The abdomen constitutes the part of the body between the thorax and pelvis, in humans and in other vertebrates. The abdomen is the frontal part of the abdominal segment of the trunk, the dorsal part of this segment being the back of the abdomen; the region occupied by the abdomen is termed the abdominal cavity. In arthropods it is the posterior tagma of the body; the abdomen stretches from the thorax at the thoracic diaphragm to the pelvis at the pelvic brim. The pelvic brim stretches from the lumbosacral joint to the pubic symphysis and is the edge of the pelvic inlet; the space above this inlet and under the thoracic diaphragm is termed the abdominal cavity. The boundary of the abdominal cavity is the abdominal wall in the front and the peritoneal surface at the rear; the abdomen contains most of the tubelike organs of the digestive tract, as well as several solid organs. Hollow abdominal organs include the stomach, the small intestine, the colon with its attached appendix. Organs such as the liver, its attached gallbladder, the pancreas function in close association with the digestive tract and communicate with it via ducts.
The spleen and adrenal glands lie within the abdomen, along with many blood vessels including the aorta and inferior vena cava. Anatomists may consider the urinary bladder, fallopian tubes, ovaries as either abdominal organs or as pelvic organs; the abdomen contains an extensive membrane called the peritoneum. A fold of peritoneum may cover certain organs, whereas it may cover only one side of organs that lie closer to the abdominal wall. Anatomists call the latter type of organs retroperitoneal. Digestive tract: Stomach, small intestine, large intestine with cecum and appendix Accessory organs of the digestive tract: Liver and pancreas Urinary system: Kidneys and ureters – but technically located in retroperitoneum – outside peritoneal membrane Other organs: SpleenAbdominal organs can be specialized in some animals. For example, the stomach of ruminants is divided into four chambers – rumen, reticulum and abomasum. In vertebrates, the abdomen is a large cavity enclosed by the abdominal muscles and laterally, by the vertebral column dorsally.
Lower ribs can enclose ventral and lateral walls. The abdominal cavity is upper part of the pelvic cavity, it is attached to the thoracic cavity by the diaphragm. Structures such as the aorta, inferior vena cava and esophagus pass through the diaphragm. Both the abdominal and pelvic cavities are lined by a serous membrane known as the parietal peritoneum; this membrane is continuous with the visceral peritoneum lining the organs. The abdomen in vertebrates contains a number of organs belonging, for instance, to the digestive tract and urinary system. There are three layers of the abdominal wall, they are, from the outside to the inside: external oblique, internal oblique, transverse abdominal. The first three layers extend between the vertebral column, the lower ribs, the iliac crest and pubis of the hip. All of their fibers merge towards the midline and surround the rectus abdominis in a sheath before joining up on the opposite side at the linea alba. Strength is gained by the criss-crossing of fibers, such that the external oblique are downward and forward, the internal oblique upward and forward, the transverse abdominal horizontally forward.
The transverse abdominal muscle is triangular, with its fibers running horizontally. It lies between the underlying transverse fascia, it originates from Poupart's ligament, the inner lip of the ilium, the lumbar fascia and the inner surface of the cartilages of the six lower ribs. It inserts into the linea alba behind the rectus abdominis; the rectus abdominis muscles are flat. The muscle is crossed by three fibrous bands called the tendinous intersections; the rectus abdominis is enclosed in a thick sheath formed, as described above, by fibers from each of the three muscles of the lateral abdominal wall. They originate at the pubis bone, run up the abdomen on either side of the linea alba, insert into the cartilages of the fifth and seventh ribs. In the region of the groin, the inguinal canal, a passage through the layers; this gap is where the testes can drop through the wall and where the fibrous cord from the uterus in the female runs. This is where weakness can form, cause inguinal hernias.
The pyramidalis muscle is triangular. It is located in the lower abdomen in front of the rectus abdominis, it is inserted into the linea alba halfway up to the navel. Functionally, the human abdomen is where most of the alimentary tract is placed and so most of the absorption and digestion of food occurs here; the alimentary tract in the abdomen consists of the lower esophagus, the stomach, the duodenum, the jejunum, the cecum and the appendix, the ascending and descending colons, the sigmoid colon and the rectum. Other vital organs inside the abdomen include the kidneys, the pancreas and the spleen; the abdominal wall is split into the posterior and anterior walls. The abdominal muscles have different important functions, they assist in the breathing process as accessory muscles of respiration. Moreover, these muscles serve as protection for the inner organs. Furthermore, together with the back muscles they provide postural support and are important in defining the form; when the glottis is closed and the thorax and pelvis are fixed, they are integral in the cough, defecation, childbirth and singing functions.
Nasogastric intubation is a medical process involving the insertion of a plastic tube through the nose, past the throat, down into the stomach. Orogastric intubation is a similar process involving the insertion of a plastic tube through the mouth. A nasogastric tube is used for feeding and administering drugs and other oral agents such as activated charcoal. For drugs and for minimal quantities of liquid, a syringe is used for injection into the tube. For continuous feeding, a gravity based system is employed, with the solution placed higher than the patient's stomach. If accrued supervision is required for the feeding, the tube is connected to an electronic pump which can control and measure the patient's intake and signal any interruption in the feeding. Nasogastric tubes may be used as an aid in the treatment of life threatening eating disorders if the patient is not compliant with eating. Nasogastric aspiration is the process of draining the stomach's contents via the tube. Nasogastric aspiration is used to remove gastrointestinal secretions and swallowed air in patients with gastrointestinal obstructions.
Nasogastric aspiration can be used in poisoning situations when a toxic liquid has been ingested, for preparation before surgery under anaesthesia, to extract samples of gastric liquid for analysis. If the tube is to be used for continuous drainage, it is appended to a collector bag placed below the level of the patient's stomach, it can be appended to a suction system, however this method is restricted to emergency situations, as the constant suction can damage the stomach's lining. In non-emergency situations, intermittent suction is applied giving the benefits of suction without the untoward effects of damage to the stomach lining. Suction drainage is used for patients who have undergone a pneumonectomy in order to prevent anesthesia-related vomiting and possible aspiration of any stomach contents; such aspiration would represent a serious risk of complications to patients recovering from this surgery. Types of nasogastric tubes include: Levin catheter, a single lumen, small bore NG tube.
It is more appropriate for administration of nutrition. Salem Sump catheter, a large bore NG tube with double lumen; this avails for aspiration in one lumen, venting in the other to reduce negative pressure and prevent gastric mucosa from being drawn into the catheter. Dobhoff tube, a small bore NG tube with a weight at the end intended to pull it by gravity during insertion. Before an NG tube is inserted, it must be measured from the tip of the patient's nose, loop around their ear and down to 5 cm below the xiphoid process; the tube is marked at this level to ensure that the tube has been inserted far enough into the patient's stomach. Many commercially available stomach and duodenal tubes have several standard depth markings, for example 18", 22", 26" and 30" from distal end; the end of a plastic tube is inserted into one of the patient's anterior nares. Treatment with 2.0 mg of IV midazolam reduces patient stress. The tube should be directed straight towards the back of the patient as it moves through the nasal cavity and down into the throat.
When the tube enters the oropharynx and glides down the posterior pharyngeal wall, the patient may gag. Once the tube is past the pharynx and enters the esophagus, it is inserted down into the stomach; the tube must be secured in place to prevent it from moving. Great care must be taken to ensure that the tube has not passed through the larynx into the trachea and down into the bronchi; the reliable method is to aspirate some fluid from the tube with a syringe. This fluid is tested with pH paper to determine the acidity of the fluid. If the pH is 4 or below the tube is in the correct position. If this is not possible correct verification of tube position is obtained with an X-ray of the chest/abdomen; this is the most reliable means of ensuring proper placement of an NG tube. The use of a chest x-ray to confirm position is the expected standard in the UK, with Dr/ physician review and confirmation. Future techniques may include measuring the concentration of enzymes such as trypsin and bilirubin to confirm the correct placement of the NG tube.
As enzyme testing becomes more practical, allowing measurements to be taken and cheaply at the bedside, this technique may be used in combination with pH testing as an effective, less harmful replacement of X-ray confirmation. If the tube is to remain in place a tube position check is recommended before each feed and at least once per day. Only smaller diameter nasogastric tubes are appropriate for long-term feeding, so as to avoid irritation and erosion of the nasal mucosa; these tubes have guidewires to facilitate insertion. If feeding is required for a longer period of time, other options, such as placement of a PEG tube, should be considered. Function of an NG tube properly placed and used for suction is maintained by flushing; this may be done by flushing small amounts of saline and air using a syringe or by flushing larger amounts of saline or water, air, assessing for the air to circulate
An analgesic or painkiller is any member of the group of drugs used to achieve analgesia, relief from pain. Analgesic drugs act in various ways on the central nervous systems, they are distinct from anesthetics, which temporarily affect, in some instances eliminate, sensation. Analgesics include paracetamol, the nonsteroidal anti-inflammatory drugs such as the salicylates, opioid drugs such as morphine and oxycodone; when choosing analgesics, the severity and response to other medication determines the choice of agent. Analgesic choice is determined by the type of pain: For neuropathic pain, traditional analgesics are less effective, there is benefit from classes of drugs that are not considered analgesics, such as tricyclic antidepressants and anticonvulsants. Topical nonsteroidal anti-inflammatory drugs provided pain relief in common conditions such as muscle sprains and overuse injuries. Since the side effects are lesser, topical preparations could be preferred over oral medications in these conditions.
Each different type of analgesic has its own associated side effects. Analgesics are classified based on their mechanism of action. Paracetamol known as acetaminophen or APAP, is a medication used to treat pain and fever, it is used for mild to moderate pain. In combination with opioid pain medication, paracetamol is now used for more severe pain such as cancer pain and after surgery, it is used either by mouth or rectally but is available intravenously. Effects last between four hours. Paracetamol is classified as a mild analgesic. Paracetamol is safe at recommended doses. Nonsteroidal anti-inflammatory drugs, are a drug class that groups together drugs that decrease pain and lower fever, and, in higher doses decrease inflammation; the most prominent members of this group of drugs, aspirin and naproxen, are all available over the counter in most countries. These drugs have been derived from NSAIDs; the cyclooxygenase enzyme inhibited by NSAIDs was discovered to have at least 2 different versions: COX1 and COX2.
Research suggested most of the adverse effects of NSAIDs to be mediated by blocking the COX1 enzyme, with the analgesic effects being mediated by the COX2 enzyme. Thus, the COX2 inhibitors were developed to inhibit only the COX2 enzyme; these drugs are effective analgesics when compared with NSAIDs, but cause less gastrointestinal hemorrhage in particular. After widespread adoption of the COX-2 inhibitors, it was discovered that most of the drugs in this class increase the risk of cardiovascular events by 40% on average; this led to the withdrawal of rofecoxib and valdecoxib, warnings on others. Etoricoxib seems safe, with the risk of thrombotic events similar to that of non-coxib NSAID diclofenac. Morphine, the archetypal opioid, other opioids all exert a similar influence on the cerebral opioid receptor system. Buprenorphine is a partial agonist of the μ-opioid receptor, tramadol is a serotonin norepinephrine reuptake inhibitor with weak μ-opioid receptor agonist properties. Tramadol is structurally closer to venlafaxine than to codeine and delivers analgesia by not only delivering "opioid-like" effects but by acting as a weak but fast-acting serotonin releasing agent and norepinephrine reuptake inhibitor.
Tapentadol, with some structural similarities to tramadol, presents what is believed to be a novel drug working through two different modes of action in the fashion of both a traditional opioid and as an SNRI. The effects of serotonin and norepinephrine on pain, while not understood, have had causal links established and drugs in the SNRI class are used in conjunction with opioids with greater success in pain relief. Dosing of all opioids may be limited by opioid toxicity, but opioid-tolerant individuals have higher dose ceilings than patients without tolerance. Opioids, while effective analgesics, may have some unpleasant side-effects. Patients starting morphine may experience vomiting. Pruritus may require switching to a different opioid. Constipation occurs in all patients on opioids, laxatives are co-prescribed; when used appropriately and other central analgesics are safe and effective, risks such as addiction and the body's becoming used to the drug can occur. The effect of tolerance means.
When safe to do so, the dosage may need to be increased to maintain effectiveness against tolerance, which may be of particular concern regarding patients suffering with chronic pain and requiring an analgesic over long periods. Opioid tolerance is addressed with opioid rotation therapy in which a patient is switched between two or more non-cross-tolerant opioid medications in order to prevent exceeding safe dosages in the attempt to achieve an adequate analgesic effect. Opioid tolerance should not be confused with opioid-induced hyperalgesia; the symptoms of these two conditions can appear similar but the mechanism of acti
Feline infectious peritonitis
Feline infectious peritonitis is the name given to an uncommon, but fatal, aberrant immune response to infection with feline coronavirus. FCoV is a virus of the gastrointestinal tract: most infections are either asymptomatic, or cause diarrhea in kittens, as maternally derived antibody wanes at between 5 and 7 weeks of age; the virus is a mutation of feline enteric coronavirus. From the gut, the virus briefly undergoes a systemic phase, returning to the gut, from where it is shed in the feces; the pathogenesis of FIP is complicated: the reductionist view is that it is due to mutation of the virus, enabling it to enter, or replicate more in, monocytes. The holistic approach is that FIP occurs as a result of a number of factors, including viral virulence, the immune status and general health of the host. FCoV is common in places; the virus is shed in feces and cats become infected by ingesting or inhaling the virus by sharing cat litter trays, or by the use of contaminated litter scoops or brushes transmitting infected microscopic cat litter particles to uninfected kittens and cats.
FCoV can be spread in ways other than through feces as well. It can be transmitted through different bodily fluids. FCoV is spread through direct contact between cats; the most common form of spreading is through saliva, as most multiple cat homes share food and water dishes. Another major form of spreading is fighting; when an infected cat grooms a healthy cat, they leave their contaminated saliva on the fur. When the healthy cat goes to groom themselves, they ingest the contaminated saliva and become infected. There are two main forms of FIP: non-effusive. While both types are fatal, the effusive form is more common and progresses more than the non-effusive form; the hallmark clinical sign of effusive FIP is the accumulation of fluid within the abdomen or chest, which can cause breathing difficulties. Other symptoms include lack of appetite, weight loss and diarrhea. Dry FIP will present with lack of appetite, jaundice and weight loss, but there will not be an accumulation of fluid. A cat with dry FIP will show ocular or neurological signs.
For example, the cat may develop difficulty in standing up or walking, becoming functionally paralyzed over time. Loss of vision is another possible outcome of the disease. Diagnosis of effusive FIP has become more straightforward in recent years: detection of viral RNA in a sample of the effusion, by reverse-transcriptase polymerase chain reaction is diagnostic of effusive FIP. However, that does require. Within the veterinary hospital there are a number of tests which can rule out a diagnosis of effusive FIP within minutes: Measure the total protein in the effusion: if it is less than 35g/l, FIP is unlikely. Measure the albumin to globulin ratio in the effusion: if it is over 0.8, FIP is ruled out, if it is less than 0.4, FIP is a possible—but not certain—diagnosis Examine the cells in the effusion: if they are predominantly lymphocytes FIP is excluded as a diagnosis. Non-effusive FIP is more difficult to diagnose than effusive FIP because the clinical signs tend to be more vague and varied: the list of differential diagnoses is therefore much longer.
Non-effusive FIP diagnosis should be considered when the following criteria are met: History: the cat is young and purebred: over 70% of cases of FIP are in pedigree kittens. History: the cat experienced stress such as recent neutering or vaccination History: the cat had an opportunity to become infected with FCoV, such as originating in a breeding or rescue cattery, or the recent introduction of a purebred kitten or cat into the household. Clinical signs: the cat has become anorexic or is eating less than usual. Biochemistry: hypergammaglobulinaemia. Hematology: lymphopenia. Serology: the cat has a high antibody titre to FCoV: this parameter should be used with caution, because of the high prevalence of FCoV in breeding and rescue catteries. Non-effusive FIP can be ruled out as a diagnosis if the cat is seronegative, provided the antibody test has excellent sensitivity. In a study which compared various commercially available in-house FCoV antibody tests, the FCoV Immunocomb was 100% sensitive.
Because FIP is an immune-mediated disease, treatment falls into two categories: direct action against the virus itself and modulation of the immune response. The most available antiviral drugs for treating FIP are either feline recombinant interferon omega or human interferon. Since the action of interferon is species-specific, feline interferon is more efficacious than human interferon. An experimental antiviral drug called GC 376 was used in a field trial of 20 cats: 7 cats went into remission, 13 cats responded but relapsed and were euthanized; this drug is not yet commercially available. The go-to immunosuppressive drug in FIP is prednisolone. An experimental polyprenyl immunostimulant is manufactured by Sass and Sass and tested by Dr. Al Legendre, who described survival over 1 year in three cats diagnosed with
Medical diagnosis is the process of determining which disease or condition explains a person's symptoms and signs. It is most referred to as diagnosis with the medical context being implicit; the information required for diagnosis is collected from a history and physical examination of the person seeking medical care. One or more diagnostic procedures, such as diagnostic tests, are done during the process. Sometimes posthumous diagnosis is considered a kind of medical diagnosis. Diagnosis is challenging, because many signs and symptoms are nonspecific. For example, redness of the skin, by itself, is a sign of many disorders and thus does not tell the healthcare professional what is wrong, thus differential diagnosis, in which several possible explanations are compared and contrasted, must be performed. This involves the correlation of various pieces of information followed by the recognition and differentiation of patterns; the process is made easy by a sign or symptom, pathognomonic. Diagnosis is a major component of the procedure of a doctor's visit.
From the point of view of statistics, the diagnostic procedure involves classification tests. The first recorded examples of medical diagnosis are found in the writings of Imhotep in ancient Egypt. A Babylonian medical textbook, the Diagnostic Handbook written by Esagil-kin-apli, introduced the use of empiricism and rationality in the diagnosis of an illness or disease. Traditional Chinese Medicine, as described in the Yellow Emperor's Inner Canon or Huangdi Neijing, specified four diagnostic methods: inspection, auscultation-olfaction and palpation. Hippocrates was known to make diagnoses by smelling their sweat. A diagnosis, in the sense of diagnostic procedure, can be regarded as an attempt at classification of an individual's condition into separate and distinct categories that allow medical decisions about treatment and prognosis to be made. Subsequently, a diagnostic opinion is described in terms of a disease or other condition, but in the case of a wrong diagnosis, the individual's actual disease or condition is not the same as the individual's diagnosis.
A diagnostic procedure may be performed by various health care professionals such as a physician, physical therapist, healthcare scientist, dentist, nurse practitioner, or physician assistant. This article uses diagnostician as any of these person categories. A diagnostic procedure does not involve elucidation of the etiology of the diseases or conditions of interest, that is, what caused the disease or condition; such elucidation can be useful to optimize treatment, further specify the prognosis or prevent recurrence of the disease or condition in the future. The initial task is to detect a medical indication to perform a diagnostic procedure. Indications include: Detection of any deviation from what is known to be normal, such as can be described in terms of, for example, physiology, pathology and human homeostasis. Knowledge of what is normal and measuring of the patient's current condition against those norms can assist in determining the patient's particular departure from homeostasis and the degree of departure, which in turn can assist in quantifying the indication for further diagnostic processing.
A complaint expressed by a patient. The fact that a patient has sought a diagnostician can itself be an indication to perform a diagnostic procedure. For example, in a doctor's visit, the physician may start performing a diagnostic procedure by watching the gait of the patient from the waiting room to the doctor's office before she or he has started to present any complaints. During an ongoing diagnostic procedure, there can be an indication to perform another, diagnostic procedure for another concomitant, disease or condition; this may occur as a result of an incidental finding of a sign unrelated to the parameter of interest, such as can occur in comprehensive tests such as radiological studies like magnetic resonance imaging or blood test panels that include blood tests that are not relevant for the ongoing diagnosis. General components which are present in a diagnostic procedure in most of the various available methods include: Complementing the given information with further data gathering, which may include questions of the medical history, physical examination and various diagnostic tests.
A diagnostic test is any kind of medical test performed to aid in the diagnosis or detection of disease. Diagnostic tests can be used to provide prognostic information on people with established disease. Processing of the answers, findings or other results. Consultations with other providers and specialists in the field may be sought. There are a number of methods or techniques that can be used in a diagnostic procedure, including performing a differential diagnosis or following medical algorithms. In reality, a diagnostic procedure may involve components of multiple methods; the method of differential diagnosis is based on finding as many candidate diseases or conditions as possible that can cause the signs or symptoms, followed by a process of elimination or at least of rendering the entries more or less probable by further medical tests and other processing until, aiming to reach the point where only one candidate disease or condit
Emergency medicine known as accident and emergency medicine, is the medical specialty concerned with the care of illnesses or injuries requiring immediate medical attention. Emergency physicians care for undifferentiated patients of all ages; as first-line providers, their primary responsibility is to initiate resuscitation and stabilization and to start investigations and interventions to diagnose and treat illnesses in the acute phase. Emergency physicians practice in hospital emergency departments, pre-hospital settings via emergency medical services, intensive care units, but may work in primary care settings such as urgent care clinics. Sub-specializations of emergency medicine include disaster medicine, medical toxicology, critical care medicine, hyperbaric medicine, sports medicine, palliative care, or aerospace medicine. Different models for emergency medicine exist internationally. In countries following the Anglo-American model, emergency medicine was the domain of surgeons, general practitioners, other generalist physicians, but in recent decades it has become recognised as a speciality in its own right with its own training programmes and academic posts, the specialty is now a popular choice among medical students and newly qualified medical practitioners.
By contrast, in countries following the Franco-German model, the speciality does not exist and emergency medical care is instead provided directly by anesthesiologists, specialists in internal medicine, cardiologists or neurologists as appropriate. In developing countries, emergency medicine is still evolving and international emergency medicine programs offer hope of improving basic emergency care where resources are limited. Emergency Medicine is a medical specialty—a field of practice based on the knowledge and skills required for the prevention and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioral disorders, it further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development. The field of emergency medicine encompasses care involving the acute care of internal medical and surgical conditions.
In many modern emergency departments, emergency physicians are tasked with seeing a large number of patients, treating their illnesses and arranging for disposition—either admitting them to the hospital or releasing them after treatment as necessary. They provide episodic primary care to patients during off hours and for those who do not have primary care providers. Most patients present to emergency departments with low-acuity conditions, but a small proportion will be critically ill or injured. Therefore, the emergency physician requires a broad field of knowledge and procedural skills including surgical procedures, trauma resuscitation, advanced cardiac life support and advanced airway management, they must have some of the core skills from many medical specialities—the ability to resuscitate a patient, manage a difficult airway, suture a complex laceration, set a fractured bone or dislocated joint, treat a heart attack, manage strokes, work-up a pregnant patient with vaginal bleeding, control a patient with mania, stop a severe nosebleed, place a chest tube, conduct and interpret x-rays and ultrasounds.
This generalist approach can obviate barrier-to-care issues seen in systems without specialists in emergency medicine, where patients requiring immediate attention are instead managed from the outset by speciality doctors such as surgeons or internal physicians. However, this may lead to barriers through acute and critical care specialties disconnecting from emergency care. Emergency medicine can be distinguished from urgent care, which refers to immediate healthcare for less emergent medical issues, but there is obvious overlap and many emergency physicians work in urgent care settings. Emergency medicine includes many aspects of acute primary care, shares with family medicine the uniqueness of seeing all patients regardless of age, gender or organ system; the emergency physician workforce includes many competent physicians who trained in other specialties. Physicians specializing in emergency medicine can enter fellowships to receive credentials in subspecialties such as palliative care, critical-care medicine, medical toxicology, wilderness medicine, pediatric emergency medicine, sports medicine, disaster medicine, tactical medicine, pain medicine, pre-hospital emergency medicine, or undersea and hyperbaric medicine.
The practice of emergency medicine is quite different in rural areas where there are far fewer other specialties and healthcare resources. In these areas, family physicians with additional skills in emergency medicine staff emergency departments. Rural emergency physicians may be the only health care providers in the community, require skills that include primary care and obstetrics. Patterns vary by region. In the United States, the employment arrangement of emergency physician practices are either private, corporate, or governmental
General surgery is a surgical specialty that focuses on abdominal contents including esophagus, small bowel, liver, gallbladder and bile ducts, the thyroid gland. They deal with diseases involving the skin, soft tissue, peripheral vascular surgery and hernias and perform endoscopic procedures such as gastroscopy and colonoscopy. General surgeons may sub-specialize into one or more of the following disciplines: In many parts of the world including North America and the United Kingdom, the overall responsibility for trauma care falls under the auspices of general surgery; some general surgeons obtain advanced training in this field and specialty certification surgical critical care. General surgeons must be able to deal with any surgical emergency, they are the first port of call to critically ill or gravely injured patients, must perform a variety of procedures to stabilize such patients, such as thoracostomy, cricothyroidotomy, compartment fasciotomies and emergency laparotomy or thoracotomy to stanch bleeding.
They are called upon to staff surgical intensive care units or trauma intensive care units. All general surgeons are trained in emergency surgery. Bleeding, bowel obstructions and organ perforations are the main problems they deal with. Cholecystectomy, the surgical removal of the gallbladder, is one of the most common surgical procedures done worldwide; this is most done electively, but the gallbladder can become acutely inflamed and require an emergency operation. Infections and rupture of the appendix and small bowel obstructions are other common emergencies; this is a new specialty dealing with minimal access techniques using cameras and small instruments inserted through 3 to 15mm incisions. Robotic surgery is now evolving from this concept. Gallbladders and colons can all be removed with this technique. Hernias are able to be repaired laparoscopically. Bariatric surgery can be performed laparoscopically and there a benefits of doing so to reduce wound complications in obese patients. General surgeons that are trained today are expected to be proficient in laparoscopic procedures.
General surgeons treat a wide variety of major and minor colon and rectal diseases including inflammatory bowel diseases, diverticulitis and rectal cancer, gastrointestinal bleeding and hemorrhoids. General surgeons perform a majority of all non-cosmetic breast surgery from lumpectomy to mastectomy pertaining to the evaluation and treatment of breast cancer. General surgeons can perform vascular surgery if they receive special training and certification in vascular surgery. Otherwise, these procedures are performed by vascular surgery specialists. However, general surgeons are capable of treating minor vascular disorders. General surgeons are trained to remove all or part of the thyroid and parathyroid glands in the neck and the adrenal glands just above each kidney in the abdomen. In many communities, they are the only surgeon trained to do this. In communities that have a number of subspecialists, other subspecialty surgeons may assume responsibility for these procedures. Responsible for all aspects of pre-operative and post-operative care of abdominal organ transplant patients.
Transplanted organs include liver, kidney and more small bowel. Surgical oncologist refers to a general surgical oncologist, but thoracic surgical oncologists, gynecologist and so forth can all be considered surgeons who specialize in treating cancer patients; the importance of training surgeons who sub-specialize in cancer surgery lies in evidence, supported by a number of clinical trials, that outcomes in surgical cancer care are positively associated to surgeon volume—i.e. The more cancer cases a surgeon treats, the more proficient he or she becomes, his or her patients experience improved survival rates as a result; this is another controversial point, but it is accepted—even as common sense—that a surgeon who performs a given operation more will achieve superior results when compared with a surgeon who performs the same procedure. This is true of complex cancer resections such as pancreaticoduodenectomy for pancreatic cancer, gastrectomy with extended lymphadenectomy for gastric cancer.
Surgical oncology is a 2 year fellowship following completion of a general surgery residency. Most cardiothoracic surgeons in the U. S. first complete a general surgery residency, followed by a cardiothoracic surgery fellowship. Pediatric surgery is a subspecialty of general surgery. Pediatric surgeons do surgery on patients age lower than 18. Pediatric surgery is 5 -- 7 years of a 2-3 year fellowship. In the 2000s minimally invasive surgery became more prevalent. Considerable enthusiasm has been built around robot-assisted surgery, despite a lack of data suggesting it has significant benefits that justify its cost. In Canada, New Zealand, the United States general surgery is a five to seven year residency and follows completion of medical school, either MD, MBBS, MBChB, or DO degrees. In Australia and New Zealand, a residency leads to eligibility for Fellowship of the Royal Australasian College of Surgeons. In Canada, residency leads to eligibility for certification by and Fellowship of the Royal College of Physicians and Surgeons of Canada, while in the United States, completion of a residency in general surgery leads to eligibility for board certification by the