NEWS

General Surgery

Concerned with diseases that can be managed by surgical means and the various types and methods of surgical procedures.

Objectives

At the end of the training, the undergraduate student should be able to

  1. Diagnose and appropriately treat common surgical ailments
  2. Identify situations calling for urgent or early surgical intervention and refer at the optimum time to the appropriate centres
  3. Requisition and interpret basic relevant investigations
  4. Provide adequate pre- and post-operative and follow-up care of surgical patients;
  5. Counsel and guide patients and relatives regarding needs, implications, and problems of surgery in the individual patient
  6. Develop adequate and right attitude in dealing with surgical problems of patients
  7. Provide emergency resuscitative measures in acute surgical situations, including trauma.
  8. Organise and conduct relief measures in situations of mass casualties.
  9. Effectively participate in the National Health Programme, especially the Family Welfare Programme.
  10. discharge effectively medico-legal and ethical responsible ties, k. Perform simple routine surgical procedures
Course Contents
  1. TRAUMA
  • General principles in diagnosis, first aid and treatment methods of closed and open fractures, open reduction including principles of internal fixation and external fixation, their complications, and preserving amputated parts before transfer.
  • General principles of diagnosis and management of non-unions and delayed unions.
  1. DIAGNOSIS, FIRST AID AND REFERRAL OF
    1. Fracture clavicle.
    2. Anterior dislocation of the shoulder.
    3. Fracture proximal end, shaft, supracondylar, and internal condylar humerus.
    4. Posterior dislocation of the elbow.
    5. Fracture shaft of radius and ulna.
    6. Fracture of the distal radius.
    7. Traumatic dislocation of the hip.
    8. Fracture of femur neck, trochanter and shaft.
    9. Fracture patella.
    10. Fracture shaft tibia and fibula.
    11. Haemarthrosis, traumatic synovitis.
    12. Injury to muscles and ligaments (shoulder arc syndrome, tennis elbow, ankle sprain).
    13. General principles of management of hand injuries.
    14. Peripheral nerve injuries.
    15. Spinal injuries.
    16. Fracture of olecranon.
    17. Monteggia fracture dislocation.
    18.  Complications of fracture: Fat embolism, Ischaemic contracture, myositis ossificans, osteodystrophy.
III. INFECTIONS OF BONES AND JOINTS Diagnosis and Principles of Management
  1. Osteomyelitis: pyogenic, tubercular, fungal (Madurafoot), syphilitic and parasitic infection of the bone.
  2. Arthritis: septic and tubercular.
  3. Tuberculosis of the spine.
  4. Leprosy – principles of corrective surgery.
IV. TUMOURS Diagnosis and Principles of Management
  1. Benign lesions: Multiple exostoses, Enchondroma, Osteoid osteoma, Simple bone cyst. Osteochondroma.
  2. Malignant lesions: Osteosarcoma, Ewing’s sarcoma, Giant cell tumor, Chondrosarcoma and Secondary deposits.
V. DEGENERATIVE DISEASES Diagnosis and Principles of Management
  1. Osteoarthritis.
  2. Spondylosis.
  3. Degenerative disc diseases.
VI. CONGENITAL ANOMALIES Diagnosis and Principles of Management
  1. Congenital dislocation hip.
  2. Congenital talipes equinovarus.
  3. Pes Planus.
VII. BONE DYSPLASIA Diagnosis and Principles of Management
  1. Osteogenesis imperfecta.
  2.  Achondroplasia.

VIII. NEURO-MUSCULAR DISORDERS Diagnosis and Principles of Management
  1. Post-polio residual Paralysis.
  2. Cerebral palsy.
IX. OSTEOCHONDROSES Diagnosis and Principles of Management
  1. Perthe’s disease
X. DEFORMITIES
  1. Scoliosis – diagnosis and referral.
  2. GenuVarum and Valgum -diagnosis.
XI. PREVENTIVE ORTHOPAEDICS
XII. BASIC PRINCIPLES OF PHYSIOTHERAPYOCCUPATIONAL THERAPY AND ORTHOTICS / PROSTHETICS
  1. Physiatric evaluation of common neurological diseases.
  2. Physiatric evaluation of common orthopaedic conditions.
  3. Principles of Exercise therapy, Electrotherapy and Occupational therapy.
  4. Principles of Orthotics and Prosthetics. Principles of Cardiopulmonary Rehabilitation.

SKILLS

 Obtain a proper relevant history and perform a humane and thorough clinical examination, including internal examinations (per-rectal and per-vaginal) and examinations of all organs/systems in adults and children.

  1. Arrive at a logical working diagnosis after clinical examination.
  2. Order appropriate investigations keeping in mind their relevance (need-based) and cost-effectiveness.
  3. Plan and institute a line of treatment which is need based, cost-effective and appropriate for common ailments taking into consideration Patient
    • Recognise situations which call for urgent or early treatment at secondary and tertiary centres and make a prompt referral of such patients after giving first aid or emergency treatment.
    • Demonstrate empathy and humane approach towards patients, relatives and attendants.
    • Develop a proper attitude towards patients, colleagues and other staff.
    • Demonstrate interpersonal and communication skills befitting a surgeon to discuss the illness and its outcome with the patient and family.
    • Establish rapport and talk to patients, relatives and the community regarding all aspects of medical care and disease.
    • Write a complete case record with all necessary details.
    • Write a proper discharge summary with all relevant information.
    • Write a proper referral note to secondary or tertiary centres or other surgeons with all necessary details.
    • Assess the need for and issue proper medical certificates to patients for various purposes.
    • Maintain ethical behaviour in all aspects of medical practice.
    • Appreciate patients’ right to privacy.
    • Obtain informed consent for any examination/procedure.
    • Be able to do surface marking of common superficial arteries, veins, nerves and viscera.
    • Assess and manage fluid/electrolyte and acid-base imbalance.
    • Adopt universal precautions for self-protection against HIV and hepatitis and counsel patients.
    • Start i.v. line and infusion in adults, children and neonates.
    • Do venous cutdown.
    • Give intradermal / SC / IM / IV injection.
    • Insert and manage a C.V.P. line.
    • Conduct CPR (Cardiopulmonary resuscitation) and first aid in newborns, children and adults, including endotracheal intubation.
    • Pass a nasogastric tube.
    • Pass a stomach tube and do a stomach wash.
    • Perform vasectomy.
    • Perform circumcision,
    • Perform reduction of paraphimosis.
    • Do Proctoscopy.
    • Do injection and banding of piles.
    • Incise and drain superficial abscesses; do dressing.
    • Manage superficial wounds and do suture of superficial wounds & wound toilet.
    • Remove small cutaneous/subcutaneous swellings.
    • Control external haemorrhage.
    • Catheterise bladder in both males and females.
    • Perform nerve blocks like infiltration, digital, pudendal, paracervical and field blocks.
    • Relieve tension pneumothorax by inserting a needle.
    • Insert flatus tube.
    • Provide first aid to patients with peripheral vascular failure and shock.
    • Assess the degree of burns and administer emergency management.