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Conditions a general surgeon treats

Conditions a general surgeon treats

Ten neurosurgical conditions explained from the symptom, with the red flags stated explicitly.

Conditions

Start from the symptom, not from the name of the operation

Ten surgical conditions explained from what you actually feel, with the red flags stated explicitly.

Gallstones

Stones in the gallbladder. Many never cause symptoms; others produce biliary colic, cholecystitis or pancreatitis. That difference decides between watching and operating.

Severe pain under the ribs on the right, appearing after eating
Pain radiating to the back or right shoulder, in episodes lasting hours
Nausea and vomiting accompanying the pain
Intolerance of fatty food, with bloating and belching
FEVER WITH RIGHT-SIDED PAIN: suggests cholecystitis, go to an emergency department
YELLOWING OF SKIN OR EYES, DARK URINE: suspicion of a stone in the bile duct

Appendicitis

The commonest abdominal surgical emergency. The pain starts near the navel and settles in the lower right. The sooner it is treated, the simpler the operation.

PAIN THAT STARTS AROUND THE NAVEL AND SETTLES IN THE LOWER RIGHT
Loss of appetite, which usually precedes everything else
Nausea and vomiting appearing after the pain, not before
Low-grade fever, rising if the process advances
Pain worse on walking, coughing or over bumps in the road
RIGID ABDOMEN AND GENERALISED PAIN: suggests perforation, immediate emergency

Abdominal wall hernias

A lump that appears on straining and disappears on lying down. It does not heal on its own, a truss will not close it, and its one serious risk is becoming trapped.

A lump in the groin, at the navel or over a scar, appearing on straining or coughing
A sense of heaviness, dragging or burning in the area, especially at the end of the day
Discomfort on lifting, coughing or exertion
A lump that has been growing over months
THE LUMP HAS TURNED HARD, HURTS BADLY AND CANNOT BE PUSHED BACK IN: immediate emergency
NAUSEA, VOMITING AND NO PASSAGE OF GAS WITH A PAINFUL HERNIA: immediate emergency

Hiatal hernia and reflux

Burning behind the breastbone, acid regurgitation, chronic cough and morning hoarseness. Most cases are controlled with medication; a proportion needs surgery.

Burning behind the breastbone, especially after eating or on lying down
Regurgitation of acid or bitter content into the throat
Chronic night-time cough, morning hoarseness or persistent throat clearing
A sensation of a lump in the throat on swallowing
Chest pain already investigated and ruled out as cardiac
PROGRESSIVE DIFFICULTY SWALLOWING, UNINTENDED WEIGHT LOSS OR ANAEMIA: investigate without delay

Obesity

A chronic disease, not a failure of willpower. Bariatric surgery is one more tool, with a clinical indication, a prior work-up and a commitment to follow-up.

Body mass index in the range indicating bariatric surgery
Type 2 diabetes, hypertension or sleep apnoea associated with excess weight
Documented weight-loss attempts without a sustained result
Fatty liver or dyslipidaemia attributable to overweight
Limiting joint pain from weight overload
Willingness to change habits and attend lifelong nutritional follow-up

Hemorrhoids

Bleeding on passing stool, a lump that comes out, burning and itching. Most are managed without surgery — but no rectal bleeding should be assumed to be haemorrhoids without investigation.

Bright red bleeding on passing stool, on the paper or in the bowl
A lump that comes out on passing stool and reduces on its own or by hand
Burning, itching or a sensation of moisture in the anal region
Severe pain with a sudden hard lump: suggests thrombosis
A feeling of incomplete evacuation
BLEEDING WITH A CHANGE IN BOWEL HABIT, WEIGHT LOSS OR ANAEMIA: investigate without delay

Diverticular disease

Small pouches in the wall of the colon. They almost never cause trouble; when they inflame they produce diverticulitis, and recurrence or complication is what leads to theatre.

Persistent pain in the lower left abdomen
Fever accompanying the abdominal pain
Change in bowel habit: new constipation or diarrhoea
Abdominal distension and nausea
Repeated episodes of the same picture over months or years
RIGID ABDOMEN, HIGH FEVER OR NO PASSAGE OF GAS OR STOOL: immediate emergency

Colorectal cancer

One of the few cancers that can be prevented by removing the polyp before it becomes a tumour. Colonoscopy is screening and treatment at the same time.

BLOOD IN THE STOOL OR BLACK STOOLS
PERSISTENT CHANGE IN BOWEL HABIT: new diarrhoea or constipation
Stools thinner than usual, persistently
A feeling of incomplete evacuation that does not settle
UNINTENDED WEIGHT LOSS, fatigue or unexplained anaemia
Persistent abdominal pain or distension that does not resolve

Thyroid nodule

A lump in the neck. The great majority are benign and are monitored; ultrasound and fine-needle biopsy are what separate the ones that need surgery.

A palpable or visible lump in the front of the neck
A sensation of pressure in the neck or on swallowing
Voice changes or persistent hoarseness without a clear cause
Symptoms of hormone excess: palpitations, weight loss, tremor, insomnia
Symptoms of deficiency: fatigue, weight gain, cold intolerance, dry skin
RAPID GROWTH, A HARD FIXED NODULE OR NECK NODES: investigate without delay

Gastritis and peptic ulcer

Burning and pain in the pit of the stomach. Almost everything is resolved with medication and eradication of Helicobacter pylori; the surgeon enters with the complication.

Burning or pain in the pit of the stomach, better or worse with eating
Early fullness, bloating and frequent belching
Nausea, especially fasting or in the morning
Pain that wakes you at night
VOMITING BLOOD OR BLACK STOOLS: immediate emergency
SUDDEN, SEVERE, GENERALISED PAIN WITH A RIGID ABDOMEN: suspected perforation, emergency

Warning signs

What each condition actually feels like

Six signs per condition, written the way a patient describes them rather than the way a textbook does — with the red flags marked in capitals.

Gallstones

Severe pain under the ribs on the right, appearing after eating
Pain radiating to the back or right shoulder, in episodes lasting hours
Nausea and vomiting accompanying the pain
Intolerance of fatty food, with bloating and belching
FEVER WITH RIGHT-SIDED PAIN: suggests cholecystitis, go to an emergency department
YELLOWING OF SKIN OR EYES, DARK URINE: suspicion of a stone in the bile duct

Appendicitis

PAIN THAT STARTS AROUND THE NAVEL AND SETTLES IN THE LOWER RIGHT
Loss of appetite, which usually precedes everything else
Nausea and vomiting appearing after the pain, not before
Low-grade fever, rising if the process advances
Pain worse on walking, coughing or over bumps in the road
RIGID ABDOMEN AND GENERALISED PAIN: suggests perforation, immediate emergency

Abdominal wall hernias

A lump in the groin, at the navel or over a scar, appearing on straining or coughing
A sense of heaviness, dragging or burning in the area, especially at the end of the day
Discomfort on lifting, coughing or exertion
A lump that has been growing over months
THE LUMP HAS TURNED HARD, HURTS BADLY AND CANNOT BE PUSHED BACK IN: immediate emergency
NAUSEA, VOMITING AND NO PASSAGE OF GAS WITH A PAINFUL HERNIA: immediate emergency

Hiatal hernia and reflux

Burning behind the breastbone, especially after eating or on lying down
Regurgitation of acid or bitter content into the throat
Chronic night-time cough, morning hoarseness or persistent throat clearing
A sensation of a lump in the throat on swallowing
Chest pain already investigated and ruled out as cardiac
PROGRESSIVE DIFFICULTY SWALLOWING, UNINTENDED WEIGHT LOSS OR ANAEMIA: investigate without delay

Obesity

Body mass index in the range indicating bariatric surgery
Type 2 diabetes, hypertension or sleep apnoea associated with excess weight
Documented weight-loss attempts without a sustained result
Fatty liver or dyslipidaemia attributable to overweight
Limiting joint pain from weight overload
Willingness to change habits and attend lifelong nutritional follow-up

Hemorrhoids

Bright red bleeding on passing stool, on the paper or in the bowl
A lump that comes out on passing stool and reduces on its own or by hand
Burning, itching or a sensation of moisture in the anal region
Severe pain with a sudden hard lump: suggests thrombosis
A feeling of incomplete evacuation
BLEEDING WITH A CHANGE IN BOWEL HABIT, WEIGHT LOSS OR ANAEMIA: investigate without delay

Diverticular disease

Persistent pain in the lower left abdomen
Fever accompanying the abdominal pain
Change in bowel habit: new constipation or diarrhoea
Abdominal distension and nausea
Repeated episodes of the same picture over months or years
RIGID ABDOMEN, HIGH FEVER OR NO PASSAGE OF GAS OR STOOL: immediate emergency

Colorectal cancer

BLOOD IN THE STOOL OR BLACK STOOLS
PERSISTENT CHANGE IN BOWEL HABIT: new diarrhoea or constipation
Stools thinner than usual, persistently
A feeling of incomplete evacuation that does not settle
UNINTENDED WEIGHT LOSS, fatigue or unexplained anaemia
Persistent abdominal pain or distension that does not resolve

Thyroid nodule

A palpable or visible lump in the front of the neck
A sensation of pressure in the neck or on swallowing
Voice changes or persistent hoarseness without a clear cause
Symptoms of hormone excess: palpitations, weight loss, tremor, insomnia
Symptoms of deficiency: fatigue, weight gain, cold intolerance, dry skin
RAPID GROWTH, A HARD FIXED NODULE OR NECK NODES: investigate without delay

Gastritis and peptic ulcer

Burning or pain in the pit of the stomach, better or worse with eating
Early fullness, bloating and frequent belching
Nausea, especially fasting or in the morning
Pain that wakes you at night
VOMITING BLOOD OR BLACK STOOLS: immediate emergency
SUDDEN, SEVERE, GENERALISED PAIN WITH A RIGID ABDOMEN: suspected perforation, emergency

Other conditions treated

Acute cholecystitis
Choledocholithiasis
Gallstone pancreatitis
Bowel obstruction
Intestinal adhesions
Anal fissure
Perianal fistula
Pilonidal cyst
Crohn's disease
Ulcerative colitis
Colonic polyps
Sigmoid volvulus
Hepatic cysts and abscesses
Goitre
Hyperthyroidism
Lipomas and sebaceous cysts
Soft-tissue abscess
Diabetic foot
Incisional hernia
Epigastric hernia

Surgical consultation

Bring your studies and settle the question

One consultation with your ultrasound or CT in hand is worth more than ten internet searches. Book by phone or through the form and you will be told what is there, what it means and what your options are.

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