1. Common Surgical Problems
Lau Cheong Chi

2. Common Surgical Problems
Abdominal pain
Foreign bodies ingestion
Perineum
Lumps & bumps
AROU
Changed bowel habits
Haematemesis, Haematuria, Haematochezia, Haemoptysis
VV, PVD, Buerger’s disease
Tumors

3. Abdominal pain HBP – cholecystitis, cholangitis,
Upper GI – PPU, gastritis, duodenitis
Lower GI – I/O, appendicitis
Genital – epididymitis +/- orchitis

4. Perineal concerns Haemorrhoids Fresh PR bleeding / mass / pain
Active inflammation?
Degree of prolapse
Manual reduction
Drugs: annusol, faktu; cream vs supp.
Banding vs surgery
Colonoscopy?

5. Foreign bodies ingestion
Most commonly caused by fish bones, followed by chicken bone
Odynophagia
Direct largynoscope
OGD
CXR / XR neck: surgical emphysema
or retrophargneal abscess

6. Lumps & Bumps Site, pain, texture, duration, size changes,
Lipoma, sebaceous cyst, neuroma
Lymphadenopathy (1ry vs 2ry)
Benign vs malignant
Referral to surgical – malignant potential: fixation, painless, induration, rapid growing, ulceration, texture changes; cosmetic reasons

7. AROU Painful retention, palpable bladder Risk of vasovagal syncope
BPH, drug (cough, TCA, antipsychotics, etc), UTI, stone, urethral trauma
Catheterization, chart RU, save urine x C/ST, AFB, cytology
? Clamp & declamping of Foley’s
Uses of minipress/hytrin/cardura; ditropan, pyridium, antibiotic (quinolones)

8. Changed bowel habit Definition of constipation
what is change in bowel habit
Blood / mucus / anaemia / evidence of malignancy
colonoscopy

9. Haematemesis, haematuria, haematochezia, haemoptysis
Haematemesis vs haemoptysis – amount, taste, cough/vomit, CHF/APO;
UGIB – varices, PU, Mallory-Weiss
Lungs – tumor, bronchiectasis, TB, etc.
Pharynx – tumor
Haematuria – early signs, medical vs surgical, macroscopic vs microscopic: TB, UTI, tumor, stone; IgA nephropathy, glomerulonephritis
Haematochezia – piles, tumor, infection

10. Tumors Alert Lumps & bumps; moles; skin (BCC vs SCC)
H&N(NPC, Ca pharygolarynx) , GI (stomach, esophageus, colon, sigmoid & rectum), HBP (HCC, CC, Ca GB),
Lymphoma, haematological malignancy

11. VV, PVD, Buerger’s Disease
VV – when to refer, need surgery? Complications, avoid topical medications
PVD – risk factors, limit daily activities? Asso. coronary & cerebral vessels, indications for surgery
Buerger’s disease – sympathetic blockage, autoamputation; education

12. Thank you