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

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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

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NATURAL SYNTHETIC

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1 la la
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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