Surgeons like systems and rules and frameworks for learning and remembering things. We love to categorise and define and make big concepts simple. Also, KBW has a Big Exam approaching that marks the end of my training so I will be adding to this page extensively for the next 6 months, or longer if i have to resit..

Pancreatitis Glasgow scoring system

PO2<8, A age>55, neutrophils>15, C calcium <2, R renal urea>16, Enzymes LDH>600, AST>200, Albumin <32, Sugar Glucose >10

score 1 for each, severe if greater than or equal to 3

Complications (I am obsessed with complications as you may know) these monsters that haunt my dreams can be classified and thus controlled:

They can be immediate, early or late, they can be local or systemic.  Let’s apply this rule to complications of a right hemicolectomy:

Immediate local: haemorrhage, damage to the right ureter

Immediate systemic: Hypotension causing myocardial ischaemia, anaphylaxis to antibiotics

Early local: anastomotic leak, post-operative haemorrhage, wound infection, ileus

Early systemic: post-operative pneumonia, acute retention of urine, septicaemia

Late local: adhesive obstruction, fistula

Late systemic: recurrence of tumour

Causes of everything can be remembered with the use of a surgical sieve:

There are loads of these to choose from, I like this one.



Infection and Inflammation

Traumatic and Iatrogenic



Idiopathic and Iatrogenic




Endocrine and Environmental


Causes of pancreatitis


Gallstones, ethanol, trauma, Steroids, Mumps, Autoimmune, Scorpio bites, Hypothermia/Hyperlipidaemia/Hypercalcaemia, ERCP, Drugs (Azathioprine etc)

Diaphragm: where structures cross
“I ate ten eggs at 12”
I8 10E A12
IVC crosses at T8, oEsophagus T10, Aorta T12.

Umbilical herniae in infants:

3% of Live births have one, only 3 in 1000 need surgery, operate on them aged 3, they recur in the 3rd trimester.

Enterocutaneous Fistula Management


Sepsis, nutrition, anatomy, proceed (or prolonged stay- ho ho)

Things that shift the oxygen haemoglobin dissociation curve to the right. “Cadet face right”

C high CO2
A high acid (low pH) and altitude
D high 2,3 DPG
E exercise
T high temperature

Contraindications to renal transplant
Untreated infection
Metastatic malignancy
PMHx of high risk malignancy


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