Long cases in surgery
,Surgery
Content overview
The long case
1. General approach to the long case in surgery
Presenting your case
Preoperative preparation of a patient for surgery
Fluid management of a surgical patient
Post operative management
2. Long cases
Neck lump
Thyroid
Breast lump
Abdominal pain
Peptic ulcer disease
Acute and chronic pancreatitis
Gallstone disease
Ureteric colic
Abdominal mass
Epigastric
Dysphagia
Dyspeptic symptoms
PR bleeding
Carcinoma of the large bowel
Alteration of bowel habits
Obstructive jaundice
Hematuria
Lower urinary tract symptoms
Peripheral vascular disease
,Presenting your case
History and examination
Always remember that the history and examination of a surgery long case should be targeted. The
following objectives should be covered by your history and examination.
Introduction of the patient
Introduction of the patient medically – Was the patient well before the current complaint? Does
the patient have any other important co morbid diseases that could have a direct impact on the
management?
Obtain a differential diagnosis for the presenting complaint and arrive at the most probable one
Assess for complications
Look for the possible aetiology for the suspected condition
Assess the fitness for surgery
Assess the social factors such as the impact of the condition on the patient’s day to day life,
family support and options for rehabilitation of the patient after treatment
Summary and problem list
This is an important aspect of the case presentation. Sometimes this is all that you may be asked during
the presentation component.
Discussion
The discussion of the case will focus on certain key aspects of the case.
What is the diagnosis/ differential diagnosis?
When giving your diagnosis the following aspects should be covered
Anatomical diagnosis
Pathological diagnosis
Complications
Possible aetiology
Why do you say so?
Be careful when answering this question. Think of your differential diagnosis. List the points in
the history and examination which support the diagnosis and those points which are against the
diagnosis. This will help you to discuss better
How will you investigate this patient?
Answer that investigations will be carried out to; confirm the diagnosis, assess for the
complications/spread, and to assess the fitness for surgery
How will you manage this patient?
Management should be discussed in the following components
Surgical management – Discussion will include preoperative preparation, anesthesia, basic facts
on the surgery, post operative management and postoperative complications
, Medical management
Discharge plan
Advice and follow up
The final part of the discussion may consist of some theory questions on the disease, pathology
and new advances in the treatment of the condition
,Surgery
Content overview
The long case
1. General approach to the long case in surgery
Presenting your case
Preoperative preparation of a patient for surgery
Fluid management of a surgical patient
Post operative management
2. Long cases
Neck lump
Thyroid
Breast lump
Abdominal pain
Peptic ulcer disease
Acute and chronic pancreatitis
Gallstone disease
Ureteric colic
Abdominal mass
Epigastric
Dysphagia
Dyspeptic symptoms
PR bleeding
Carcinoma of the large bowel
Alteration of bowel habits
Obstructive jaundice
Hematuria
Lower urinary tract symptoms
Peripheral vascular disease
,Presenting your case
History and examination
Always remember that the history and examination of a surgery long case should be targeted. The
following objectives should be covered by your history and examination.
Introduction of the patient
Introduction of the patient medically – Was the patient well before the current complaint? Does
the patient have any other important co morbid diseases that could have a direct impact on the
management?
Obtain a differential diagnosis for the presenting complaint and arrive at the most probable one
Assess for complications
Look for the possible aetiology for the suspected condition
Assess the fitness for surgery
Assess the social factors such as the impact of the condition on the patient’s day to day life,
family support and options for rehabilitation of the patient after treatment
Summary and problem list
This is an important aspect of the case presentation. Sometimes this is all that you may be asked during
the presentation component.
Discussion
The discussion of the case will focus on certain key aspects of the case.
What is the diagnosis/ differential diagnosis?
When giving your diagnosis the following aspects should be covered
Anatomical diagnosis
Pathological diagnosis
Complications
Possible aetiology
Why do you say so?
Be careful when answering this question. Think of your differential diagnosis. List the points in
the history and examination which support the diagnosis and those points which are against the
diagnosis. This will help you to discuss better
How will you investigate this patient?
Answer that investigations will be carried out to; confirm the diagnosis, assess for the
complications/spread, and to assess the fitness for surgery
How will you manage this patient?
Management should be discussed in the following components
Surgical management – Discussion will include preoperative preparation, anesthesia, basic facts
on the surgery, post operative management and postoperative complications
, Medical management
Discharge plan
Advice and follow up
The final part of the discussion may consist of some theory questions on the disease, pathology
and new advances in the treatment of the condition
