Surgery
ROTATION SPECIFIC OBJECTIVES:
- Discuss the pathophysiology, clinical presentation, non-surgical management and indications for surgical intervention of the following:
Acute appendicitis
Acute calculous cholecystitis
Acute uncomplicated and complicated diverticulitis
Small bowel obstruction
Acute abdomen secondary to perforated viscus
Acute mild pancreatitis and severe necrotizing pancreatitis
Fulminant Crohn’s disease
- Discuss the etiology, microbiology and treatment of intra-abdominal infections, differentiating between secondary and tertiary peritonitis, explaining the controversial role of Enterococcus involvement and demonstrating an understanding of the importance of source control.
- Demonstrate an understanding of the abdominal exam and specific signs and landmarks which classically pertain to GI and biliary tract emergencies (Murphy’s sign, Charcot’s triad, Rovsing’s sign, psoas sign, obturator sign, guarding and rebound, McBurney’s point).
- Explain the underlying pathophysiology and the conservative and surgical management of post-operative complications following abdominal surgery:ileus, small bowel obstruction, enterocutaneous fistulas, abdominal compartment syndrome.
- Demonstrate the ability to anticipate and determine the cause of acid-base and electrolyte abnormalities and appropriately manage such abnormalities in the surgical patient with an NG tube, ileostomy, high output fistula, vomiting, diarrhea, refeeding syndrome, renal insufficiency.
- Discuss the prophylaxis of venous thromboembolism in the general surgery patient undergoing “open” and laparoscopic surgery. Understand which risk factors place the general surgery patient at high risk for VTE, what dose of unfractionated heparin or low molecular weight heparin should be used, when prophylaxis should begin and end, which patients may require extended VTE prophylaxis beyond discharge.
- Discuss the use of pre-operative antimicrobial prophylaxis to prevent surgical site infections. For which abdominal processes should antimicrobial therapy continue post-operatively for 24 hours? 5-7 days? Longer than 7 days?
- Determine the appropriateness of drug therapy based on patient past and present history, physical exam, lab data, literature review and collaboration with other healthcare providers.
- Demonstrate the ability to identify, prevent and solve drug related problems independently.
- Demonstrate the ability to effectively communicate with healthcare professionals, patients and family members.
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