Gastrointestinal Surgery
Core concepts
Know the surgical anatomy relevant to the foregut, midgut, and hindgut, including blood supply and lymphatic drainage. Understand the pathophysiology and operative indications for appendicitis, cholecystitis, bowel obstruction, diverticulitis, inflammatory bowel disease, and colorectal malignancy. Master the principles of anastomosis (tension-free, adequate blood supply, healthy tissue, no distal obstruction), stoma care, and the difference between small bowel and large bowel obstruction presentations. Understand the acute abdomen approach: history, examination, laboratory, and imaging selection (ultrasound, CT, contrast studies).
Traps in questions
Questions often test whether a patient needs urgent surgery versus medical management, such as uncomplicated diverticulitis versus perforation, or adhesive small bowel obstruction versus strangulation. Distinguish mechanical obstruction from ileus. Watch for questions about anastomotic leak timing and presentation. Another trap is confusing upper and lower GI bleeding management. Be careful with questions about appendicitis in pregnancy and the elderly, where presentation is atypical.
Worked rule of thumb
For bowel obstruction, ask: is there strangulation? Signs include fever, tachycardia, peritoneal signs, leukocytosis, and acidosis. If present, operate urgently. If absent, trial of nonoperative management with nasogastric decompression and serial exams is reasonable, with surgery for failure to resolve.
Exam strategy
Use anatomy to predict symptoms and complications. A right-sided colon cancer presents with anemia and mass; left-sided with obstruction.