THINK LIKE A SURGEON
Welcome to our website, thinklikeasurgeon, a platform for hosting our e-book, an interactive, high quality, General Surgery teaching resource. We are a group of speciality registrars training in the Department of General Surgery at Ninewells hospital, NHS Tayside.
We are approached by keen trainees and nurse practitioners regularly, seeking learning opportunities. That’s what motivated us to create this content. The following sections are broadly divided into Emergency and Ward-based management chapters. We have kept things simple and concise.
Our sole purpose is to improve your knowledge and confidence in dealing with surgical admissions. We hope you enjoy our startup website. It is a work in progress and any feedback or suggestion is very welcome.
FLOWCHARTS -
This section is designed as a guide to reviewing patients in the emergency setting. Abdominal pain is the most common presenting symptom in General Surgery.
In each ‘region of the abdomen’, you will find a flowchart illustrating the initial investigations and management, along with a list of differentials to guide your thought process.
Next to the flowchart, you will find clickable links to severity grading scores, fluid guidelines and more..
CHAPTERS -
There are 15 chapters in this version of the THINK e-book. Out of these, TEN chapters cover Emergency General Surgery topics such as abdominal pain (nine regions of the abdomen), Abscesses and Gastro-intestinal bleeding. The remaining chapters cover topics related to post operative management and management of patients on the wards.
Each topic has been covered using a systematic approach starting with anatomy, pathophysiology, relevant investigations, complications and management. At the end of each topic you will find links to radiology resources and one eminent guideline for further reading (should you wish to read further).
EMERGENCY MANAGEMENT CHAPTERS:
RIGHT UPPER QUADRANT – This chapter covers key differentials in the RUQ such as biliary disease and pancreatico-biliary malignancies.
EPIGASTRIC REGION – This chapter covers key differentials in the epigastric region such as pancreatitis and peptic-ulcer disease.
LEFT UPPER QUADRANT – This chapter covers key differentials in the left upper quadrant such as chest trauma (rib fractures), splenic injuries and ischaemic colitis.
LUMBAR REGION/BACK – This chapter covers key differentials in patients that present with loin/back pain. Most importantly, AAA and urological emergencies.
CENTRAL ABDOMEN – This chapter covers key differentials in the central abdomen or umbilical region such as small bowel obstruction, mesenteric ischemia (acute and chronic) and ventral hernias.
RIGHT ILIAC FOSSA – This chapter covers key differentials in the RIF such as appendicitis, Gynaecological emergencies (Ovarian torsion and ectopic pregnancy), groin hernias, Inflammatory bowel disease and urological emergencies.
LEFT ILIAC FOSSA – This chapter covers key differentials in the left iliac fossa such as different types of colitis including diverticulitis, groin hernias, urological and gynaecological emergencies.
SUPRAPUBIC REGION – This chapter covers key differentials in the suprapubic region such as Diverticlutis (The sigmoid can be very floppy), Bladder outflow obstruction and urological emergencies such as prostatitis.
GASTROINTESTINAL BLEEDING – This chapter covers G.I. Bleeding. Lower GI Bleeding is covered in more detail.
ABSCESSES – This chapter is your go-to-guide for when you review an abscess. Everything you need to know about the types of abscesses seen by General surgeons is in this chapter. Beware the ischiorectal abscess, minimum skin changes but maximum internal damage. These patients are often septic because the ischiorectal space is a massive dead space allowing all that pus to brew internally.
WARD BASED CHAPTERS:
Surgical drains can be challenging to say the least. At your stage, the most important aspect of drain management is understanding how to examine a drain and when to seek senior advice. In this chapter, you will learn just that!
Stomas are openings on the patients abdomen that can be connected to different parts of the digestive tract or urological tract. We will focus on the former. Most important lesson we have learnt over the years is to remind ourselves of the physiology of the GI tract.
Most people are scared of nutrition in the peri-operative period. Granted, it can become complicated but in this chapter, we have summarised the salient features of nutrition in a surgical patient. (Thanks to a comprehensive review from the book on Care of the critically ill surgical patients)
One of the most crucial aspect of any clinical job is to identify an unwell patient and intervene before things go out of hand. There is no fast way to learn this, only with repeated practise.Remember though, when in doubt, ask for help! In this chapter, we have highlighted our thought process for when we review an unwell patient.