Reading all the prescribed books during General Surgery residency, everyone knows that it is easier said than done. So it is necessary to know about few basic textbooks which are a must read.

You must have heard a very popular saying

"He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all."

So the first step to learn surgery is reading the right books and having enough working knowledge for clinical and surgical application.

Best General Surgery textbooks for Surgery Residents 

For reading general surgery, first book that comes to mind is Bailey and Love. As most of us have read it during our MBBS. But usually by the time we join General surgery residency, all the information stored in our brain evaporates. Bailey and Love is the preferred textbook for MRCS Part A and B examinations which aim to test basic surgical knowledge.

While choosing the best textbook for surgery you need to keep Surgery NEET SS and DNB CET SS entrance in mind. For MCh and DNB SS, in terms of depth of information, Bailey alone is not adequate.

Amongst Sabiston and Schwartz, Sabiston is usually the choice for NEET SS and DNB CET SS entrance. One of them must be read.

For your university exams SRB is a life saver, cannot miss its mention here. SRB tackles most of the topics from which Long notes and Short notes are asked in MS Gen Surgery university examinations.       

Bailey and Love's Short Practice Of Surgery

Good for surgery basics and UG level.

Sabiston's Textbook of Surgery 

If you want to choose one single textbook to read in your surgery residency, I would recommend Sabiston. Good illustrations and many high yield points asked in MCh/DrNB Entrance exams. Also, it is one of the best books to study Gi surgery from.

Schwartz's Principles Of Surgery

The only issue is information overload and not visually appealing.

 

Srb'S Manual Of Surgery

Last-minute book for university exams.

Best Operative Surgery textbooks for Surgery Residents

Reading a separate book for operative surgery is an important but neglected aspect in a surgical residency. They are typically used as reference books. Once you know the list of cases to be posted on the next day, it is advised to read and understand the relevant anatomy and operative steps before going to watch or assist the case. Many studies show that lack of perfect knowledge of operative steps can adversely impact the performance in surgery.  Any one of the following operative surgery books can be used:

Farquharson's Textbook of Operative General Surgery, 10th Edition

Operative Techniques in Surgery Hardcover by Michael W. Mulholland et al

Chassin's Operative Strategy in General Surgery

Video: BEST BOOKS TO READ DURING YOUR GENERAL SURGERY RESIDENCY

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Check out other posts on best surgery books:

SURGICAL NEET SS EXAM PREPARATION AND BOOKS

http://www.worldsurgeryforum.net/2017/02/surgical-neet-ss-preparation-and-books.html

BEST BOOK FOR STUDYING CLINICAL EXAMINATION FOR MRCS PART B

http://www.worldsurgeryforum.net/2016/12/best-book-for-studying-clinical.html

TOP BOOKS TO STUDY CLINICAL SURGERY

http://www.worldsurgeryforum.net/2016/05/top-books-to-study-clinical-surgery.html

HOW TO CRACK MRCS PART A AND THE BEST BOOKS FOR MRCS PART A PREPARATION

http://www.worldsurgeryforum.net/2016/04/how-to-crack-mrcs-part-and-best-books.html

3/31/2021 10:00:00 PM

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6/25/2020 10:20:00 PM

 

Laparoscopy, Pneumoperitoneum

What are various options for creating pneumoperitoneum?

CO2, N2O, Air, Helium, Neon and Argon

What is the problem with using Air for insufflation?

• The problem with using air insufflation is that nitrogen of air is poorly soluble in blood and is slowly absorbed across the peritoneal surfaces. 
• Air pneumoperitoneum was believed to be more painful than nitrous oxide (N2O) pneumoperitoneum. 
• However air is less painful than carbon dioxide (CO2) pneumoperitoneum.    

What are the advantages of using N2O as an insufflating agent?

• N2O has the advantage of being physiologically inert and rapidly absorbed. It also provided better analgesia for laparoscopy performed under local anesthesia when compared with CO2 or air.
• Despite initial concerns that would not suppress combustion, controlled clinical trials have established its safety within the peritoneal cavity.
• N2O has been shown to reduce the intraoperative end-tidal CO2 and minute ventilation required to maintain homeostasis when compared to CO2 pneumoperitoneum.

What are issues with using inert gases for insuffluation?

• Alternative gases that have been suggested for laparoscopy include the inert gases helium, neon, and argon. 
• These gases are appealing because they cause no metabolic effects, but are poorly soluble in blood (unlike CO2 and N2O) and are prone to create gas emboli if the gas has direct access to the venous system

What are various local and systemic effects of Carbon dioxide gas insufflated into the peritoneal cavity ?

Local and systemic effects of CO2 pneumoperitoneum

 

What is most common arrhythmia caused due to pneumoperitoneum?

• The most common arrhythmia created by laparoscopy is bradycardia. 
• A rapid stretch of the peritoneal membrane often causes a vagovagal response with bradycardia and, occasionally, hypotension. 
• The appropriate management of this event is desufflation of the abdomen, administration of vagolytic agents (e.g., atropine), and adequate volume replacement   

"Serum cortisol levels after laparoscopic operations are often higher than after the equivalent operation performed through an open incision." Is the statement True/ False?

• True, however there is more rapid equilibration of most stress-mediated hormone levels after laparoscopic surgery

 What is the maximal pressure range for pneumoperitoneum?

• The abdomen is inflated with a pressure-limited insufflator. CO2 gas usually is used, with maximal pressures in the range of 14 to 15 mmHg    

References

Schwartzs 10th ed (http://amzn.to/1q10JSc)

5/22/2016 09:42:00 PM

Continuing with the MCQ which I posted yesterday, today let's go through the answers and in-depth review of the concepts around obstructive jaundice. Here I would try and cover as many surgery viva questions on Obstructive jaundice as I can.

If you want to go through the question again, here is the link.

Firstly in relation to the the picture which was attached to the last post showing the yellow stained sclera of a jaundice person. The first question was

What is the lowest level of bilirubin to detect jaundice in the sclera? 

Answer: At a total serum bilirubin of 42.8 mmol/l (2.5 mg/dl) and 53.0 mmol/l (3.1 mg/dl), 58% (95% confidence interval [CI] 33-80%) and 68% (95% CI 46-85%) of examiners detected the presence of scleral icterus, respectively [1]

Q.2: What can be the cause of this presentation.
1. Liver cirrhosis with spontaneous bacterial peritonitis
2. Carcinoma of periampullary region with spontaneous bacterial peritonitis
3. Acute Fulminant Viral Hepatitis
4. Carcinoma Stomach with liver metastasis and peritoneal seeding

 Answer: 2. Carcinoma of periampullary region with spontaneous bacterial peritonitis

Points in favour of Periampullary Ca

• Painless progressive jaundice with clay colored stools
• SAP was found to elevated more than 3 times the normal value and mildly elevated ALT/AST
• He does not report any fever at the onset of jaundice. The onset of jaundice was Insidious. History of 2 days of fever can be attributed to SBP. 
• He is a young individual, though he is an alcoholic, but alcoholic liver disease and liver cirrhosis would take quite a long time of exposure to heavy drinking to present.
• Obstructive jaundice due to metastasis will be seen in advanced stages and usually jaundice will not be the first presenting symptom

To confirm our diagnosis we would do a CECT of the abdomen.

Obstructive Jaundice: Points to remember

Differential Diagnosis of Obstructive Jaundice

Intrahepatic cholestasis.

1. PBC.
2. Drugs (for example, phenothiazines).
3. Primary sclerosing cholangitis
4. Dubin-Johnson syndrome: autosomal recessive disorder characterised by conjugated hyperbilirubinaemia and deposition of pigment in hepatocytes.
5. Rotor's syndrome.

Extrahepatic Cholestasis

From within the lumen, in the wall of the duct or from external compression

1. Choledocholithiasis
2. Periampullary Ca
3. Ca Gallbladder
4. Cholangiocarcinoma involving bile duct
5. Lymph node mass in the porta causing biliary obstruction
6. Bile duct stricture
7. Sclerosing Cholangitis
8. Chronic Pancreatitis with duct obstruction

What is Courvoisier's Law?

In cases of jaundice:

• If Gall bladder is palpable, it is not due to choledocholithiasis (Secondary CBD Stone), as it will get fibrosed due to cholecystitis by ongoing disease process and not get distended.

What are exceptions of Courvoisier's Law?

• Double impact action of stone- one at common bile duct and another at cystic duct
• Primary CBD stone
• Distended Gall bladder due to large stone load

---To Be Continued---

References

http://www.ncbi.nlm.nih.gov/pubmed/9271910
http://patient.info/doctor/jaundice-pro

4/19/2016 11:12:00 PM