Surgery Mnemonics
Pancreatitis: treatment MACHINES:
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review
Appendicitis: Alvarado's scoring system for diagnosis
MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more =
appendicitis is confirmed.
MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more =
appendicitis is confirmed.
Post operative order list check-up FLAVOR:
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx [medications]
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx [medications]
Child-Pugh classification "Pour Another Beer
At Eleven":
PT
Albumin
Bilirubin
Ascites
Encephalopathy
·Scoring (each is either 1, 2 or 3 points):
PT (greater than 12 sec.): 1-3 or 4-6 or >6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).
Class B: 7-9 points (consider chemoembolization or RFA).
Class C: 10-15 points (consider options in B or no therapy).
At Eleven":
PT
Albumin
Bilirubin
Ascites
Encephalopathy
·Scoring (each is either 1, 2 or 3 points):
PT (greater than 12 sec.): 1-3 or 4-6 or >6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).
Class B: 7-9 points (consider chemoembolization or RFA).
Class C: 10-15 points (consider options in B or no therapy).
Hernias of Abdominal Wall Think of the abdomen as a bucket,
or PAIL that contains the viscera. These are the four groups of hernias:
Pelvic hernias: obturator, perineal, sciatic
Anterior hernias: epigastric, incisional, Spigelian, supravesical,
umbilical
Inguinal hernias: indirect, direct, femoral
Lumbar hernias: inferior lumbar triangle (Petit), superior lumbar
triangle (Grynfelt)
or PAIL that contains the viscera. These are the four groups of hernias:
Pelvic hernias: obturator, perineal, sciatic
Anterior hernias: epigastric, incisional, Spigelian, supravesical,
umbilical
Inguinal hernias: indirect, direct, femoral
Lumbar hernias: inferior lumbar triangle (Petit), superior lumbar
triangle (Grynfelt)
Hernias: abdominal wall: pelvic The end products of
metabolism that are released through the pelvis, are "Pee Or Stool":
Perineal hernia
Obturator hernia
Sciatic hernia
metabolism that are released through the pelvis, are "Pee Or Stool":
Perineal hernia
Obturator hernia
Sciatic hernia
Hernias: abdominal wall: lumbar triangles (with eponyms)
PIGS:
Petit aka Inferior lumbar triangle
Grynfelt aka Superior lumbar triangle
PIGS:
Petit aka Inferior lumbar triangle
Grynfelt aka Superior lumbar triangle
TPN indications "MISIPPI Burning":
Major visceral injury
IBD
Sepsis
Ileus
Post-op
Paralysis
Intestinal fistula
Burns
Major visceral injury
IBD
Sepsis
Ileus
Post-op
Paralysis
Intestinal fistula
Burns
Surgical discharge checklist FLAG COUP:
Lucid
Ambulatory
GP letter sent
CVS checked (BP, pulse
Operation site OK
Urinating OK
Prescription
Lucid
Ambulatory
GP letter sent
CVS checked (BP, pulse
Operation site OK
Urinating OK
Prescription
Compartment syndrome: signs and symptoms · 5 P's:
Pain
Palor
P ulseless
Paresethesia
Pressure (increased)
Pain
Palor
P ulseless
Paresethesia
Pressure (increased)
Oesophageal cancer risk factors PC BASTARDS:
Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture
Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture
Abdominal aortic aneurysm: genetic component AAA (3
A's) is sometimes due to a defect in the gene encoding for type III
procollagen.
A's) is sometimes due to a defect in the gene encoding for type III
procollagen.
Disease description: organization of answer "In A
Surgeon's Gown, Physicians May Make Some
Clinical Progress":
Incidence
Age
Sex
Geography
Predisposing factors
Macroscopic appearance
Microscopic appearance
Spread
Clinical features
Prognosis
Surgeon's Gown, Physicians May Make Some
Clinical Progress":
Incidence
Age
Sex
Geography
Predisposing factors
Macroscopic appearance
Microscopic appearance
Spread
Clinical features
Prognosis
Inguinal mass: differential "Hernias Very Much
Like To Swell":
Hernias (inguinal, femoral)
Vascular (femoral aneurysm, sapheno varyx)
Muscle (psoas abscess)
Lymph nodes
Testicle (ectopic, undescended)
Spermatic cord (lipoma, hydrocoele)
Like To Swell":
Hernias (inguinal, femoral)
Vascular (femoral aneurysm, sapheno varyx)
Muscle (psoas abscess)
Lymph nodes
Testicle (ectopic, undescended)
Spermatic cord (lipoma, hydrocoele)
Haematocele: etiology 3T's and 2 H's:
Tumor
Torsion
Trauma
Hydrocele as a complication
Haemophilia (blood diseases)
Tumor
Torsion
Trauma
Hydrocele as a complication
Haemophilia (blood diseases)
Abdomen: inspection 5 S's:
Size
Shape
Scars
Skin lesions
Stoma
Size
Shape
Scars
Skin lesions
Stoma
Varicose veins: symptoms AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)
Swollen leg: unilateral swelling causes TV BAIL:
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema
Ulcers: edge types F PURE:
Flat (eg venous)
Punched-out (eg trophic, arterial)
Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)
Flat (eg venous)
Punched-out (eg trophic, arterial)
Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)
Post-operative fever causes Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may
have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted
mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever
Wind: pulmonary system is primary source of fever first 48 hours, may
have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted
mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever
Scrotum: scrotum swelling differential THE THEATRES:
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB
Post-operative complications (immediate) "Post-op
PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis
PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis
Fistulas: conditions preventing closure FETID:
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction
Oedema causes: generalised "HILARI IS SAVE" (Hilary):
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
· Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
· Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)
Oedema causes: localised ALIVE:
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)
GI bleeding: causes ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel
Melanoma sites "Mel SEA" (Pronounced "Mel C" from the
Spice Girls)
· Melanoma sites, in order of frequency:
Skin
Eyes
Anus
Spice Girls)
· Melanoma sites, in order of frequency:
Skin
Eyes
Anus
Fistulas: conditions preventing closure FRIEND:
Foreign body
Radiation
Infection/ Inflammation (Crohn)
Epithelialization
Neoplasia
Distal obstruction
Foreign body
Radiation
Infection/ Inflammation (Crohn)
Epithelialization
Neoplasia
Distal obstruction
Appendicectomy: complications WRAP IF HOT:
Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)
Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)