Iraqi Board General Surgery key terms

Inflammation of the peritoneal lining, usually caused by bacterial contamination from a perforated viscus, ischaemic bowel, or postoperative leak. Presents with guarding, rigidity, and rebound tenderness and generally requires urgent laparotomy or laparoscopy with lavage and source control.

Failure of healing at a surgical join between two bowel ends, allowing luminal contents to escape into the peritoneal cavity or wound. Presents with fever, tachycardia, ileus, pain, and rising inflammatory markers, typically days 5 to 8 after surgery, and needs drainage and often reoperation.

A staged operative strategy in severely injured or physiologically deranged patients: control haemorrhage and contamination quickly, temporarily close the abdomen, then correct hypothermia, acidosis, and coagulopathy in intensive care before definitive reconstruction at a later operation.

The self-reinforcing combination of hypothermia, metabolic acidosis, and coagulopathy that develops after major trauma or prolonged shock. Each component worsens the others, driving uncontrolled bleeding and death unless resuscitation and haemorrhage control are rapid.

Deliberately accepting a lower-than-normal blood pressure during resuscitation of uncontrolled haemorrhage, aiming to maintain organ perfusion while avoiding clot disruption and dilutional coagulopathy. Typically targets a systolic pressure near 80 to 90 mmHg, and is avoided in traumatic brain injury.

A pre-planned, protocol-driven approach to replacing large blood losses, delivering packed red cells, plasma, and platelets in balanced ratios alongside tranexamic acid, calcium, and warming. It reduces crystalloid use, prevents dilutional coagulopathy, and is activated early in major haemorrhage.

A structured perioperative care pathway combining preoperative counselling, avoidance of prolonged fasting and bowel preparation, opioid-sparing multimodal analgesia, early feeding and mobilisation, and early drain and catheter removal to shorten hospital stay and reduce complications.

Infection occurring within 30 days of surgery (or up to 90 days with implants) at or near the operative site, classified as superficial incisional, deep incisional, or organ space. Prevention relies on timely prophylactic antibiotics, normothermia, glycaemic control, and meticulous asepsis.

The set of practices that keep the operative field free of microorganisms, including sterile gowning and gloving, skin antisepsis, sterile drapes, instrument sterilisation, and strict separation of sterile from non-sterile staff and equipment in theatre.

Healing of a clean, apposed wound with minimal tissue loss, where the edges are approximated and epithelialisation occurs rapidly over a small gap. Scarring is minimal and tensile strength rises steadily over weeks, reaching roughly 80 percent of normal by three months.

Healing of a wound left open or with significant tissue loss, where granulation tissue fills the defect from the base before epithelialisation from the margins. It takes longer, produces more contraction and scarring, and is typical of abscess cavities and infected wounds.

Application of controlled sub-atmospheric pressure through a sealed foam dressing to remove exudate, reduce oedema, and promote granulation in open or contaminated wounds. It is used as a bridge to closure or grafting and must not be applied over untreated infection or exposed vessels.

A graft comprising epidermis and a variable portion of dermis, harvested from a donor site and placed on a vascularised bed. It survives by plasmatic imbibition then inosculation, contracts more than a full-thickness graft, and leaves a donor site that heals by secondary intention.

A unit of tissue moved with its own blood supply, either as a pedicle attached to the donor site or as a free flap with microvascular anastomosis. Unlike a graft, a flap brings its own perfusion and can cover exposed bone, tendon, or hardware.

Raised pressure within a closed fascial compartment that compromises capillary perfusion and threatens muscle and nerve viability. Presents with pain out of proportion, pain on passive stretch, and tense swelling; pulselessness is late, and urgent fasciotomy is required.

Ischaemic contracture and fibrosis of the forearm flexor muscles following untreated compartment syndrome or brachial artery injury. It produces a fixed flexion deformity of the wrist and fingers with sensory loss, and is largely preventable by early fasciotomy.

A fracture of the distal humerus just above the condyles, most common in children after a fall on the outstretched hand. It risks brachial artery injury and compartment syndrome, and is classified by displacement, with pulselessness demanding urgent reduction and vascular assessment.

Telescoping of one segment of bowel into the adjacent distal segment, causing venous congestion, ischaemia, and obstruction. Typically affects infants aged 6 to 18 months with colicky pain, vomiting, and redcurrant-jelly stool, and is reduced by air or contrast enema.

Abnormal rotation and fixation of the midgut during fetal development, leaving the bowel on a narrow mesenteric pedicle prone to volvulus. Presents in neonates with bilious vomiting and requires urgent laparotomy with Ladd procedure to prevent midgut infarction.

Vomiting of green or yellow-green fluid, indicating obstruction distal to the ampulla of Vater. In a neonate it is a surgical emergency until malrotation with volvulus is excluded, and it also occurs in atresia, stenosis, and meconium ileus.

A life-threatening exacerbation of thyrotoxicosis with fever, tachycardia, agitation, and heart failure, often triggered by surgery, infection, or trauma. Management includes beta-blockade, thionamide, iodine given after the thionamide, steroids, cooling, and intensive care support.

A branch of the vagus nerve supplying most intrinsic laryngeal muscles, running in the tracheo-oesophageal groove and at risk during thyroid and parathyroid surgery. Unilateral injury causes hoarseness; bilateral injury can cause airway obstruction requiring urgent intervention.

Excess parathyroid hormone secretion from one or more abnormal parathyroid glands, usually a single adenoma, causing hypercalcaemia. Presents with stones, bones, abdominal groans, and psychiatric moans; surgery is indicated for symptoms or complications, with focused parathyroidectomy guided by imaging.

Identification and removal of the first draining lymph node(s) after injection of blue dye or radiolabelled colloid, to detect occult metastasis without full nodal dissection. It is standard in early breast cancer and melanoma and reduces lymphoedema compared with routine clearance.

Surgical clearance of axillary levels I and II nodes, used for proven axillary metastasis or after positive sentinel biopsy in selected patients. It provides staging and local control but carries risks of lymphoedema, seroma, and nerve injury.

The combined evaluation of a breast lump by clinical examination, imaging (mammography and ultrasound as appropriate), and tissue sampling by core biopsy or fine needle aspiration. Concordant benign or malignant results guide management; discordance requires further biopsy.

Systematic description of cancer extent using the TNM system for primary tumour, regional nodes, and distant metastasis, grouped into stages that guide treatment and predict prognosis. Accurate staging requires imaging and pathological data and must be recorded before therapy begins.

Systemic or radiation treatment given before planned definitive surgery to shrink a tumour, improve resectability, or test tumour biology. It is used in locally advanced rectal, oesophageal, and breast cancer and may allow breast-conserving surgery.

Complete surgical removal of a tumour with microscopically negative margins, as opposed to R1 (microscopic residual disease) or R2 (macroscopic residual disease). R0 status is a key determinant of local recurrence and survival in solid tumour surgery.

A permanent focal dilatation of the abdominal aorta to at least 3 cm, most often infrarenal and degenerative. Repair is considered when diameter exceeds about 5.5 cm, grows rapidly, or becomes symptomatic, by open or endovascular technique.

Exclusion of an aortic aneurysm by a stent-graft delivered through the femoral arteries, avoiding a major abdominal incision. It has lower early mortality and faster recovery than open repair but requires lifelong imaging surveillance for endoleak and graft migration.

Sudden loss of arterial perfusion to a limb, usually from embolism or in-situ thrombosis, presenting with pain, pallor, pulselessness, paraesthesia, paralysis, and poikilothermia. It is a vascular emergency requiring prompt anticoagulation and revascularisation to avoid amputation.

The three factors predisposing to thrombosis: venous stasis, endothelial injury, and hypercoagulability. It underpins risk assessment and prophylaxis for deep vein thrombosis in surgical patients through early mobilisation, compression, and pharmacological thromboprophylaxis.

Occlusion of pulmonary arteries by thrombus, usually embolised from deep veins of the legs or pelvis. Presents with sudden dyspnoea, pleuritic pain, tachycardia, and hypoxia; diagnosis uses CT pulmonary angiography, and treatment is anticoagulation with thrombolysis in unstable cases.

Classification of burn injury as superficial, superficial partial, deep partial, or full thickness based on appearance, blanching, sensation, and capillary refill. Depth guides fluid needs, dressing choice, and the decision for early excision and grafting.

A resuscitation guide giving crystalloid at 4 mL per kg body weight per percent total body surface area burned in the first 24 hours, half in the first 8 hours from the time of injury and the remainder over 16 hours. Actual rates are titrated to urine output.

Radiographic imaging of the biliary tree during cholecystectomy by injecting contrast through the cystic duct. It demonstrates ductal anatomy, detects unsuspected common bile duct stones, and identifies bile duct injury, though routine use remains debated.

A non-invasive MRI technique producing high-contrast images of the biliary and pancreatic ducts without instrumentation. It is the investigation of choice for suspected common bile duct stones and for defining ductal strictures before endoscopic or surgical intervention.

Escape of bile from the cystic duct stump, duct of Luschka, or an injured bile duct after gallbladder removal. Presents with pain, fever, and bilious drain output; management is endoscopic stenting with drainage, reserving surgery for major ductal injury.

The process of obtaining a patient's voluntary agreement to treatment after explaining the diagnosis, proposed procedure, material risks, alternatives, and consequences of refusal, in language they understand. It requires capacity and documentation and is a core ethical and legal duty in surgery.

A documented advance decision, made with the patient or in their best interests, that cardiopulmonary resuscitation should not be attempted if cardiac arrest occurs. It does not preclude other active treatment such as surgery, analgesia, or antibiotics.

A regular structured conference where surgical teams review complications, deaths, and adverse events to identify system and technical failures and implement improvements. It is a key component of clinical governance and patient safety culture.

The number of patients who must receive an intervention to prevent one additional adverse outcome, calculated as the reciprocal of the absolute risk reduction. It translates trial results into clinical effort and is central to evidence-based surgical decision-making.

A study in which participants are randomly allocated to intervention or control groups to minimise selection bias and allow causal inference. Randomisation, allocation concealment, blinding, and intention-to-treat analysis determine its quality and are essential for appraising surgical evidence.

A 3 to 15 point score assessing eye opening, verbal response, and best motor response to quantify level of consciousness after head injury. A score of 8 or less indicates severe injury and prompts airway protection and neurosurgical referral.

Bleeding between the skull and dura, usually from a torn middle meningeal artery after temporal bone fracture. Classically shows a lucid interval then deterioration with a biconvex haematoma on CT, and requires urgent craniotomy and evacuation.

The pressure within the rigid skull exerted by brain, blood, and cerebrospinal fluid, normally below about 15 mmHg. Sustained elevation reduces cerebral perfusion and causes herniation; management includes head elevation, osmotherapy, sedation, and sometimes decompressive craniectomy.

Accumulation of air in the pleural space under pressure, shifting the mediastinum and impairing venous return. Presents with severe dyspnoea, hypotension, distended neck veins, and absent breath sounds; immediate needle decompression followed by chest drain is life-saving.

The biological process by which fractured bone ends are bridged by callus and remodelled into continuous bone, restoring mechanical strength. It depends on adequate blood supply, stability, and apposition, and failure leads to delayed union or non-union.

Injection of local anaesthetic into the subarachnoid space to block nerve roots, producing surgical anaesthesia and often hypotension from sympathetic blockade. It is used for lower abdominal, urological, and lower limb surgery and is avoided in coagulopathy or patient refusal.

A pharmacogenetic reaction to volatile anaesthetics or depolarising muscle relaxants causing uncontrolled muscle hypermetabolism, hypercapnia, rigidity, and hyperthermia. Treatment is immediate cessation of triggering agents, dantrolene, cooling, and aggressive supportive care.