CSHK Part 2 EMQ key terms

A state of inadequate tissue perfusion causing cellular oxygen debt and organ dysfunction, recognised by hypotension, tachycardia, altered mentation, oliguria and raised lactate, and classified as hypovolaemic, cardiogenic, distributive or obstructive.

A strategy for exsanguinating patients combining permissive hypotension, early balanced blood product transfusion over crystalloid, warming and rapid haemorrhage control, accepting temporary physiological instability to prevent the lethal triad.

The self-reinforcing combination of hypothermia, acidosis and coagulopathy that develops after major haemorrhage and predicts death unless bleeding is controlled and physiology actively corrected.

A pre-agreed hospital pathway for rapidly supplying balanced red cells, plasma and platelets with predefined triggers, single-caller activation and regular coagulation and calcium monitoring during major haemorrhage.

The rate at which blood lactate falls over time, used as a marker of successful resuscitation; failure to clear lactate within hours of surgery or sepsis predicts ongoing hypoperfusion and higher mortality.

A set of six early actions in suspected sepsis: oxygen if needed, blood cultures, intravenous antibiotics, intravenous fluids, lactate measurement and hourly urine output monitoring, completed within one hour.

The physical elimination of the anatomical focus driving infection, such as drainage of an abscess, debridement of necrotic tissue or resection of a perforated viscus, without which antibiotics alone will fail.

Sustained intra-abdominal pressure above 20 mmHg with new organ dysfunction, causing reduced venous return, oliguria and impaired ventilation, treated by decompressive laparotomy and temporary abdominal closure.

An abbreviated initial operation for the unstable or physiologically exhausted patient, controlling haemorrhage and contamination, packing and temporarily closing the abdomen, with planned re-look surgery after intensive care stabilisation.

An evidence-based perioperative care package combining preoperative counselling, carbohydrate loading, avoidance of prolonged fasting, opioid-sparing analgesia, early feeding and early mobilisation to shorten hospital stay.

Structured estimation of a patient's likelihood of death or major complication after an operation, using tools such as ASA physical status, cardiopulmonary exercise testing and validated risk calculators to guide consent and optimisation.

Preoperative interventions such as exercise training, nutritional support, smoking cessation and anaemia correction that improve physiological reserve before elective major surgery and reduce postoperative complications.

Measures to prevent perioperative deep vein thrombosis and pulmonary embolism, combining risk-stratified low molecular weight heparin or fondaparinux with mechanical compression and early mobilisation, balanced against bleeding risk.

Transient generalised impairment of gastrointestinal motility after surgery or injury, causing nausea, distension, absent bowel sounds and failure to tolerate diet, managed largely supportively with fluids and nasogastric decompression if needed.

Failure of a surgical join between two hollow viscera with spillage of luminal contents, presenting with pain, fever, tachycardia, peritonitis or sepsis, and usually requiring imaging, drainage or reoperation.

An abnormal tract between bowel and skin discharging intestinal content, most often after anastomotic breakdown or iatrogenic injury, managed with sepsis control, nutrition, skin protection and delayed definitive surgery.

Provision of enteral or parenteral calories and protein to malnourished or catabolic surgical patients, with the enteral route preferred where the gut works to maintain mucosal integrity and reduce infection.

Blockage of small intestinal transit, commonly by adhesions, hernia or tumour, presenting with colicky pain, vomiting, distension and absolute constipation, with computed tomography distinguishing simple from strangulating obstruction.

Inadequate blood flow to the intestine causing mucosal injury and necrosis, with pain out of proportion to examination in acute mesenteric ischaemia and a high mortality requiring urgent revascularisation or resection.

Inflammation of the vermiform appendix, typically producing migrating periumbilical to right iliac fossa pain, anorexia and localised peritonism, treated by laparoscopic appendicectomy or, in selected cases, antibiotics.

A ten-point clinical score for suspected appendicitis combining migration of pain, anorexia, nausea, tenderness, rebound, fever and leucocytosis, used to stratify need for imaging or surgery.

Inflammation of the peritoneal cavity, either bacterial from a perforated viscus or chemical from bile, blood or gastric content, producing rigidity, rebound tenderness and systemic sepsis requiring urgent source control.

Spontaneous full-thickness rupture of the oesophagus after forceful vomiting, causing severe chest pain, subcutaneous emphysema and mediastinitis, needing urgent imaging, drainage and repair or stenting.

Yellow discolouration from conjugated hyperbilirubinaemia due to biliary obstruction, often with pale stools, dark urine, pruritus and dilated ducts on imaging, requiring investigation for stones or malignancy.

Bacterial infection of an obstructed biliary tree presenting with Charcot's triad of fever, jaundice and right upper quadrant pain, requiring antibiotics, resuscitation and urgent biliary drainage by ERCP or percutaneous route.

Sudden inflammation of the pancreas, usually from gallstones or alcohol, diagnosed when two of pain, amylase or lipase over three times normal, and imaging are present, and stratified for severity and organ failure.

Non-viable pancreatic or peripancreatic tissue complicating severe acute pancreatitis, which may become infected and require delayed drainage or necrosectomy rather than early open surgery.

A prognostic scoring system using eight variables within 48 hours of admission, including age, white cell count, glucose, urea, calcium and oxygen saturation, to identify severe acute pancreatitis.

A hernia whose contents cannot be reduced back into the abdomen, risking obstruction and strangulation and therefore usually requiring urgent surgical repair.

A hernia with compromised blood supply to its contents, producing severe pain, tenderness, systemic toxicity and obstruction, and demanding emergency operation rather than attempted reduction.

Necrotising fasciitis of the perineum and genitalia, seen especially in diabetic patients, producing pain, crepitus, skin necrosis and sepsis, and treated with resuscitation, broad antibiotics and repeated radical debridement.

Risks of thyroid surgery including recurrent laryngeal nerve injury causing hoarseness, hypocalcaemia from parathyroid devascularisation, haematoma causing airway compromise and, rarely, thyroid storm.

Assessment and securing of the airway in surgical patients, including prediction of difficult intubation, rapid sequence induction for full stomachs, and cricothyroidotomy when intubation fails in a cannot-intubate cannot-ventilate situation.

A rapid bedside ultrasound examination of pericardium, hepatorenal and splenorenal recesses and pelvis to detect free fluid in injured patients, guiding immediate laparotomy or further imaging.

Surgical removal of the spleen, performed for trauma, haematological disease or hypersplenism, after which patients need pneumococcal, meningococcal and Haemophilus vaccination plus prophylactic penicillin because of encapsulated organism risk.

Separation of a surgical wound, ranging from superficial skin breakdown to full fascial disruption with bowel evisceration, associated with poor technique, infection, raised intra-abdominal pressure and malnutrition.

Infection arising within 30 days of surgery, or one year if an implant is present, at the incision or deeper, classified as superficial, deep or organ-space and reduced by asepsis, antibiotic prophylaxis and normothermia.

Radiographic imaging of the biliary tree during cholecystectomy, used to clarify anatomy, detect unsuspected common bile duct stones and identify bile duct injury.

Use of high-frequency alternating current to cut tissue or coagulate bleeding vessels, with monopolar and bipolar modes, requiring attention to burns, pacemakers and operating theatre fire risk.