeding stabilize the vitals 4
site immediately Removethe
without any other packs
intervention
SHIFT 11
I
Abdominal wall not
closed as such Repair
the bleeding
f site 4
OPSITESHEAT
damage
VACCUM DRESSING
MONITORING OFTRAUMA PT
a serumLactate
urine output
Cup
used for lookfor
f usedfor
a
Bestclinicalparameter a Tissue Perfusion
Adequacyof resistation Amount of fluids
to beinfused
Drugs delivery 2mmol 12 5min04
Evpnot accurate in f to
Cardiogenic septicshock Good Bad
pewpused
12
BLOOD BANK
BLOOD PRODUCTS
1
D
Ii
FIEF Screening
is HIV 192
2 HBV
3 Hey
Syphilis
5 CTDls
Blood stored
in
SAG M SalinetAdenine t Glucose Mannitol
for
45day
PRBC pep CP platelets
330Mt 250mL 15Mt 50Mt
1 to
forAnemia CHF Richin Fact I Rich in Factor VII
Trauma
VI vWF
Deff A Factor I Fibrinogen
VI I
I lose in plateletfnx
I Rpta
storage storage storage storage
2 4C 40 C 400C 242
45days 2yrs 2yos 5days
Massive BT 10unit of PRBC
plasma
Platelets
COMPLICATIONS
OF MASSIVE BLOOD TRANSFUSION
y Hyperkalemia dlt RBClysis 13
2 Coaguloportly
3
Hypercalcemia dlt to binding A cart by citrate used as anticoagulant
4
Hypothermia
5 Volume overload
Aum's
191
Metabolic Alkalosis stored blood pH 6 3 boss Massive B T sodiumcitrate
is
metabolized in liver to sodium bicarbonate
7 Dilutional thrombocytopenia
8 tased Oz delivery DIE to decrease in 2 3 DPG
9 Rare Metabolic Acidosis
AI 9 Massive blood transfusion courses
af metabolic alkalosis
b metabolic acidosis
Respiratory acidosis
d Respiratory alkalosis
14
AHN EXTENDED MATCHING
µov'M
A
2cases
case 9 24 yr old gentleman with Yo of haemophilia current
two units of FFP since
bleeding episode was treated with
coyoperecipitate
Factor will concentrate is not available 2 houses offers the transfusion
revealed BIL crepitations IR showed BIL infiltrates in the hilsonregion
Batwing what could be the diagnosis
ASTRAL's
TACO
Pulmonary edema
d ARDS
e sepsis
TRAU i comms is with plasma components particularity after FFP
platelets
is usually happens within 6 hours of transfusion q presents
with features of new Au hemodynamic compromise
Mx supportive
Unlikely to be TACO since the patient is young without cardio
renal illness 3 has a JVP hypotension
patient tends to be HTN in Taco
Transfusion Rn and sepsis are unlikely with given Cle
case 2
win
A person admitted in cardiac failure ward for heart transplant also
has a compromised renal function 4h s post blood transfusion
developed chest tightness dyspuse BP 160194mmHg G JVP is
elevated What is the probable DX
or TRALI
ITALO
G Pulmonary Edema
d ARDS
e sepsis
Sol Both patient present with respiratory distress d1E acute onset
pulmonary edema With TRACI patients also often have hypotension
and fever and cars have transient leukopenia
TACO HTN
lack of fever Sterekopenia
15
SUTURES
la to
NATURAL SYNTHETIC
te
1 la la
l
la
Absorbable Mon Absorbable Absorbable Non
te Absorbable
CATGUT
f f to
SILK POLY940021C
N'LON 6090 POLYGLACTIC
ftp.OLYGLYCPRONE Polyester
STEEL days Polybutester
Polypropiline
daysa Polyp ANONE
120
PDS Polytetra
flsuroethyline
DACRON
Ceti
Brown colorsuture
Derived from sheep s I submucosa
Absorbable plain todays
Chromium 60 90days
coated
Absorbed via Enzymatic degradation Highest inflammation
Estored in
isopropyl Alcohol
BANNED IN U K
16
