Unit 1.

Gastrointestinal Tract

1. Esophagus Part - 1

● Anatomy: Structure of the esophagus, histology, and physiological functions such as

peristalsis.
● Pathology Overview: Common conditions like GERD (Gastroesophageal Reflux
Disease) and esophagitis.
● Diagnostic Tools: Barium swallow, endoscopy, and manometry basics.

2. Esophagus Part - 2

● Benign Lesions: Esophageal webs, rings, and strictures.

● Malignancies: Types, including squamous cell carcinoma and adenocarcinoma.
● Management: Surgical and non-surgical treatments for esophageal diseases.

3. Stomach Part - 1

● Anatomy & Physiology: Gastric regions, histological layers, and gastric secretions.
● Diseases: Overview of gastritis (acute and chronic), peptic ulcer disease.

4. Stomach Part - 2

● Gastric Neoplasms: Benign and malignant tumors (e.g., adenocarcinoma, GISTs).

● Investigations: Endoscopy, biopsy, and imaging techniques for gastric conditions.
● Management: Medications like proton pump inhibitors, surgical interventions.

5. Small Bowel

● Anatomy & Function: Role in digestion and nutrient absorption.

● Disorders: Includes celiac disease, Crohn’s disease, and infections.
● Diagnostics & Treatment: Endoscopy (capsule endoscopy), imaging, dietary
modifications.

6. Appendix & Intestinal Diverticuli

● Appendix: Appendicitis—clinical presentation, complications (perforation, abscess).

● Diverticuli: Diverticulosis and diverticulitis—pathophysiology, clinical features,
treatment strategies.

7. Colon

● Diseases: Includes inflammatory bowel diseases (Ulcerative colitis), infectious colitis.

● Neoplasms: Polyps and colorectal cancer.
● Screening: Colonoscopy and other methods for early detection.

8. Intestinal Obstruction

● Types: Mechanical (e.g., volvulus, hernia) and functional (e.g., paralytic ileus).
 ● Symptoms: Abdominal pain, vomiting, distension.
● Management: Surgical and non-surgical interventions.

9. Rectum

● Common Conditions: Rectal prolapse, anorectal abscess, and fistula.

● Malignancies: Rectal cancer—diagnosis and treatment.

10. Anal Canal

● Diseases: Hemorrhoids, fissures, anal fistulae.

● Diagnosis: Physical examination, anoscopy.
● Treatment: Conservative methods, surgical interventions like hemorrhoidectomy.

11. Hernia and Peritoneum

● Hernias: Types (inguinal, femoral, umbilical, incisional). Clinical features and

management.
● Peritoneal Disorders: Peritonitis—causes, presentations, treatment. Ascites and its
management.

Unit 2. Hepato-Pancreatico-Biliary

12. Liver

● Anatomy: Structure and blood supply (dual supply from hepatic artery and portal
vein).
● Functions: Metabolism, detoxification, synthesis of proteins (albumin, clotting
factors).
● Diseases:
○ Hepatitis: Viral (A, B, C, etc.), autoimmune, and toxic.
○ Cirrhosis: Causes, complications (portal hypertension, ascites).
○ Hepatocellular carcinoma: Risk factors (HBV, HCV), diagnosis, and
treatment.
● Investigations: Liver function tests (LFTs), imaging (ultrasound, CT), biopsy.

13. Gall Bladder

● Anatomy & Function: Bile storage and concentration.

● Diseases:
○ Cholelithiasis (gallstones): Types (cholesterol, pigment), risk factors, clinical
presentation.
○ Cholecystitis: Acute and chronic inflammation of the gallbladder.
○ Gallbladder carcinoma: Rare, aggressive tumor.
● Management: Laparoscopic cholecystectomy, ERCP for biliary obstruction.

14. Biliary Tree

 ● Anatomy: Intrahepatic and extrahepatic bile ducts, sphincter of Oddi.
● Diseases:
○ Biliary Atresia: Congenital obstruction.
○ Cholangiocarcinoma: Rare cancer of the bile ducts.
○ Choledocholithiasis: Stones in the bile ducts.
○ Primary Sclerosing Cholangitis: Chronic inflammatory condition.
● Diagnostics: MRCP, ERCP, liver biopsy.

15. Pancreas Part - 1

● Anatomy & Physiology: Endocrine (insulin, glucagon) and exocrine (enzymes like
amylase, lipase) functions.
● Acute Pancreatitis:
○ Causes: Gallstones, alcohol, hypertriglyceridemia.
○ Clinical features: Severe epigastric pain, nausea, vomiting.
○ Investigations: Serum amylase/lipase, imaging (CT scan).
○ Treatment: Supportive care (IV fluids, pain control).

16. Pancreas Part - 2

● Chronic Pancreatitis:
○ Causes: Alcohol, genetic mutations, autoimmune.
○ Features: Chronic pain, malabsorption, diabetes.
○ Treatment: Enzyme replacement, surgery in advanced cases.
● Pancreatic Cancer:
○ Types: Most common is adenocarcinoma.
○ Presentation: Painless jaundice, weight loss.
○ Diagnostics: CA 19-9 marker, imaging (CT, MRI).
○ Treatment: Surgery (Whipple procedure), chemotherapy.

17. Spleen and Portal Hypertension

● Spleen:
○ Anatomy & Functions: Hematopoiesis, filtration of blood, immune function.
○ Disorders: Splenomegaly, hypersplenism.
● Portal Hypertension:
○ Causes: Cirrhosis, portal vein thrombosis.
○ Complications: Esophageal varices, splenomegaly, ascites.
○ Management: Beta-blockers, endoscopic band ligation, TIPS (Transjugular
Intrahepatic Portosystemic Shunt).

Unit 3. Trauma

18. General Principles of Trauma

● Definition: Physical injury or wound caused by external force.

● Initial Assessment (ATLS Protocol):
 ○ Primary Survey (ABCDE): Airway, Breathing, Circulation, Disability
(neurological status), Exposure.
○ Resuscitation: Fluid replacement (crystalloids, blood transfusion),
stabilization of vital functions.
● Trauma Classification:
○ Blunt vs. Penetrating trauma.
○ Polytrauma: Multiple injuries involving various systems.
● Management Principles:
○ Stabilization: Prevent further injury (spinal immobilization, hemostasis).
○ Definitive Care: Surgery, fracture management, wound care.
● Complications: Shock, sepsis, multiple organ dysfunction syndrome (MODS).

19. Head Injury and Neck Injury

● Head Injury:
○ Types: Concussion, contusion, intracranial hematomas (epidural, subdural,
intracerebral).
○ Glasgow Coma Scale (GCS): Assessment of consciousness.
○ Imaging: CT scan preferred for detecting hemorrhages, fractures.
○ Management:
■ Mild: Observation.
■ Severe: Decompression surgery, intracranial pressure (ICP)
monitoring.
● Neck Injury:
○ Types: Blunt (whiplash, cervical fractures), penetrating (vascular/airway
damage).
○ Zones of the Neck:
■ Zone I: Thoracic outlet to cricoid cartilage.
■ Zone II: Cricoid to angle of mandible.
■ Zone III: Angle of mandible to skull base.
○ Management: Airway control, vascular repair, imaging (CT angiography).

20. Chest Trauma

● Types:
○ Blunt: Rib fractures, flail chest, pulmonary contusions.
○ Penetrating: Gunshot wounds, stab injuries.
● Life-Threatening Injuries:
○ Tension pneumothorax: Air in pleural space under pressure; treated with
needle decompression.
○ Hemothorax: Blood in pleural cavity; managed by chest tube placement.
○ Cardiac tamponade: Blood in pericardium; treated by pericardiocentesis.
● Investigations: Chest X-ray, CT scan, focused assessment with sonography for
trauma (FAST).
● Management:
○ Airway control: Intubation if necessary.
○ Chest tube insertion: For pneumothorax/hemothorax.
○ Thoracotomy: Emergency surgery for uncontrolled hemorrhage.
21. Abdomen Injury and Retroperitoneum

● Abdominal Trauma:
○ Blunt Trauma: Commonly involves liver, spleen, intestines.
○ Penetrating Trauma: Gunshot wounds, stab injuries.
○ Signs: Abdominal tenderness, rigidity, shock.
○ Investigations:
■ FAST: Detects free fluid in the abdomen.
■ CT scan: Identifies organ injury.
○ Management:
■ Non-operative: Stable patients with minimal organ damage.
■ Surgical: Laparotomy for bleeding, organ rupture.
● Retroperitoneal Injuries:
○ Organs Involved: Kidneys, pancreas, aorta, adrenal glands.
○ Signs: Flank pain, hematoma.
○ Imaging: CT scan for detailed assessment.
○ Management: Depends on the organ and severity (renal repair, vascular
control).

Unit 4. Urology

22. Kidney and Ureter Part - 1

● Anatomy and Physiology:

○ Kidneys: Bean-shaped organs responsible for filtration, electrolyte balance,
and erythropoietin production.
○ Ureters: Muscular tubes conducting urine to the bladder.
● Congenital Anomalies:
○ Horseshoe kidney, renal agenesis, duplex ureter.
● Infections:
○ Pyelonephritis: Inflammation due to bacterial infection.
○ Clinical features: Fever, flank pain, dysuria.
● Obstructions:
○ Causes: Stones, strictures, tumors.
○ Investigations: Ultrasound, intravenous pyelography (IVP).
○ Management: Ureteroscopy, lithotripsy, or surgery.

23. Kidney and Ureter Part - 2

● Renal Stones:
○ Types: Calcium oxalate, uric acid, struvite.
○ Symptoms: Severe flank pain, hematuria.
○ Diagnosis: CT-KUB (Kidney-Ureter-Bladder).
○ Treatment: Medical (hydration, alkalinization), surgical (PCNL, lithotripsy).
● Renal Tumors:
○ Types: Renal cell carcinoma (most common), Wilms tumor (pediatric).
○ Symptoms: Hematuria, mass, pain.
 ○ Management: Nephrectomy, targeted therapy.
● Trauma:
○ Causes: Blunt/penetrating injuries.
○ Management: Conservative for minor injuries, surgical intervention for severe
damage.

24. Urinary Bladder

● Infections:
○ Cystitis: Commonly caused by E. coli.
○ Symptoms: Dysuria, urgency, frequency.
○ Treatment: Antibiotics, hydration.
● Bladder Stones:
○ Symptoms: Dysuria, hematuria, suprapubic pain.
○ Treatment: Cystolitholapaxy or surgery.
● Bladder Tumors:
○ Most common: Transitional cell carcinoma.
○ Risk factors: Smoking, chemical exposure.
○ Management: TURBT (Transurethral Resection of Bladder Tumor),
intravesical therapy.

25. Urethra, Penis and Scrotum

● Urethra:
○ Strictures: Narrowing due to trauma, infection.
○ Investigations: Retrograde urethrogram.
○ Management: Urethral dilation, urethroplasty.
● Penis:
○ Conditions: Phimosis, paraphimosis, Peyronie's disease.
○ Tumors: Squamous cell carcinoma.
● Scrotum:
○ Hydrocele: Fluid accumulation around the testes.
○ Varicocele: Dilated veins in the pampiniform plexus.
○ Management: Surgical repair (hydrocelectomy, varicocelectomy).

26. Prostate

● Benign Prostatic Hyperplasia (BPH):

○ Symptoms: Weak stream, nocturia, incomplete emptying.
○ Diagnosis: Digital rectal exam (DRE), PSA (Prostate-Specific Antigen).
○ Management: Alpha-blockers, TURP (Transurethral Resection of Prostate).
● Prostate Cancer:
○ Risk factors: Age, genetics.
○ Diagnosis: Elevated PSA, biopsy.
○ Treatment: Surgery, radiation, hormonal therapy.

27. Testes

● Cryptorchidism:
 ○ Undescended testes, associated with infertility and cancer risk.
○ Treatment: Orchidopexy.
● Testicular Torsion:
○ Sudden, severe pain; requires emergency surgery.
● Tumors:
○ Types: Germ cell tumors (seminoma, non-seminoma).
○ Symptoms: Painless mass, swelling.
○ Diagnosis: Ultrasound, tumor markers (AFP, hCG, LDH).
○ Management: Orchiectomy, chemotherapy, radiotherapy.

Unit 5. Plastic Surgery

28. Burns

● Classification:
○ Based on depth:
■ Superficial (1st degree): Epidermis only, red, painful, no blisters.
■ Partial-thickness (2nd degree): Extends into dermis, blisters, very
painful.
■ Full-thickness (3rd degree): Entire dermis destroyed, leathery
appearance, no pain due to nerve damage.
■ Fourth degree: Involves underlying muscles, bones.
○ Based on extent: Calculated using the "Rule of Nines."
● Pathophysiology:
○ Burn shock: Massive fluid loss due to increased capillary permeability.
○ Hypermetabolic state: Increased energy demand and protein catabolism.
● Management:
○ Immediate Care:
■ Stop burning process, cool burns with tepid water (not ice).
■ Ensure airway, breathing, circulation (ABC).
■ Cover wounds with clean cloth.
○ Fluid Resuscitation:
■ Parkland formula: 4 mL × weight (kg) × % burn area; half given in first
8 hours.
○ Wound Care:
■ Debridement of necrotic tissue, antimicrobial dressings.
■ Grafting for deep burns.
○ Complications:
■ Infection, sepsis, contractures, hypertrophic scars.
● Rehabilitation:
○ Physical therapy to prevent contractures, psychological support.

29. Plastic Surgery and Skin Tumors

● Plastic Surgery:
○ Reconstructive Surgery:
 ■ For trauma, burns, congenital anomalies (e.g., cleft lip/palate).
■ Techniques: Skin grafts, flaps, tissue expansion.
○ Cosmetic Surgery:
■ Aimed at improving aesthetics (e.g., rhinoplasty, liposuction).
○ Microsurgery:
■ Free tissue transfer, nerve repair, replantation of severed parts.
● Skin Tumors:
○ Benign Tumors:
■ Seborrheic keratosis, epidermoid cysts, lipomas.
○ Premalignant Lesions:
■ Actinic keratosis: Scaly patches due to sun exposure, risk of
squamous cell carcinoma.
○ Malignant Tumors:
■ Basal Cell Carcinoma (BCC): Most common, slow-growing, rarely
metastasizes.
■ Features: Pearly nodule, telangiectasia.
■ Squamous Cell Carcinoma (SCC): Arises from keratinocytes, higher
metastasis risk.
■ Features: Ulcerated lesion, sun-exposed areas.
■ Melanoma: Arises from melanocytes, aggressive.
■ Features: ABCDE criteria (Asymmetry, Border irregularity,
Color variation, Diameter >6 mm, Evolving).
○ Management:
■ BCC and SCC: Surgical excision, Mohs surgery for cosmetically
sensitive areas.
■ Melanoma: Wide excision, sentinel lymph node biopsy,
immunotherapy for advanced cases.

Unit 6. Pediatric Surgery

30. Principles and Common Pediatrics

● Principles of Pediatric Surgery:

○ Anatomical and Physiological Considerations:
■ Smaller anatomy and organ size require precise surgical techniques.
■ Immature physiological systems (e.g., thermoregulation, renal
function) demand specialized perioperative care.
○ Preoperative Evaluation:
■ Emphasis on birth history, developmental milestones, and specific
symptoms.
■ Address comorbid conditions like congenital heart disease.
○ Anesthesia in Children:
■ Pediatric-specific dosages and techniques.
■ Greater risk of airway compromise; use specialized equipment.
○ Postoperative Care:
■ Monitor for complications like hypothermia, apnea, or infections.
 ■ Nutritional support for growth and healing.
● Common Pediatric Surgical Conditions:
○ Congenital Anomalies:
■ Esophageal Atresia and Tracheoesophageal Fistula:
■ Symptoms: Drooling, choking, cyanosis during feeding.
■ Treatment: Surgical repair (primary anastomosis or staged
procedures).
■ Congenital Diaphragmatic Hernia (CDH):
■ Features: Respiratory distress due to herniated abdominal
organs.
■ Management: Stabilization, followed by surgical correction.
■ Hypertrophic Pyloric Stenosis:
■ Symptoms: Projectile vomiting, palpable "olive-shaped" mass.
■ Treatment: Pyloromyotomy.
■ Anorectal Malformations:
■ Range from imperforate anus to complex fistulas.
■ Treatment: Staged surgical reconstruction.
■ Congenital Hernias:
■ Umbilical hernia: Often resolves spontaneously; surgical repair
if large or symptomatic.
■ Inguinal hernia: Requires surgical repair to prevent
incarceration.
○ Neonatal Emergencies:
■ Necrotizing Enterocolitis (NEC):
■ Features: Abdominal distension, feeding intolerance, bloody
stools.
■ Management: Supportive care, surgical intervention for
perforation.
■ Intestinal Malrotation and Volvulus:
■ Symptoms: Bilious vomiting, abdominal distension.
■ Treatment: Ladd’s procedure.
○ Pediatric Tumors:
■ Wilms' Tumor:
■ Common renal tumor in children; presents with abdominal
mass.
■ Treatment: Nephrectomy with chemotherapy.
■ Neuroblastoma:
■ Features: Abdominal mass, catecholamine-related symptoms.
■ Management: Multimodal (surgery, chemotherapy, radiation).
○ Trauma in Pediatrics:
■ Special considerations due to pliable bones and unique injury
patterns.
■ Emphasis on non-operative management where possible.
○ Other Conditions:
■ Appendicitis: Similar presentation as in adults but with variable
symptoms.
■ Intussusception: "Currant jelly" stools; treated with air enema or
surgery.
Unit 7. Vascular Surgery and Lymphatics

31. Arterial Disorders

● Atherosclerosis:
○ Pathophysiology: Accumulation of lipid plaques in arterial walls leading to
stenosis and ischemia.
○ Clinical Features: Claudication, ischemic ulcers, and gangrene.
○ Treatment:
■ Medical: Antiplatelets (aspirin), statins, and control of risk factors
(diabetes, hypertension).
■ Surgical: Angioplasty, stenting, or bypass surgery.
● Peripheral Arterial Disease (PAD):
○ Symptoms: Intermittent claudication, rest pain, reduced distal pulses.
○ Diagnosis: Ankle-brachial index (ABI), duplex ultrasonography, angiography.
○ Management: Lifestyle modification, revascularization for critical limb
ischemia.
● Acute Arterial Occlusion:
○ Causes: Embolism, thrombosis, trauma.
○ Signs: The 6 Ps – Pain, Pallor, Pulselessness, Paralysis, Paresthesia,
Poikilothermia.
○ Treatment: Emergency thrombolysis, embolectomy, or bypass.
● Aneurysms:
○ Abdominal Aortic Aneurysm (AAA):
■ Symptoms: Often asymptomatic; possible pulsatile abdominal mass or
rupture causing severe pain and hypotension.
■ Diagnosis: Ultrasound or CT angiography.
■ Treatment: Surgical repair or endovascular aneurysm repair (EVAR)
if >5.5 cm or symptomatic.
○ Peripheral Aneurysms: Common in popliteal arteries; risk of thrombosis or
embolism.
● Raynaud's Disease and Phenomenon:
○ Episodic vasospasm of the digits triggered by cold or stress.
○ Management: Avoid triggers, calcium channel blockers (e.g., nifedipine).
● Buerger's Disease (Thromboangiitis Obliterans):
○ Non-atherosclerotic inflammatory disease, associated with tobacco use.
○ Features: Digital ischemia, claudication, ulcers.
○ Treatment: Smoking cessation, vasodilators, or surgical sympathectomy.

32. Venous and Lymphatic Disorders

● Venous Disorders:
○ Varicose Veins:
■ Pathophysiology: Incompetent valves in superficial veins.
■ Symptoms: Dilated, tortuous veins; heaviness or aching in legs.
■ Treatment: Compression stockings, sclerotherapy, or vein stripping.
○ Deep Vein Thrombosis (DVT):
■ Symptoms: Swelling, pain, redness, Homan's sign.
 ■ Diagnosis: Duplex ultrasonography, D-dimer.
■ Treatment: Anticoagulation (heparin, warfarin, or DOACs),
thrombolysis for severe cases.
○ Chronic Venous Insufficiency (CVI):
■ Features: Edema, skin changes (stasis dermatitis,
lipodermatosclerosis), venous ulcers.
■ Management: Compression therapy, wound care, surgical correction
of venous insufficiency.
● Lymphatic Disorders:
○ Lymphedema:
■ Causes: Primary (congenital) or secondary (filariasis, cancer surgery,
radiation).
■ Features: Non-pitting edema, skin thickening, recurrent infections.
■ Management: Compression therapy, manual lymphatic drainage,
surgical options (lymphatic bypass, liposuction).
○ Lymphangitis:
■ Acute bacterial infection of lymphatic vessels, often due to
Streptococcus pyogenes.
■ Symptoms: Red streaks, fever, swollen lymph nodes.
■ Treatment: Antibiotics and supportive care.

Unit 8. General Surgery

33. Wounds, Ulcers, and Gangrene

● Wounds:
○ Types:
■ Incised wounds: Caused by sharp objects, clean-cut edges.
■ Lacerated wounds: Irregular edges, caused by blunt trauma.
■ Puncture wounds: Caused by sharp, pointed objects.
■ Contused wounds: Caused by blunt force, leading to tissue bruising.
○ Wound Healing:
■ Phases: Inflammatory, proliferative, and maturation phases.
■ Factors affecting healing: Infection, oxygenation, nutrition, age, and
comorbidities (e.g., diabetes).
■ Wound closure: Primary intention (direct closure), secondary intention
(granulation), tertiary intention (delayed closure).
● Ulcers:
○ Pressure ulcers (Bedsores):
■ Stages: From reddening (stage 1) to full-thickness tissue loss (stage
4).
■ Treatment: Offloading pressure, wound care, debridement, and
surgical repair for advanced cases.
○ Diabetic ulcers:
■ Common on feet due to neuropathy and poor circulation.
 ■ Treatment: Glycemic control, wound care, debridement, and offloading
pressure.
● Gangrene:
○ Dry Gangrene: Results from ischemia; tissue becomes dry, shriveled, and
black.
○ Wet Gangrene: Bacterial infection complicating ischemia; tissue becomes
swollen, moist, and foul-smelling.
○ Gas Gangrene: Caused by Clostridium perfringens, producing gas and
toxins, leading to rapid tissue destruction.
■ Treatment: Surgical debridement, antibiotics, and hyperbaric oxygen
therapy for gas gangrene.

34. Principles of Suturing, Laparoscopy

● Suturing:
○ Types of sutures: Absorbable (e.g., vicryl) and non-absorbable (e.g., silk,
nylon).
○ Suture techniques:
■ Simple interrupted suture: Common, individual knots for each stitch.
■ Continuous suture: Continuous stitch with a running suture, used for
longer wounds.
■ Subcuticular suture: Placed just below the skin surface, often for
cosmetic results.
■ Vertical and Horizontal mattress sutures: Used to close tensioned
wounds.
○ Needle selection: Round-bodied needles for soft tissue, cutting needles for
tough tissue (e.g., skin).
● Laparoscopy:
○ Minimally invasive surgery using small incisions and a camera (laparoscope).
○ Advantages: Smaller incisions, quicker recovery, reduced post-operative
pain, lower risk of infection.
○ Common procedures: Laparoscopic cholecystectomy, appendectomy,
hernia repair, and bariatric surgery.
○ Steps in laparoscopy:
■ Creation of pneumoperitoneum (carbon dioxide insufflation).
■ Insertion of laparoscope and instruments.
■ Visual inspection and intervention (e.g., removal of gallbladder).

35. Oral Cavity

● Anatomy of the Oral Cavity:

○ Teeth: Important for mastication, classified into incisors, canines, premolars,
and molars.
○ Tongue: Involved in taste, speech, and swallowing; has taste buds located on
papillae.
○ Salivary Glands: Parotid, submandibular, and sublingual glands produce
saliva for digestion and oral health.
● Common Pathologies:
 ○ Oral Cancer: Can affect lips, tongue, floor of the mouth; often related to
tobacco or alcohol use.
■ Symptoms: Non-healing ulcers, pain, difficulty swallowing.
■ Treatment: Surgery, radiation, and chemotherapy.
○ Dental Abscesses: Localized collection of pus due to bacterial infection.
■ Treatment: Drainage, antibiotics, and root canal therapy.
○ Temporomandibular Joint (TMJ) Disorders: Pain and dysfunction in jaw
joint.
■ Treatment: Pain management, physical therapy, or surgery in severe
cases.

36. Salivary Glands and Neck

● Salivary Glands:
○ Sialography: Imaging study for salivary gland duct obstruction.
○ Sialolithiasis: Formation of stones within the salivary glands, causing
swelling and pain.
○ Salivary Gland Tumors:
■ Benign tumors: Pleomorphic adenoma, Warthin's tumor.
■ Malignant tumors: Mucoepidermoid carcinoma, adenoid cystic
carcinoma.
■ Treatment: Surgical excision.
● Neck Pathologies:
○ Cervical Lymphadenopathy: Enlarged lymph nodes, often indicating
infection (e.g., tuberculosis, viral infections) or malignancy (e.g., lymphoma).
○ Thyroid Disorders: Goiter, hyperthyroidism, or thyroid cancer.
■ Treatment: Thyroidectomy, radioactive iodine therapy.
○ Carotid Artery Disease: Atherosclerosis of the carotid arteries leading to
stroke risk.
■ Treatment: Carotid endarterectomy or stenting.

37. Hemorrhage, Fluids, and Nutrition

● Hemorrhage:
○ Types of Bleeding:
■ Arterial bleeding: Bright red, pulsatile, high pressure.
■ Venous bleeding: Dark red, steady flow, lower pressure.
■ Capillary bleeding: Oozing from small blood vessels.
○ Management: Direct pressure, elevation, hemostatic agents, tourniquets for
severe cases, blood transfusions, and surgical intervention if necessary.
● Fluid Management:
○ Types of Fluids:
■ Crystalloids: Normal saline, Ringer’s lactate (for fluid resuscitation).
■ Colloids: Albumin, dextran (for volume expansion in critical patients).
■ Blood Products: Packed red blood cells, plasma, platelets.
○ Fluid Resuscitation: Based on clinical signs, urine output, and laboratory
markers. The rule of thumb is 3:1 ratio for crystalloids in cases of major fluid
loss (e.g., burns, shock).
 ● Nutritional Support:
○ Enteral Nutrition: Feeding via gastrointestinal tract (e.g., nasogastric tube).
○ Parenteral Nutrition: IV administration of nutrients for patients who cannot
use the GI tract.
○ Indications: Severe malnutrition, bowel obstruction, or post-surgical patients.
○ Complications: Infection (e.g., catheter-related sepsis), electrolyte
imbalances.

Unit 9. Breast and Endocrine

38. Breast Part 1

● Anatomy of the Breast:

○ Composed of glandular tissue, ducts, fatty tissue, and connective tissue.
○ Glandular tissue: Contains lobules that produce milk, connected to the
nipple by ducts.
○ Fatty tissue: Surrounds the glandular tissue, influencing breast size.
○ Nipple: Contains ducts for milk secretion, surrounded by the areola, which
has sebaceous glands.
● Physiology:
○ Menstrual Cycle and Hormonal Influence: Estrogen and progesterone
regulate the development and function of the breast tissue, especially during
puberty, pregnancy, and lactation.
○ Lactation: Milk production initiated by prolactin, with milk release facilitated
by oxytocin during breastfeeding.
● Common Disorders:
○ Fibrocystic Breast Changes: Non-cancerous condition causing lumpiness,
pain, and swelling, often related to hormonal fluctuations.
○ Benign Breast Lumps: Include fibroadenomas (non-cancerous, solid
tumors) and cysts (fluid-filled sacs).
○ Mastitis: Infection of the breast tissue, often occurring in breastfeeding
women, causing swelling, pain, and redness.

39. Breast Part 2

● Breast Cancer:
○ Types:
■ Ductal Carcinoma In Situ (DCIS): Early-stage cancer confined to the
milk ducts.
■ Invasive Ductal Carcinoma (IDC): Most common type of breast
cancer, spreading beyond the ducts.
■ Invasive Lobular Carcinoma (ILC): Begins in the milk-producing
lobules.
■ Triple-Negative Breast Cancer: Lacks estrogen, progesterone, and
HER2 receptors; more aggressive.
 ■ HER2-positive Breast Cancer: Overexpression of the HER2 protein,
more likely to spread.
○ Diagnosis:
■ Mammography: Primary screening tool.
■ Ultrasound: Used for distinguishing between solid masses and cysts.
■ Biopsy: Fine needle aspiration or core needle biopsy to confirm
malignancy.
■ MRI: Used for further evaluation in dense breasts or high-risk patients.
○ Treatment:
■ Surgery: Lumpectomy (removal of tumor) or mastectomy (removal of
the whole breast).
■ Radiation Therapy: Post-surgery to destroy any remaining cancer
cells.
■ Chemotherapy: Used for more aggressive cancers or when
metastasis is suspected.
■ Hormonal Therapy: Tamoxifen or aromatase inhibitors for hormone
receptor-positive cancers.
■ Targeted Therapy: HER2 inhibitors (e.g., trastuzumab) for HER2-
positive cancers.
● Breast Reconstruction: Surgical options available post-mastectomy, including
implants or autologous tissue reconstruction.

40. Thyroid Part 1

● Anatomy of the Thyroid:

○ Located in the anterior neck, shaped like a butterfly, with two lobes connected
by the isthmus.
○ Function: Regulates metabolism, growth, and development through thyroid
hormones (T3 and T4).
● Thyroid Hormones:
○ Thyroxine (T4): Main hormone produced by the thyroid gland.
○ Triiodothyronine (T3): The active form of thyroid hormone, derived from T4.
○ Calcitonin: Produced by parafollicular cells (C cells), involved in calcium
homeostasis.
● Regulation:
○ Hypothalamus secretes TRH (Thyrotropin-releasing hormone), which
stimulates the pituitary gland.
○ Pituitary gland releases TSH (Thyroid Stimulating Hormone) to stimulate
the thyroid gland to produce T3 and T4.
● Thyroid Disorders:
○ Hypothyroidism: Underactive thyroid, leading to fatigue, weight gain, cold
intolerance, constipation, and depression.
■ Common causes: Hashimoto’s thyroiditis, iodine deficiency.
■ Treatment: Levothyroxine (synthetic thyroid hormone).
○ Hyperthyroidism: Overactive thyroid, leading to weight loss, heat
intolerance, tremors, and anxiety.
■ Common causes: Graves’ disease, toxic multinodular goiter.
 ■ Treatment: Antithyroid medications (e.g., methimazole), radioactive
iodine therapy, or thyroidectomy.

41. Thyroid Part 2

● Thyroid Cancer:
○ Types:
■ Papillary Thyroid Cancer: Most common, slow-growing, usually
presents with a painless nodule.
■ Follicular Thyroid Cancer: Often more aggressive than papillary
cancer.
■ Medullary Thyroid Cancer: Arises from C cells that produce
calcitonin, associated with familial syndromes.
■ Anaplastic Thyroid Cancer: Very aggressive, often presents with
rapidly growing neck mass.
○ Diagnosis:
■ Ultrasound: Used to assess the characteristics of thyroid nodules.
■ Fine Needle Aspiration (FNA): Biopsy to assess for malignancy.
■ Thyroid Function Tests: Measure TSH, T3, and T4 levels, but not
diagnostic for cancer.
■ Thyroid Scan: Use of radioactive iodine to assess the function of
thyroid tissue.
○ Treatment:
■ Surgical Removal: Total thyroidectomy for cancer.
■ Radioactive Iodine Therapy: Used post-surgery to ablate residual
thyroid tissue or metastasis.
■ Thyroid Hormone Replacement: Lifelong levothyroxine after
thyroidectomy.

42. Parathyroid, Adrenal, and MEN

● Parathyroid Glands:
○ Function: Secrete parathyroid hormone (PTH), which regulates calcium
and phosphate balance.
○ Hyperparathyroidism:
■ Primary: Overproduction of PTH, often due to adenoma.
■ Secondary: Due to chronic renal failure, leading to low calcium levels.
■ Symptoms: Osteoporosis, kidney stones, fatigue, and depression.
■ Treatment: Surgical removal of adenomas, correction of calcium
levels.
○ Hypoparathyroidism: Low PTH levels, leading to hypocalcemia, muscle
cramps, and tetany.
■ Treatment: Calcium and vitamin D supplementation.
● Adrenal Glands:
○ Located on top of the kidneys, divided into two parts: Adrenal cortex
(produces corticosteroids) and Adrenal medulla (produces catecholamines).
○ Adrenal Disorders:
 ■ Cushing's Syndrome: Overproduction of cortisol, leading to central
obesity, skin thinning, and hypertension.
■ Cause: Pituitary adenoma (Cushing’s disease), adrenal
adenoma, or exogenous corticosteroid use.
■ Treatment: Surgery (tumor removal), medications, and
radiation therapy.
■ Addison's Disease: Underproduction of cortisol and aldosterone,
leading to fatigue, weight loss, and hyperpigmentation.
■ Treatment: Hormone replacement therapy (hydrocortisone,
fludrocortisone).
■ Pheochromocytoma: Tumor of the adrenal medulla, causing excess
catecholamine production (e.g., adrenaline).
■ Symptoms: Hypertension, palpitations, sweating.
■ Treatment: Surgical removal of the tumor.
● Multiple Endocrine Neoplasia (MEN):
○ MEN Type 1: Parathyroid hyperplasia, pancreatic tumors, pituitary
adenomas.
○ MEN Type 2: Medullary thyroid cancer, pheochromocytomas,
hyperparathyroidism.
○ MEN Type 3: Also known as MEN 2B, features medullary thyroid carcinoma,
pheochromocytomas, and mucosal neuromas.
○ Management often involves early detection and surgical removal of tumors,
with genetic counseling for affected families.

Unit 10. Miscellaneous

43. Neurosurgery and Cardiothoracic Surgery

● Neurosurgery:
○ Brain Tumors: Surgical removal of tumors like gliomas, meningiomas, and
metastases. Craniotomy is a common procedure.
○ Spinal Disorders: Decompression surgery for conditions like spinal stenosis
or herniated discs.
○ Trauma: Management of traumatic brain injuries (TBI) and spinal cord
injuries, often requiring immediate surgery to alleviate pressure or stabilize
fractures.
○ Hydrocephalus: Treatment through shunting to divert excess cerebrospinal
fluid and prevent brain damage.
○ Neurovascular Surgery: Includes procedures for aneurysms, arteriovenous
malformations (AVMs), and carotid artery stenosis, typically requiring
microsurgery or endovascular techniques.
● Cardiothoracic Surgery:
○ Coronary Artery Bypass Grafting (CABG): Surgery to bypass blocked
coronary arteries, improving blood flow to the heart muscle.
 ○ Valve Repair/Replacement: Surgical intervention for heart valve disease,
such as aortic or mitral valve replacement, using mechanical or bioprosthetic
valves.
○ Lung Surgery: Includes procedures like lobectomy for lung cancer, or
surgery for pulmonary conditions like emphysema or tuberculosis.
○ Congenital Heart Surgery: Corrects congenital heart defects such as atrial
or ventricular septal defects.
○ Thoracic Aortic Surgery: Involves the repair or replacement of the aorta,
particularly in cases of aneurysms or dissections.
○ Minimally Invasive Surgery: Increasingly common in cardiothoracic
procedures, reducing recovery time and complications.

44. Miscellaneous in GIT and HPB (Hepato-Pancreatico-Biliary)

● Gastrointestinal Bleeding:
○ Upper GI Bleeding: Common causes include peptic ulcers, varices, and
gastritis. Endoscopy is used for diagnosis and treatment (e.g., banding
varices).
○ Lower GI Bleeding: Causes include diverticulosis, colorectal cancer, and
hemorrhoids. Treatment often involves colonoscopy and interventional
radiology.
○ Surgical Intervention: In cases of massive bleeding, surgery may be
necessary to control the source of hemorrhage.
● HPB (Hepato-Pancreatico-Biliary) Surgery:
○ Liver Surgery: Includes resection for tumors (e.g., hepatocellular carcinoma),
trauma, or benign conditions (e.g., cysts or abscesses).
○ Pancreatic Surgery: Includes procedures for pancreatic cancer, pancreatitis,
and cystic conditions. Whipple procedure (pancreaticoduodenectomy) is often
performed for pancreatic cancer.
○ Biliary Surgery: Cholecystectomy (gallbladder removal) for gallstones and
cholecystitis, common bile duct exploration for stones or strictures, and biliary
bypass surgery for obstructive jaundice.

45. Bariatric Surgery

● Indications: Primarily used for patients with severe obesity (BMI >40 or >35 with
comorbidities like type 2 diabetes or hypertension) who have not responded to
lifestyle changes and medical treatments.
● Types of Bariatric Surgery:
○ Roux-en-Y Gastric Bypass (RYGB): A common procedure where the
stomach is divided into a small upper pouch, bypassing the majority of the
stomach and a portion of the small intestine to promote weight loss.
○ Sleeve Gastrectomy: Involves removal of a large portion of the stomach to
create a sleeve-like structure, reducing capacity and hunger.
○ Adjustable Gastric Banding: Placement of a band around the upper portion
of the stomach to create a small pouch, limiting food intake.
 ○ Biliopancreatic Diversion with Duodenal Switch (BPD/DS): A more
complex procedure that involves a partial gastrectomy and rerouting of the
small intestine.
● Outcomes and Complications:
○ Successful weight loss, improvement in comorbidities (like diabetes), but risks
include infection, nutritional deficiencies, and long-term complications such as
dumping syndrome or gastrointestinal leaks.

46. Transplant Surgery

● Organ Transplantation: Surgical procedure to replace a failing or damaged organ

with a healthy one from a donor.
○ Kidney Transplant: Most common transplant, done for patients with end-
stage renal disease. Both living and deceased donor kidneys can be used.
○ Liver Transplant: Performed for liver failure or liver cancer. Can involve
whole liver transplantation or split-liver transplantation.
○ Heart Transplant: For patients with end-stage heart failure. Often requires
lifetime immunosuppression to prevent organ rejection.
○ Lung Transplant: Performed for severe respiratory failure, often due to
conditions like COPD or pulmonary fibrosis.
○ Pancreas Transplant: Typically combined with a kidney transplant for
patients with diabetes and renal failure.
● Immunosuppression: Vital to prevent organ rejection, patients must undergo
lifelong immunosuppressive therapy to reduce the likelihood of rejection. However,
this increases the risk of infections and malignancies.
● Living Donor Transplantation: For some organs like kidneys, living donor
transplants are an option, providing faster and more successful outcomes in certain
cases.

47. Miscellaneous in General Surgery

● Wound Management:
○ Types of Wounds: Include incisions, abrasions, lacerations, and puncture
wounds.
○ Acute vs Chronic Wounds: Acute wounds heal quickly, while chronic
wounds (e.g., diabetic ulcers, pressure sores) require specialized care.
○ Principles of Wound Healing: Involves the stages of hemostasis,
inflammation, proliferation, and remodeling.
○ Wound Care: Includes cleaning, debridement, dressing, and sometimes
surgical closure or grafting.
● Laparoscopic Surgery:
○ Minimally invasive surgery using small incisions and a camera (laparoscope)
to perform procedures.
○ Common surgeries: Cholecystectomy, appendectomy, hernia repairs, and
bariatric surgery.
○ Advantages: Reduced postoperative pain, shorter recovery time, and smaller
scars.
● Hernia Surgery:
 ○ Inguinal Hernia: Most common type, requiring surgical repair (mesh or
suture).
○ Umbilical Hernia: Found around the belly button, treated surgically.
○ Hiatal Hernia: The stomach protrudes through the diaphragm; can be
managed surgically or with lifestyle changes.
● Endoscopic Surgery:
○ Endoscopic Procedures: Involve inserting a flexible tube (endoscope) into a
body cavity for diagnostic or therapeutic purposes. Common examples
include colonoscopy, bronchoscopy, and gastroscopy.
● Colorectal Surgery:
○ Colon Cancer: Surgical removal of the tumor (colon resection) and possibly
part of the rectum.
○ Inflammatory Bowel Disease: Surgery may be needed for conditions like
Crohn's disease or ulcerative colitis when medical management fails.
● Trauma Surgery:
○ Involves the management of traumatic injuries, including fractures, internal
bleeding, and organ damage. Emergency surgery may be required for
conditions like ruptured spleens, brain injuries, or large burns.