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Egyptian Board General Surgery study materials
Egyptian Board General Surgery study resources

Egyptian Board General Surgery: Gastrointestinal and Hepatobiliary-Pancreatic Surgery

Egyptian Board General Surgery · Work through your exam, one topic at a time.

All guide sections

Gastrointestinal and Hepatobiliary-Pancreatic Surgery

This is the largest clinical domain: oesophagus, stomach, small and large bowel, liver, biliary tree, pancreas and spleen. Questions test pattern recognition, classification systems and the timing of operative versus endoscopic or radiological intervention.

Oesophagus and stomach

  • Boerhaave syndrome: transmural rupture after vomiting, left pleural effusion and mediastinal air; urgent surgery with drainage and repair.
  • Achalasia: bird's-beak on barium swallow, absent peristalsis, failure of relaxation; Heller myotomy or pneumatic dilatation.
  • Gastric cancer: distal tumours are intestinal type; D2 lymphadenectomy for advanced resectable disease. GIST is CD117 (c-KIT) positive and treated with imatinib.
  • Perforated peptic ulcer: omental (Graham) patch, peritoneal lavage, Helicobacter pylori eradication afterwards.

Small and large bowel

  • Adhesive small bowel obstruction: water-soluble contrast is diagnostic and therapeutic; operate for strangulation (fever, tachycardia, tenderness, rising lactate).
  • Crohn disease affects any part of the gut, skip lesions, transmural inflammation, fistulae; ulcerative colitis is mucosal, continuous, from the rectum.
  • Hinchey classification of perforated diverticulitis: I pericolic abscess, II pelvic abscess, III purulent peritonitis, IV faecal peritonitis. III and IV need surgery.
  • Sigmoid volvulus: coffee-bean sign; sigmoidoscopy detorsion if no gangrene, then elective resection.

Liver and biliary tree

  • Couinaud's eight segments; segment I is the caudate lobe; segments II–IV left, V–VIII right.
  • Child-Pugh score uses bilirubin, albumin, INR, ascites and encephalopathy; MELD uses bilirubin, INR and creatinine.
  • Acute cholangitis: Charcot's triad (fever, jaundice, right upper quadrant pain); Reynolds pentad adds hypotension and confusion. Resuscitate, give antibiotics, and drain the biliary tree by ERCP within 24 hours in severe disease.
  • Mirizzi syndrome: impacted stone in the cystic duct compressing the common hepatic duct. Gallstone ileus: Rigler's triad of pneumobilia, obstruction and an ectopic stone.

Pancreas and spleen

  • Atlanta classification separates interstitial oedematous pancreatitis from necrotising pancreatitis; infected necrosis is treated by a step-up approach (drainage first).
  • Pseudocyst requires a mature wall, usually more than 4 weeks, before endoscopic or surgical drainage.
  • After splenectomy: vaccinate against pneumococcus, meningococcus and Haemophilus influenzae, give penicillin prophylaxis and warn about malaria and animal bites.

Worked example

A 68-year-old woman has fever 39 °C, jaundice, right upper quadrant pain, confusion and a systolic pressure of 85 mmHg. This is Reynolds pentad - severe acute cholangitis. Management is simultaneous resuscitation, intravenous antibiotics and urgent biliary decompression by ERCP after initial stabilisation; cholecystectomy is deferred.

Traps that lose marks

Mixing Hinchey stages; operating on pancreatitis before adequate resuscitation; forgetting post-splenectomy prophylaxis; calling a pseudocyst before the wall matures.