A. BASIC SURGERY 1. FLUIDS AND ELECTROLYTES a, Normal composition of body fluids b. Fluid and electrolyte imbalance Volume deficit and excess Concentration changes c. Acid base imbalance Respiratory acidosis/alkalosis Metabolic acidosis/alkalosis d. Principles of fluid and electrolyte therapy Parenteral solutions Preoperative fluid therapy Intraoperative and Postoperative fluid therapy SHOCK & RESUSCITATION a. Definition b. Pathophysiology c. Types of shock 4. Treatment SURGICAL NUTRITION a. Nutrition risk assessment Subjective Global Assessment b. Nutritional Intervention Oral feeding Enteral feeding Parenteral feeding ©. Complications related to Nutritional support d. Nutritional immunomodulation ENDOCRINE AND ETABOLIC RESPONSE TO INJURY a. Central nervous system and endocrine changes b. Metabolic changes. Energy, CHO, fat and protein-metabolism. Starvation Metabolic effects of injury Blood coagulation c. Acid-base balance, water and electrolyte metabolism d. Oxygen transport e. Organ system changes WOUND HEALING a. Physiology of wound healing Phases of wound healing Factors affecting healing c. Wound care d. Wound closure 20BLEEDING AND BLOOD TRANSFUSION a. Biology of normal hemostasis b. Blood coagulation Intrinsic pathway Extrinsic pathway Fibrinolytic system Clinical tests for hemostasis Clinical defects in hemostasis -manifestations and treatment e. Blood transfusion Replacement/Component therapy Indications Complications f° BURNS a. Classification according to extent & depth b. Systemic changes c. Therapy Airway Fluid resuscitation, Rule of Nines, Brooke's and Parkland formulae Burn wound care, skin grafting Complications SURGICAL ONCOLOGY a, Molecular Biology and Oncogenesis b, Pathology ©. Clinical Manifestations of Cancer d. Diagnosis and Staging e. — Multidisciplinary management options Surgery Radiotherapy Chemotherapy Immunotherapy Targeted therapy Hormonal therapy Prognosis g. Long-term care and follow-up TRAUMA a. Epidemiology, Patterns of injury and Prevention b. Basic Life Support and Triage ¢. Principles of Management Primary Survey Resuscitation Secondary Survey Definitive Management 24BLEEDING AND BLOOD TRANSFUSION a. Biology of normal hemostasis b. Blood coagulation Intrinsic pathway Extrinsic pathway Fibrinolytic system Clinical tests for hemostasis Clinical defects in hemostasis -manifestations and treatment e. Blood transfusion Replacement/Component therapy Indications Complications f° BURNS a. Classification according to extent & depth b. Systemic changes c. Therapy Airway Fluid resuscitation, Rule of Nines, Brooke's and Parkland formulae Burn wound care, skin grafting Complications SURGICAL ONCOLOGY a, Molecular Biology and Oncogenesis b, Pathology ©. Clinical Manifestations of Cancer d. Diagnosis and Staging e. Multidisciplinary management options Surgery Radiotherapy Chemotherapy Immunotherapy Targeted therapy Hormonal therapy Prognosis g. Long-term care and follow-up TRAUMA a. Epidemiology, Patterns of injury and Prevention b. Basic Life Support and Triage ¢. Principles of Management Primary Survey Resuscitation Secondary Survey Definitive Management 2410. 1. 12. d. Management of Specific Injuries Head Neck Chest Abdomen Extremities Others ‘Approach to the multiply injured patient Care of the critically ill trauma patient Rehabilitation Mass casualty and disaster management CRITICAL CARE a. Physiologic Monitoring b. Specific Conditions SIRS Sepsis MODs MOF ARDS DIC c. Vascular Access Peripheral Central d. Metabolic Support gare SURGICAL INFECTION a. Sepsis, Asepsis and Antisepsis b. General Principles of Diagnosis, Antibiotic and Surgical Therapy ©, Antibacterial / Antifungal /Anti-Viral Drugs: Classification, Principles, Therapy d. Specific infections Streptococcal Staphylococcal Gram negative infections Anaerobic infection Fungal infections AIDS Viral Hepatitis @. Surgical Aspects of Treatment PRINCIPLES OF IMMUNOLOGY AND TRANSPLANTATION a, Immunosuppression b. Clinical Tissue and Organ Transplantation ¢. Organ Preservation 2213. 14. 15. 16. SURGICAL COMPLICATIONS, a. Recognition b. Diagnosis c. Management MINIMALLY INVASIVE SURGERY a, Principles of MIS. Physiologic response to Pneumoperitoneum b, Equipment c. Energy sources Electrosurgical safety d. Operating room set-up ©. Ergonomics and Instrumentation Basic Skills, Looping Clipping Ligation in-continuity Endo-dissection Extra/Intra-corporeal tying Endo-suturing 9. Basic Laparoscopic procedures Diagnostic Laparoscopy Laparoscopic Cholecystectomy Laparoscopic Appendectomy PERIOPERATIVE CARE a. Patient preparation b. _ Co-morbidities and risk assessment c. Pain control PATIENT SAFETY AND PROFESSIONALISM B. CLINICAL SURGERY-GENERAL SURGERY i HEAD AND NECK Anatomy and Physiology Clinical Presentation Diagnostics ‘Specific Condition Congenital Masses Thyrogiossal cysts Teratomas Branchial clefts Vascular tumors Hygromas aoge 23Noncongenital lesions Papillomas Polyps Dermoid tumors Rhabdomyomas and Neurofibromas Chemodectomas Malignaney General Principles epidemiology, risk factors, clinical work-up, therapeutic considerations Neck cancer ~ triangles of the neck - staging ~ TNM - surgical treatment- radical neck dissection Nasal Cavity and Paranasal sinuses Nasopharynx Oropharynx Salivary Glands Treatment Follow up THE THYROID AND PARATHYROID GLANDS ae ge ‘Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Hyperthyroidism/nypothyroidism Thyroid neoplasms Papillary Follicular Medullary Anaplastic cancers Hyperparathyroidism / hypoparathyroidism Parathyroid neoplasms Treatment Follow up THE BREAST pers Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Benign Cystic changes Breast infections Fibroadenoma Ductal papilloma 24Gynecomastia Galactocoele Malignant Ductal carcinoma In situ Invasive Lobular carcinoma In situ Invasive Special types of carcinoma Sarcoma Phyllodes Tumor Congenital ©. Treatment f. Follow up Skin and Soft Tissue Tumors a. Anatomy and Physiology b. Clinical Presentation c. Diagnostics d. Specific Conditions Benign Malignant e. Treatment f Follow up ABDOMINAL WALL DEFECTS AND HERNIAS Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Umbilical Indirect inguinal Direct inguinal Femoral Sliding Ventrat Incisional Others 2. Treatment Open Tissue Repair Open Mesh Repair Laparoscopic Approach TAPP TEP eecDp 25fe Follow up THE ESOPHAGUS aoe 2 f Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Motility disturbances Diverticulae Esophageal Strictures (Benign) Esophageal Perforation Esophageal varices Malignant Tumors ‘Adenocarcinoma Squamous Cell Others Treatment Follow up THE STOMACH AND DUODENUM poop Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Peptic Ulcer Disease and its Complications Gastric varices Gastric Malignancies Morbid Obesity Treatment Follow up THE SMALL-INTESTINE, COLON, RECTUM AND ANUS ao7D Anatomy and Physiology Clinical Presentation Diagnostics Specific conditions Polyps Intestinal Obstruction Intestinal Tuberculosis Amoebic Colitis Typhoid Enteritis Diverticular Disease Crohn's disease & ulcerative colitis, Volvulus 2610, e. i Rectal Prolapse Intussusception Malignant conditions of the small intestines Surgical lesions of the appendix - appendicitis, ete. Short Bowel Syndrome Colonic malignancies Rectal Malignancies Hemorrhoids, Abscesses and Fistula-in-ano Anal Carcinoma Condyloma Acuminata Trauma Others Treatment Follow up THE LIVER, GALLBLADDER AND BILIARY TREE pose e. if Anatomy and physiology Clinical Presentation Diagnostics Specific Conditions Liver abscesses Liver Cysts Benign hepatic tumors Primary and metastatic cancer of the liver Portal Hypertension Gallstones Acute and chronic cholecystitis, Cholangitis Cholangiocarcinomas Choledochal cysts Trauma Others Treatment Follow up THE PANCREAS & SPLEEN aese Anatomy and Physiology Clinical Presentation Diagnostics Specific Conditions Pancreatitis, Cysts & Pseudocysts Pancreatic tumors Hypersplenism Trauma ar1. e. f, Treatment Follow up ACUTE SURGICAL ABDOMEN eaogn Definition Clinical manifestations Conditions which may mimic or give rise to acute surgical abdomen Approach to patients with suspected acute surgical abdomen Principles of surgical management . CLINICAL SURGERY ~ SUBSPECIALTY SURGERY Objective: At the end of the specialty rotations, the resident should be able to recognize and institute initial management for common and life or limb-threatening specialty problems. 1 3. PEDIATRIC SURGERY a. Perioperative Care b. Common Pediatric Surgical Conditions Acute Abdomen — Appendicitis, Gl bleeding, Obstruction in older children Inguino-Scrotal Problems Neonatal Surgical Emergencies ~ Imperforate Anus, Intestinal obstruction, abdominal wall defects, TEF, Diaphragmatic hernia ©. Congenital Masses - Thyrogiossal cysts, Teratomas, Branchial clefts, vascular tumors, Hygromas PLASTIC SURGERY a. Technical considerations in skin grafts & flaps b. Management of maxillofacial trauma . Congenital anomalies Cleft lip and palate d. Cosmetic surgery ~ Principles Scar revision Rhinoplasty Blepharoplasty Mammoplasty UROLOGY a, Anatomy and Physiology of GUT b. Diagnosis c. Disease Conditions and Treatment Urinary calculi 28‘Tumors ~ Renal, Bladder, Prostatic, Testicular Urologic Trauma Other Urologic Emergencies ~ Anuria due to obstructive uropathy, bilateral, ouilet obstruction including neurogenic bladder ~ Acute scrotum (testicular torsion) ORTHOPEDICS a. Orthopedic Trauma Fractures ‘Common long bone fractures Hand injuries Orthopedic infection — Septic arthritis, osteomyelit Pott's Disease Bone and Soft tissue neoplasms of the extremities Congenital orthopedic deformities, Scoliosis Diagnostic: FNAB, Superficial joint aspiration (elbow and knee) Technical considerations: casting, splinting, traction techniques THORACIC AND CARDIOVASCULAR SURGERY a b. ‘Anatomy and Physiology of the Heart & Lungs Common Surgical Conditions Trauma Peripheral Vas: Diaphragmatic Neoplasms. Lung ~ primary and metastatic Metastatic Mediastinal tumors Infections Empyema thoracis ‘Common Vascular conditions Peripheral vascular occlusive disease Varicose veins ‘Abdominal aortic aneurysm Common Cardiac Conditions Pericardial effusion NEUROSURGERY Anatomy and Physiology of the CNS Common surgical conditi Recognition and initial management of increased ICP- trauma, space-occupying lesions 29‘Trauma — low velocity gun shot wounds ¢. Indications for use and interpretation of diagnostic tests- skull x-ray, CT, angiogram D. PRINCIPLES OF SURGICAL DIAGNOSTICS: 4: see Laboratory work ups Blood Chemistry Immunohistochemistry Tumor Markers Others Imaging Studies X-ray Ultrasound CT scan MRI PET scan Nuclear Scintigraphy Endoscopy Laparoscopy Biopsy