Facharzt Allgemeinchirurgie Kuwait

• Enhanced recovery pathways combine carbohydrate loading, limited fasting (solids to 6 hours, clear fluids to 2 hours), opioid-sparing multimodal analgesia, early feeding and early mobilisation, and shorten stay without raising complications.
• Perioperative cardiac risk is stratified first by urgency, then by functional capacity (METs) and surgical risk. Further testing is only worthwhile if it changes management; routine coronary revascularisation purely to get a patient through non-cardiac surgery does not improve outcome.
• Severely malnourished patients (weight loss over 10 to 15 per cent in 6 months, BMI under 18.5 kg/m2, albumin is a poor marker) benefit from 7 to 14 days of nutrition support before major GI surgery, preferably enteral. Refeeding syndrome is prevented by thiamine and slow caloric build-up.
• Antibiotic prophylaxis is given within 60 minutes before incision (120 minutes for vancomycin or fluoroquinolones), repeated after two half-lives or major blood loss, and stopped within 24 hours of surgery.

• Upper GI bleeding: resuscitate, give a PPI after endoscopy, and treat high-risk stigmata (spurting vessel, visible vessel, adherent clot) endoscopically with a combination of adrenaline injection plus a second modality; rebleeding after successful endoscopic therapy is treated with repeat endoscopy before surgery or radiology.
• Bariatric surgery is indicated for BMI 35 kg/m2 or more regardless of comorbidity and may be considered from 30 kg/m2 with metabolic disease. Sleeve gastrectomy raises reflux risk; Roux-en-Y gastric bypass is preferred when significant GORD or Barrett's is present.
• Achalasia is diagnosed by high-resolution manometry (absent peristalsis with incomplete lower sphincter relaxation); pneumatic dilation, laparoscopic Heller myotomy and peroral endoscopic myotomy (POEM) are all first-line options, and the choice follows manometric subtype and fitness.
• Locally advanced resectable gastric and oesophageal adenocarcinoma is treated with perioperative chemotherapy (FLOT for gastric/GOJ) or neoadjuvant chemoradiation (CROSS for oesophageal); D2 lymphadenectomy is standard for resectable gastric cancer in experienced centres.

• Acute cholangitis (Charcot triad: fever, jaundice, right upper quadrant pain; Reynolds adds shock and confusion) needs antibiotics, resuscitation and biliary drainage, urgently if severe. ERCP is the standard drainage route; percutaneous drainage is the alternative when ERCP fails.
• Acute biliary pancreatitis: early enteral feeding, goal-directed moderate fluid resuscitation with a balanced crystalloid, no prophylactic antibiotics, cholecystectomy in the same admission for mild disease; delay until collections resolve in severe disease. Infected necrosis is managed by a step-up approach (drain first, then minimally invasive necrosectomy).
• Pancreatic head cancer: resectable disease goes to surgery with adjuvant mFOLFIRINOX; borderline or locally advanced disease receives neoadjuvant therapy. Biliary drainage before surgery is used only for cholangitis, severe symptoms, delay or neoadjuvant treatment.
• Hepatocellular carcinoma in cirrhosis is staged by BCLC: very early or early disease is resected, ablated or transplanted; intermediate disease is treated with transarterial chemoembolisation; advanced disease with systemic immune-based therapy. Liver failure (Child-Pugh B or C) limits resection.

• Staging of rectal cancer with MRI defines the circumferential margin and nodal risk; threatened margin or node-positive disease usually receives neoadjuvant therapy before total mesorectal excision.
• Complicated diverticulitis with abscess over 4 to 5 cm is drained percutaneously in stable patients; colonoscopy 6 to 8 weeks later excludes cancer.
• Acute severe ulcerative colitis not improving after 3 days of intravenous steroids needs rescue therapy (ciclosporin or infliximab) and surgical review; colectomy follows failure.
• Anal squamous carcinoma is cured by chemoradiotherapy; abdominoperineal excision is salvage. Chronic fissure failing medical therapy is treated with sphincterotomy or botulinum toxin.

• Asymptomatic inguinal hernia in men can be observed; repair is offered when symptoms appear. Femoral hernias in women carry a high risk of strangulation and need mesh repair.
• Endoscopic (TEP/TAPP) repair reduces chronic pain and speeds recovery in primary unilateral inguinal hernia; use a different plane for recurrent hernia.
• Mesh repair beats suture repair for umbilical hernias over 1 cm and incisional hernias; sublay is the preferred mesh plane.
• Optimise modifiable risks (BMI, smoking, diabetes) before elective incisional hernia repair; in contaminated fields consider tissue repair or biological mesh.

• Sentinel node biopsy is standard for clinically node-negative invasive breast cancer; neoadjuvant systemic therapy suits HER2-positive and triple-negative disease with large tumours or node-positive status.
• Persistent unilateral nipple eczema needs biopsy to exclude Paget disease; lactational abscess is managed by aspiration with antibiotics.
• Bethesda V and VI thyroid cytology go to surgery; total thyroidectomy with neck dissection for high-risk papillary cancer; exclude phaeochromocytoma first in MEN2.
• Symptomatic post-thyroidectomy hypocalcaemia needs IV calcium; phaeochromocytoma needs alpha-blockade before beta-blockade.

• Elective AAA repair at 5.5 cm or more in men; ruptured AAA gets permissive hypotension and rapid repair, EVAR if anatomy allows.
• Type A dissection needs emergency open repair; uncomplicated type B is treated medically with anti-impulse therapy.
• Claudication: exercise, risk factors, antiplatelet and statin. Chronic limb-threatening ischaemia and acute limb ischaemia need urgent revascularisation; watch for compartment syndrome after reperfusion.
• Symptomatic carotid stenosis (50-99 per cent) should be treated within 14 days; superficial venous reflux is treated with endovenous ablation; proximal DVT needs three months of anticoagulation.

• Primary survey (ABCDE): treat life threats as found; unstable blunt trauma with positive FAST goes to laparotomy, and tension pneumothorax is decompressed clinically.
• Haemorrhage control: balanced transfusion, early tranexamic acid, pelvic binder, damage control surgery in the lethal triad.
• Non-operative management is first line for stable blunt splenic and liver injury; hard signs of vascular or neck injury need exploration.
• Burns: Parkland formula, escharotomy for constriction, early intubation in inhalation injury, burn centre referral for face, hand or large burns.

• Appendicitis: appendicectomy is standard; abscess is drained then interval surgery considered; older patients need colonoscopy to exclude tumour.
• Adhesive small bowel obstruction without ischaemia: nasogastric decompression, fluids and water-soluble contrast; operate for peritonitis, ischaemia or failure at 48-72 hours.
• Perforated duodenal ulcer: resuscitate, antibiotics, surgical patch; cholangitis needs urgent drainage; mild gallstone pancreatitis gets cholecystectomy the same admission.
• Time-critical emergencies: ruptured AAA, mesenteric ischaemia, testicular torsion, necrotising infection, infected obstructed kidney.

• Resectable gastric and oesophageal adenocarcinoma beyond early stage: perioperative or neoadjuvant therapy plus surgery (D2 gastrectomy).
• Biopsy sarcoma by planned core biopsy at a specialist centre; retroperitoneal sarcoma needs en bloc resection.
• Pancreatic cancer: borderline resectable gets neoadjuvant therapy; resected disease gets adjuvant chemotherapy; non-functioning NET over 2 cm is resected.
• RAS mutation excludes anti-EGFR therapy; dMMR/MSI-high predicts checkpoint inhibitor response; high-risk GIST gets three years of imatinib.

• Prophylactic antibiotics are given within 60 minutes before incision and redosed in long operations or major blood loss; do not continue for days after surgery.
• Superficial SSI is treated by opening and draining the wound; necrotising infection needs immediate radical debridement; burst abdomen is an emergency.
• Wound healing phases: haemostasis, inflammation, proliferation (collagen III, angiogenesis), remodelling (collagen I). Vitamin C is a cofactor for collagen synthesis.
• Optimise diabetes, nutrition and smoking before elective surgery; use alcohol-based chlorhexidine; clip hair rather than shave; use drains selectively.

nicht veröffentlicht. Genaue Fragenzahl, Zeit und Bestehensgrenze stehen in Ihrer Buchung.

Die größten Themen sind Colorectal & anal (12 %), Trauma & burns (12 %), Hepatopancreatobiliary & spleen (11 %). Der Kurs umfasst 11 Themen mit insgesamt 0 Kapiteln.

Arbeiten Sie die Kapitel Thema für Thema durch, wiederholen Sie die Lernnotizen und üben Sie dann mit zeitgesteuerten Probeprüfungen im Format Ihrer Behörde.

Der Zugang gilt 90 Tage ab Zahlung für das gewählte Land und den gewählten Beruf.

Jeden Browser auf Computer, Tablet oder Handy sowie die MediFlow-App mit demselben Konto.

Bitte lesen Sie vor dem Kauf unsere Erstattungsrichtlinie. Erstattungsrichtlinie