Compare & Recall: High-Yield Surgery Tables for NEET PG

Class I

Class II

Class III

Class IV

• Also known as clean wound 
• It includes 

• Uninfected operative wounds without inflammation 
• Respiratory, alimentary, genital, or urinary tract are not entered
• These wounds are closed primarily (if necessary drained with closed drainage)

• Also known as Clean contaminated wound
• It includes

• Operative wound in which the Respiratory tract, GIT, and Genito urinary tract are entered under controlled conditions without unusual contamination

• Also known as Contaminated wounds
• It includes

-Open, fresh Accidental wounds

-Operations with major breaks in sterile techniques or gross spillage from GIT

-Incisions in which acute non-purulent inflammation is encountered

• Also known as Dirty wound
• It includes 

-Old traumatic wound with retained devitalized tissue

-wound with clinical infection or perforated viscera with a high degree of contamination

-Organism causing postoperative infection is already present in the wound before the operation

-Associated with severe inflammation

• Examples

-Inguinal hernia operation

-Mastectomy

-Thyroidectomy

-Joint replacement

-Abdominal Aortic -Aneurysm repair

• Examples

-Cholecystectomy

-CBD exploration

-Elective Gl surgery (Elective colonic Resection, Elective Gastrectomy)

• Examples

Appendicular perforation

-Gastric perforation

-Enterotomy during bowel obstruction

-Human bite

-Open fracture

• Examples 

-Perforated diverticulitis 

-Fecal peritonitis 

-Presence of frank pus 

-Necrotizing soft tissue infection

HYPOTHYROIDISM

HYPERTHYROIDISM

• Decreased basal metabolic rate
• Weight gain
• Decreased appetite
• Confusion
• Middle ear effusion
• Bradycardia
• Diastolic hypertension
• Constipation
• In females:
  • Menorrhagia
  • Loss of hair 

• Weight loss
• Increased appetite
• Increased basal metabolic rate
• They have sympathetic stimulation. This causes:
  • Tachycardia
  • Heat intolerance 
  • Increased sweating

• GI symptoms involve:
  • Diarrhea

• In females:

  Amenorrhea Increased risk of abortions Infertility

The Chicago Classification of Esophageal Motility

Criteria

Achalasia and Esophagogastric Junction Outflow Obstruction

• Type I achalasia (Classic)
• Type II achalasia (with esophageal compression)
• Type III achalasia (Spastic achalasia)
• Esophagogastric junction outflow obstruction (achalasia in evolution)

• Median IRP >15 mm Hg, 100% failed peristalsis (DCI <100 mm Hg/s/cm); premature contractions with DCI <450 mm Hg-s-cm satisfy criteria for failed peristalsis. 
• Median IRP >15 mm Hg; 100% failed peristalsis, paraesophageal pressurization with ≥20% of swallows 
• Median IRP >15 mm Hg; no normal peristalsis, spastic contractions with DCI >450 mm Hg/s/cm with ≥20% of swallows.
• Median IRP >15 mm Hg; sufficient evidence of peristalsis such that criteria for types I-III are not met.

Major Disorders of Peristalsis

• Absent contractility
• Distal esophageal spasm
• Hypercontractile esophageal (nutcracker/jackhammer esophagus)

• Normal median IRP, 100% failed peristalsis
• Normal median IRP, >20% premature contractions with DCI >450 mmHg /s/cm. 
• At least 2 swallows with DCI 8000 mm Hg/s/cm.

Minor Disorders of Peristalsis

• Infective esophageal motility
• Fragmented peristalsis
• Normal esophageal motility

• >50% ineffective swallows
• >50% fragmented contractions with DCI >450 mm Hg-s-cm
• None of the above criteria are met

Crohn’s disease

Ulcerative colitis

Macroscopic features

• Distribution – Segmental with Skip areas

• Distribution – Continuous without Skip areas

• Location – Ileum (&/or) Cecum & Ascending colon

• Location – Rectum, Sigmoid & Extending upwards cranially

• Extent – Entire Thickness of Bowel wall

• Extent – Superficial, confined to mucosal layer

• Ulcers – Serpiginous ulcers that may develop into Deep ulcers

• Ulcers – Superficial mucosal ulcers

• Pseudo polyps – Rarely seen

• Pseudo polyps – Commonly seen

• Fibrosis - Common

• Fibrosis - Rare

• Shortening – Due to Fibrosis

• Shortening – Due to Contraction of Muscularis

Microscopic features

• Depth of inflammation – Transmural (mucosa + submucosa + Muscularis propria)

• Depth of inflammation – Mucosal + Submucosal

• Type of inflammation

• Non-Caseating granuloma
• Infiltrate of Mononuclear cells

• Type of inflammation

• Non-specific Acute & Chronic inflammatory cells

• Mucosal changes – Patchy Ulceration

• Mucosal changes - Hemorrhagic mucosa with ulceration

• Submucosa – Widened due to edema & lymphoid aggregates

• Submucosa – Normal or reduced in width

• Muscularis - Infiltrated by inflammatory cells

• Muscularis - Spared

• Fibrosis - Present

• Fibrosis - Absent

Complications

• Fistula formation – Internal & External fistula in 10% cases

• Fistula formation - Rare

• Malignant changes

• Colon cancer – UC = CD
• SI Malignancy – CD > UC
• Cholangiocarcinoma – UC > CD

• Fibrotic strictures - Common

• Fibrotic strictures - Rare

• Toxic Megacolon - Rare

• Toxic Megacolon - ↑sed risk

Named features

1. String sign of Kantor
2. Hose pipe appearance
3. Creeping fat sign
4. Comb sign
5. Raspberry Thorn / Rose Thorn appearance
6. Fat Halo sign

1. Garden hose appearance
2. Pipe stem colon
3. Lead pipe sign
4. Stove pipe appearance
5. Collar button ulcers

Hypertrophic scar

Keloid

• It is a widened or unsightly scar that does not grow beyond the original boundaries of the wound. 
• Its incidence is 40-70% following surgery and up to 91% following burns. 
• Predilection sites are shoulders, neck, presternum knees, and ankle. 
• No claw-like processes are there.

• There is no genetic predisposition. 
• Time course is usually between 4 to 8 weeks. There is regression for a few years. 
• It may be pruritic but it is non-tender. 
• There is no pain or hyperesthesia.
• It does not recur after excision if the causative factor is removed. 

• It is an abnormal scar that grows beyond the boundaries of the original site of injury. 
• Its incidence is 6-16% in African populations.
• It may involve the anterior chest, shoulders, ears, upper arm, cheeks, mandibular border, and posterior neck.
• Claw-like processes are present.
• There is familial transmission. 
• It occurs within years after minor injuries or it is spontaneous formation on the mid-chest in the absence of any known injury. It is persistent for a long period without regression. 

• It is pruritic and tender. 
• It may be associated with pain and hyperesthesia. 
• It recurs even after excision. 

EDH

(Extradural Hematoma/ Epidural Hematoma)

SDH

(Subdural Hematoma)

• Arterial blood collects between the skull and dura (peeled off)
• Does not cross the suture line
• Most common site - Temporal bone (pterion - the weakest part of the skull) (Trivial Trauma)
• Caused by injury to the middle meningeal artery
• Lucid interval is positive: it is the period of consciousness in between the periods

of unconsciousness.

• Characterized by collection of venous blood b/w dura & arachnoid (intact)
• Crosses the suture line
• Caused by injury to the cortical veins or bridging veins
• Acute SDH → < 3 days
• Subacute → 4-21 days
• Chronic → > 21 days or >3 weeks
• Elderly
• Usually caused by significant trauma
• Have impaired consciousness.

Investigation

• IOC for diagnosis - NCCT head
• In NCCT - shows biconvex or lenticular or lens- shaped hyperdense lesion

Investigation

• IOC for diagnosis - NCCT head
• In NCCT - shows concavo-convex hyperdense lesion

Treatment – Drainage by

• Burr hole
• Craniotomy

Treatment

• Conservative management for smaller SDH
• Drainage by Craniotomy for large SDH