General Surgery
Core concepts
Master the acute abdomen: appendicitis, cholecystitis, diverticulitis, bowel obstruction, and perforated viscus. Know imaging choices (ultrasound first for biliary disease, CT for most undifferentiated abdomens) and when operative versus nonoperative management applies. Understand hernia anatomy and strangulation risk, and the principles of damage control surgery in the unstable patient.
Key disease patterns
- Appendicitis: Alvarado scoring, imaging in equivocal cases, antibiotics plus appendectomy.
- Cholecystitis: Tokyo grading guides severity and timing of cholecystectomy.
- Diverticulitis: uncomplicated cases often managed outpatient; abscess drainage for large collections; surgery for perforation or failed medical therapy.
- Bowel obstruction: distinguish small from large bowel, look for strangulation signs (fever, tachycardia, pain out of proportion, acidosis).
Traps
- Assuming every bowel obstruction needs immediate surgery - many adhesive obstructions resolve with nasogastric decompression.
- Missing strangulation in a "stable" patient.
- Confusing the timing of cholecystectomy for mild versus severe disease.
- Forgetting that elderly and immunosuppressed patients may lack classic signs.
Worked example
A 70-year-old with left lower quadrant pain, fever, and CT showing a 5 cm diverticular abscess: percutaneous drainage plus antibiotics, not emergent resection. Rule of thumb: drain collections over 3-4 cm, operate for perforation or peritonitis.
Study strategy
Build a table of condition, imaging, and operative threshold. Rehearse the unstable patient pathway: resuscitation, broad-spectrum antibiotics, and source control.