Surgery notes for competitive examinations

Dr Sreeja S     

Intervals, Durations etc.

Abdomen

• Interval appendicectomy – two months after acute attack
• Appendicular mass resolves within three days or else it forms appendicular abscess by 5 to 10 days.
• Appendicular mass is to be operated immediately after it resolves.
• Cholecystectomy for acute cholecystits is preferably done after 8 to 10 weeks.
• Colostomy matures after two months and it can be closed thereafter.
• In carcinoma pancreas, death usually occurs in six months after obstructive jaundice.
• Chronic intestinal ischaemia—Pain in abdomen occurs in 30 minutes after food intake.
• Return of intestinal motility after operation occurs after 16 hours.
• Duodenal blow out occurs on 4th postoperative day of gastrectomy.
• Stoma should be open after polyagastrectomy by 3rd day.
• Stoma should be open after Billroth 1 operation in five days.
• Postoperative obstruction by fibrinous adhesions occurs in three to six postoperative days, m) Postoperative obstruction by fibrous adhesions—anytime,
• Splenectomy in hereditary spherocytosis done best at 7 years (if asymptomatic),
• Schistosomiasis (Egyptian splenomegaly)—Survival after ascites only 6 to 12 months,
• Obstructive appendicitis—Gangrene occurs in 12-18 hours.
• Choledochal cysts are seldom seen before six months of age.
• Acute pancreatitis—Pseudopancreatic cyst may form at the end of 2nd week. Abscess after 3rd week.

General

• Wound tensile strength approaches that of normal tissue by six months but 100% normal after 2 year only.
• Primary suture of wound—within six hours.
• Crushed and devitalised wounds. Delayed primary suture in 4 to 6 days after injury.
• Embolectomy is to be done within 10 hours.
• Graft rejection – Inflammation appears by 4th day (first set response). Sloughs appear by 10^th day. If again grafted from same donor (second set response) sloughs by 6th day.
• After starting treatment with stilbesterol, for prostatic carcinoma histological changes in 48 hr. Symptoms improve in 2 weeks and prostate smaller in size by 3 to 4 weeks. ;
• In thyrotoxicosis
  • Treatment with carbimazole, symptoms relieved after 7 to 14 days.
  • Treatment with I131 in 8 to 12 weeks, patient becomes asymptomatic.
  • Repeat the dose after 12 weeks if necessary. -1 Antithyroid drugs can be given 48 hr after I’31.
• Postoperative thyroid insufficiency manifests in 2 to 3 days after thyroidectomy.
• Response to iodine in thyrotoxicosis is seen in 24 hours (quickest acting).
• Parathyroid tetany manifests on 2nd or 3rd postoperative day after thyroidectomy.
• Pregnancy is contraindicated for 3 years after operation for breast carcinoma.
• In haemorrhage, physiologically fluid loss is replaced immediately.
• Stored blood for transfusion, platelets live for 3 days.
• RBC are suitable for transfusion for 3 weeks after collection.
• RBC become functional in the body 3 days after transfusion.
• Phenindione and dicumarol start acting after 36—48 hr.
• Prothrombin estimation not valid within 6 hr after heparin.

Paediatric Surgery

• Cleft lip operated at 3 months of age.
• Cleft palate operated at 1V2 to 2 years.
• Exomphalos major operated within few hours.
• Surgery for sacrococcygeal teratoma—soon after birth
• Orchipexy for undescended testes—2 years (essentially before puberty)
• Operation for Hirschprung’s disease—after the child gains 8 kg weight and is well thriving
• Hirschsprung’s disease, symptoms appear in 3 days after birth
• Congenital hypertrophic pyloric stenosis—symptoms appear at 3 to 6 weeks of age
• Ectopia vesicae—Diversion of urine best done at 4 to 6 weeks.
• Operation for patent vitellointestinal duct at 6 months of age
• Neonatal tetanus occurs within 5-15 days. Usually around 8th day. So called 8th dayisease.
• Operation for ASD—first decade
• Operation for PDA—before the child goes to school
• Fallot’s tetralogy in infancy—palliative correction
• Posterior fontanelle closes at the age of 4 months.
• Anterior fontanelle closes at the age of 9-18 months,
• Newborn passes urine usually within 24 hours,
• Newborn passes meconium usually within 12 hours,
• Witch’s milk appears on 3rd day; disappears in 3 weeks,
• Alpha-fetoprotein disappears in a few weeks after birth.

Neurosurgery

• Reaction of degeneration occurs in 3 weeks after nerve injury.
• Irreversible changes at motor end plates after denervation seen after 18 months.
• Meningitis after head injury develops in 3-5 days.
• Extradural haemorrhage usally presents before 18 hours after injury.
• In head injury, prophylactic anticonvulsants are given forj6 weeks.
• In post-traumatic epilepsy, or after major head injury, antiepilepties are given for 3 years.
• Idiopathic epilepsy is rare before 6 years and after 30 years, h)   Spinal concussion—Recovery occurs in 24-48 hours.
• Spinal injury—Mass reflex appears at 3-6 weeks.

Orthopaedics

• Menisci injury heals in 6 weeks.
• X-ray signs in osteomyelitis seen in 2-3 weeks.
• Angular deformities of limbs (genu valgum or varus) and in-toeing spontaneously correct by 6 weeks. If necessary, correction done after 6 weeks
• In-toeing in girls for cosmetic purpose—operation at about 11 years of age.
• Earliest X-ray sign in myositis ossificans is a cloud of new bone by 4-6 weeks after injury

Medicine

• Pulmonary infarction signs detectable in X-ray in 12 hours.
• X-ray positive for pneumonia 12-18 hours after symptoms appear.
• Vitamin C stores last for 21/2 to 3 months.
• B12 stores last for 3 years.
• Thiamine stores last for few weeks.
• Drug induced hepatitis occurs within 2 weeks after drug intake.
• Recovery of vision in multiple sclerosis occurs usually 4-6 weeks after attack.
• Post streptococcal glomerulonephritis—1 to 3 weeks after streptococcal infection. Post
• streptococcal rheumatic fever 2-3 weeks after sore throat,
• After myocardial infarction, leukocytosis peaks on 1st day, fever peaks on 3rd or 4th day
• Dressier’s syndrome – few weeks or months after myocardial infarction; recovers in a fewdays.
• Myocardial infarction surgical repair lesions after 6 weeks.
• Time to reach normal counts in CML with busulphan: 12-18 weeks,
• Idiopathic thrombocytopenic purpura remits in young in 2-3 weeks,
• Rose-Waaler test in rheumatoid arthritis positive after 18 months,
• Reiter’s disease—1-3 weeks after sexual intercourse or dysentery.

Gynaecology and Obstetrics

• Myomectomy—6 months after caesarian.
• Time for Huhner’s test or Sim’s test—2 hours after and within 16 hours of intercourse.
• Fistulas develop 10 days after ureteral ligation or interfering with its blood supply.
• In prolonged labour, the urinary fistulae develop usually on 5th day.
• Forceps etc., instrumentation—the urinary fistulas develop immediately. 

Download the complete articles: www.homeobook.com/pdf/surgery-notes-study-materials.pdf