RACS GSSE key terms

Failure of a surgical join between two hollow organs, allowing luminal contents to escape into the abdomen or chest. It typically presents with pain, fever, tachycardia, and sepsis days after operation.

A surgical connection created between two tubular structures, such as bowel, bile duct, or vessels. It may be fashioned end-to-end, side-to-side, or end-to-side, stapled or hand-sewn.

A systemic inflammatory response caused by infection within the peritoneal cavity, often from a perforated viscus or leaking anastomosis. Management combines resuscitation, antibiotics, and source control by drainage or surgery.

Procedures that eliminate the origin of an intra-abdominal infection, such as closing a perforation, resecting dead bowel, or draining an abscess. Antibiotics alone fail without adequate source control.

Leaving the abdominal cavity open after surgery, covered by a temporary dressing or negative-pressure device, to allow repeat inspection or avoid abdominal compartment syndrome. Closure is planned once contamination and oedema resolve.

Organ dysfunction caused by sustained intra-abdominal pressure above 20 mmHg, producing reduced venous return, oliguria, and impaired ventilation. Treatment is decompression, usually by opening the abdomen.

A staged approach for critically ill or physiologically deranged patients: stop bleeding and contamination quickly, temporarily close, then return for definitive repair after correction of hypothermia, acidosis, and coagulopathy.

The self-reinforcing combination of hypothermia, metabolic acidosis, and coagulopathy that drives haemorrhagic death in severely injured or shocked patients. It guides early transfusion, warming, and abbreviated surgery.

A predetermined system for rapidly delivering balanced blood components, typically red cells, plasma, and platelets, to a bleeding patient. It aims to limit crystalloid, correct coagulopathy early, and avoid the lethal triad.

An evidence-based bundle of perioperative care measures, including avoiding prolonged fasting, opioid-sparing analgesia, early feeding, and early mobilisation, designed to shorten hospital stay and speed functional recovery after major operations.

Structured evaluation of a patient's fitness for surgery using history, examination, functional capacity, and tools such as cardiac risk indices or cardiopulmonary exercise testing. It informs consent, optimisation, and level of postoperative care.

A state of reduced physiological reserve and increased vulnerability to stressors, common in older surgical patients. It predicts complications, delayed recovery, and mortality better than chronological age alone.

An acute, fluctuating disturbance of attention and cognition caused by illness, drugs, pain, or surgery. It is common in older inpatients and is managed by treating the cause plus non-drug measures such as orientation and sleep hygiene.

Temporary, generalised impairment of gastrointestinal motility after surgery or injury, causing nausea, distension, and failure to pass flatus or stool. Management is supportive, correcting electrolytes and limiting opioids.

Mechanical or functional blockage of intestinal flow, presenting with colicky pain, vomiting, distension, and absolute constipation. Adhesions and hernia are common causes; strangulation requires urgent surgery.

Compromise of the blood supply to a segment of bowel, usually from a tight constriction such as a hernia neck or volvulus. It risks ischaemia, perforation, and sepsis, and mandates prompt operative assessment.

An abnormal tract between bowel lumen and skin, often arising after surgery, with output of enteric contents. Management includes sepsis control, nutritional support, skin protection, and delayed definitive repair.

Injury to the colon from inadequate blood flow, typically in watershed segments, presenting with pain and bloody diarrhoea. Severe cases with peritonitis or gangrene need resection.

Sudden loss of blood flow to the small bowel, usually from arterial embolism, thrombosis, or venous occlusion. Pain out of proportion to examination is typical; early CT angiography and revascularisation are critical.

Twisting of a bowel loop or organ on its mesenteric axis, causing closed-loop obstruction and risk of ischaemia. Sigmoid and caecal volvulus are classic forms, often managed by decompression or resection.

A surgically created opening of bowel onto the abdominal wall, either end or loop, to divert faeces or urine. Complications include skin excoriation, prolapse, retraction, stenosis, and high output.

Education and practical management of a stoma and its appliance, including sizing, skin protection, diet, and output monitoring. Good care prevents skin breakdown and supports rehabilitation and independence.

An abnormal narrowing of a tubular structure such as bowel, bile duct, or oesophagus, causing obstruction or stasis. Causes include inflammation, ischaemia, and scarring; treatment may be dilation, stenting, or resection.

Irreducible trapping of tissue, usually bowel, within a hernia sac. It may progress to strangulation, so painful irreducible hernias need urgent surgical assessment.

Protrusion of an organ or tissue through a defect in the wall of the cavity that normally contains it. Common sites include inguinal, femoral, and incisional; repair may be open or laparoscopic, often with mesh.

Inflammation of the vermiform appendix, typically presenting with periumbilical pain migrating to the right iliac fossa, anorexia, and fever. Treatment is appendicectomy, often laparoscopic, with antibiotics as adjunct.

Inflammation of the peritoneum, which may be sterile or microbial. Microbial peritonitis from a perforated viscus causes rigidity, rebound tenderness, and sepsis and requires source control.

Inflammation of the gallbladder, usually due to obstruction of the cystic duct by a gallstone. It presents with right upper quadrant pain, fever, and a positive Murphy sign; treatment is antibiotics and cholecystectomy.

Infection of the bile ducts, often from obstruction by a stone or stricture, causing fever, jaundice, and right upper quadrant pain. Urgent biliary drainage plus antibiotics is required.

Inflammation of the pancreas, commonly caused by gallstones or alcohol. It presents with severe epigastric pain radiating to the back; severe cases develop necrosis, organ failure, and fluid collections.

Mechanical cleansing of the colon, or administration of oral antibiotics, before colorectal surgery. Mechanical preparation is now used selectively, while oral antibiotic regimens are used in some enhanced recovery protocols.

Infection of a wound created by an operation, classified as superficial, deep, or organ-space. Risk reduction includes aseptic technique, appropriate prophylaxis, normothermia, and glycaemic control.

Administration of an antimicrobial before surgery to reduce the risk of surgical site infection. Timing, agent choice, and redosing are based on the procedure, likely organisms, and patient factors.

Coordinated efforts to use antibiotics appropriately, including correct indication, agent, dose, and duration, to improve outcomes and limit resistance. In surgery it emphasises timely cessation of prophylaxis.

Formation of thrombus in the venous system, usually in leg veins, which may embolise to the lungs. Surgical patients are at increased risk and require risk-stratified prophylaxis.

Measures to prevent clot formation in at-risk patients, including early mobilisation, graduated compression stockings, and pharmacological agents such as low-molecular-weight heparin. Choice depends on bleeding risk.

Occlusion of pulmonary arteries by thrombus, usually embolised from deep veins. It presents with dyspnoea, chest pain, and hypoxia and is diagnosed by CT pulmonary angiography; treatment is anticoagulation.

The process of discussing a proposed operation's indications, benefits, alternatives, and material risks so the patient can decide freely. It requires capacity and documentation and is central to ethical surgical practice.

A collaborative process in which clinician and patient weigh treatment options together, incorporating evidence and the patient's values and preferences. It supports informed consent and realistic goal setting.