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
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.
Post operative order list check-up FLAVOR:
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).
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)
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
Hernias: abdominal wall: lumbar triangles (with eponyms)
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
Surgical discharge checklist FLAG COUP:
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)
Oesophageal cancer risk factors PC BASTARDS:
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.
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
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)
Haematocele: etiology 3T's and 2 H's:
Tumor
Torsion
Trauma
Hydrocele as a complication
Haemophilia (blood diseases)
Abdomen: inspection 5 S's:
Size
Shape
Scars
Skin lesions
Stoma
Varicose veins: symptoms AEIOU:
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
Ulcers: edge types F PURE:
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
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
Post-operative complications (immediate) "Post-op
PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis
Fistulas: conditions preventing closure FETID:
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)
Oedema causes: localised ALIVE:
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
Melanoma sites "Mel SEA" (Pronounced "Mel C" from the
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
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)
