PGIM CSE Surgical Specialties key terms

A surgical incision into the abdominal cavity, usually through the midline, performed for emergency exploration, trauma, or access to intra-abdominal organs when a minimally invasive route is unsuitable.

A staged approach in severely injured or physiologically unstable patients in which only bleeding and contamination are controlled at the first operation, with definitive reconstruction deferred until normal physiology is restored.

Failure of a surgical join between two bowel ends or between bowel and another structure, allowing luminal contents to escape, presenting with sepsis, peritonitis, or a persistent collection.

Organ dysfunction caused by sustained intra-abdominal pressure above about 20 mmHg, producing respiratory, renal, and cardiovascular compromise and requiring decompression, usually by opening the abdomen.

Resection of the rectosigmoid with closure of the rectal stump and formation of a terminal colostomy, commonly used in emergency left-sided disease when primary anastomosis is considered unsafe.

A multimodal perioperative care pathway using preoperative counselling, carbohydrate loading, opioid-sparing analgesia, early feeding, and early mobilisation to shorten hospital stay and reduce complications.

Preoperative optimisation of a patient's physical function, nutrition, and psychological readiness before major surgery, aiming to reduce postoperative complications and speed recovery.

Temporary, non-mechanical cessation of gastrointestinal motility after surgery, causing nausea, distension, absent bowel sounds, and intolerance of oral intake, usually resolving with supportive care.

A clinical classification of chronic liver disease severity based on bilirubin, albumin, prothrombin time, ascites, and encephalopathy, used to estimate operative risk and prognosis.

Abnormally raised pressure in the portal venous system, usually from cirrhosis, causing varices, ascites, splenomegaly, and risk of life-threatening haemorrhage.

Pancreaticoduodenectomy, the resection of the pancreatic head, duodenum, distal bile duct, and often part of the stomach, with reconstruction by three anastomoses, used for periampullary and pancreatic head tumours.

Leakage of pancreatic juice from a pancreatic anastomosis or resection margin after pancreatic surgery, graded by clinical impact, and a leading cause of morbidity after pancreaticoduodenectomy.

Yellow discolouration and cholestasis caused by blockage of bile flow, typically from stones or tumour, producing dark urine, pale stools, pruritus, and risk of cholangitis.

Infection of the biliary tract, usually complicating obstruction, presenting with fever, jaundice, and right upper quadrant pain, and requiring antibiotics plus urgent biliary drainage.

An endoscopic technique that cannulates the bile and pancreatic ducts for imaging, stone removal, stenting, or tissue sampling, carrying a recognised risk of pancreatitis and bleeding.

Sharp dissection of the rectum within its enveloping mesorectal fascia, removing the rectum and its lymphatic drainage as an intact package, which reduces local recurrence in rectal cancer.

A cluster of bowel dysfunction after sphincter-preserving rectal surgery, including urgency, frequency, fragmentation, and incontinence, which may improve over time but can persist.

A surgically created opening of bowel onto the abdominal wall, either ileostomy or colostomy, to divert faeces or urine, requiring appliance care and attention to output, skin, and hydration.

Identification and removal of the first draining lymph node or nodes from a tumour using dye or radiotracer, used to stage the axilla or groin while avoiding unnecessary full dissection.

Removal of axillary lymph nodes at levels I and II for proven nodal disease, providing staging and local control at the cost of lymphoedema, nerve injury, and shoulder stiffness.

Removal of a breast tumour with clear margins while preserving the remaining breast, usually combined with radiotherapy, as an alternative to mastectomy in suitable patients.

Chronic swelling caused by impaired lymphatic drainage, commonly of an arm after axillary treatment or a leg after groin dissection, managed with compression, exercise, and skin care.

Risks of thyroid removal include recurrent laryngeal nerve injury causing hoarseness, hypocalcaemia from parathyroid disturbance, haematoma with airway compromise, and thyroid storm.

A branch of the vagus nerve running close to the thyroid and tracheo-oesophageal groove, controlling most vocal cord muscles, and vulnerable to injury during thyroid, parathyroid, and oesophageal surgery.

A permanent focal dilatation of the abdominal aorta, usually defined as diameter over 3 cm, which may rupture and is monitored by size and repaired electively or urgently.

Exclusion of an aortic aneurysm by deploying a stent-graft through the femoral arteries, avoiding a major abdominal incision but requiring lifelong imaging surveillance for endoleak.

Sudden loss of arterial perfusion to a limb, presenting with pain, pallor, pulselessness, paraesthesia, and paralysis, and requiring urgent revascularisation to prevent irreversible tissue loss.

Raised pressure within a closed fascial compartment that compromises perfusion, causing disproportionate pain, tense swelling, and sensory change, and needing urgent fasciotomy.

A fracture with a wound communicating with the fracture site, requiring urgent antibiotics, tetanus cover, debridement, and stabilisation to reduce deep infection and non-union.

A scored assessment of eye opening, verbal response, and motor response, ranging from 3 to 15, used to grade and monitor level of consciousness after head injury.

The pressure within the rigid skull, normally kept low by cerebrospinal fluid and blood volume regulation; sustained elevation risks herniation and secondary brain injury.

Blood accumulating between skull and dura, often from middle meningeal artery injury, producing a lucid interval followed by deterioration and requiring urgent surgical evacuation.

A circuit that temporarily takes over oxygenation and circulation while the heart is stopped, allowing surgery on the arrested heart, and carrying risks of bleeding, stroke, and systemic inflammation.

Surgical revascularisation of obstructed coronary arteries using arterial or venous conduits, indicated for certain patterns of multivessel or left main disease and for selected acute presentations.

Air trapped in the pleural space under pressure, shifting mediastinal structures and impairing venous return, requiring immediate needle or finger decompression before imaging.

A tube placed into the pleural space to remove air, blood, or fluid and restore lung expansion, requiring attention to swing, bubbling, drainage volume, and safe removal.

Endoscopic removal of obstructing prostate tissue through the urethra for benign enlargement, with risks including bleeding, infection, retrograde ejaculation, and dilutional hyponatraemia.

Non-malignant enlargement of the prostate transition zone causing lower urinary tract symptoms, retention, or infection, treated with medication or surgical resection.

A soft tube placed in the ureter to maintain urine flow past an obstruction or after instrumentation, often left with a string or requiring later removal, and associated with discomfort and infection.

Transfer of epidermis and part or all of the dermis from a donor site to a wound bed, requiring adequate vascularity and immobilisation, and distinguished from flaps by lacking its own blood supply.

Transfer of tissue with its own blood supply, either pedicled or free, to cover defects, restore contour, or reconstruct function after excision, trauma, or infection.

Hypertrophy of the pyloric muscle in early infancy causing projectile non-bilious vomiting, dehydration, and hypochloraemic alkalosis, treated after correction of metabolic derangement by pyloromyotomy.

Telescoping of one segment of bowel into the next, usually ileocolic in young children, causing colicky pain, vomiting, and redcurrant-jelly stool, often reduced by air enema.

A pharmacogenetic reaction to volatile anaesthetics or depolarising muscle relaxants causing hyperthermia, rigidity, and hypermetabolism, managed by stopping the trigger and giving dantrolene.

Measures to prevent deep vein thrombosis and pulmonary embolism in surgical patients, selected by risk assessment and including early mobilisation, mechanical devices, and anticoagulants.

A structured team verification before induction, before incision, and before leaving theatre, confirming patient identity, site, allergies, equipment, and anticipated critical events.

A serious, largely preventable patient safety incident, such as wrong-site surgery or retained surgical item, that should not occur and triggers mandatory investigation.

A patient's voluntary agreement to treatment after receiving and understanding information about the condition, proposed procedure, alternatives, and material risks, documented before surgery.

A person's ability to understand, retain, weigh, and communicate a decision about treatment, assessed at the time it is needed and presumed unless shown otherwise.

A professional obligation to be open and honest with patients when something goes wrong in their care, including apologising, explaining what happened, and offering remedy.