Surgery Shortcut

Shortcut Code Version

Lump Examination LUMPX 1
Kidney Stone KSTONEX 1
BPH BPHX 1
Varicose Veins VARIX 1
Dupuytren DUPUYTRENX 1

Lump Examination - LUMPXM

Examination :
Lump on ^ , ^ cm in diameter , round shape
Smooth surface, -ve tenderness
Normal temperature, -ve tansillumination
Soft consistency, moves with skin
-ve pulsation, -ve fluctuation, irreducible

Kidney Stones – KSTONEX

Noted kidney stones on the CT scan, located on the ^

Size ^ mm. No signs of hydronephrosis, no anatomical abnormality

Noted previous lab test : ^

Still complaining of pain on the ^

Urine color is clear

Possible risk of stone formation : ^ -look at tool

Examination :
BP : ^ HR : ^ T: ^
Abdomen : soft normal active bowel sounds, -ve hepatosplenomegaly, -ve mass, -ve defans, -ve
guarding, -ve bilateral CVA tenderness

Diagnostic :
FBE, U/E, Calcium, phosphate, Uric acid, PTH
Urine MSU and pH
CT scan of KUB
24h urine collection for total volume, pH, Calcium, Oxalate, uric acid, citrate, Sodium, potassium and
creatinine level

Medication :
Tamsulosin for 10-14 days

Medical dissolution therapy

Uric acid and cystine stone : Potassium citrate 40mEq and Potassium Bicarbonate 20mEmaintain
urinary pH 6.5-7.0
Calcium stones : thiazide diuretic and/or potassium citrate 40meQ

Management :
Refer to dietician
Advise to drink at least 2.5L/day with aiming urine production of 2L/day
Advise to do surveillance US every 6-12 months
Advise referral to urologist for further evaluation and management

BPH – BPHX

Symptoms of difficulty of urination

Obstructive symptoms : hesitancy, weak urinary stream, intermittency, straining to void, sensation
of incomplete bladder emptying

Irritative Symptoms : urgency, urge incontinence, frequency nocturia

Still sexually active

PMH : no prior history of recurrent UTI, no bladder stones, no urinary retention, no renal
impariment
FH : no prostate cancer

Examination :
BP : ^ HR : ^
Eyes : -ve signs of cataracts
Abdomen : soft, -ve guarding, -ve defans, -ve mass, -ve CVA tenderness
Rectal examination : performed with patient consent verbally :
Good anal sphinter tone, prostate is firm, -ve nodules, -ve tenderness

IPSS Score : ^

Noted US results : size : ^ post residual volume : ^ mL

Reason for contact :

BPH

Diagnostic :
FBE, U/E, LFT, PSA
US of KUB, prostate

Meds :
5 alpha reductase inhibitors – prevent conversion of testosterone to dihydrotestosterone
Indication : significant enlarged gland min more than 40mL with obstructive symptoms
check pre treatment PSA then every 6 months
Side effect :reduced libido, impotence, reduced ejaculate volume
Finasteride 5mg/tab OD – inhibit type 2 isoenzyme only, half live 6 hours, 5mg/day
Dutasteride inhibit 5alpha type 1 and 2 isoenzymes, half life 3-5 weeks, 500 ug/day

Alpha blocker – relax smooth muscle by blocking alpha-1 receptor, Prazosin, terazosin, Tamsulosin –
Side effect : hypotension, intraoperative floppy iris dynrome
Alfuzosin 10mg/day, tamsulosisn 400 ug/day
Terazosin 1mg/day to 7 days then titrate up to 5-10mg/day

Combined alpha blocker and finasteride

Cholinergics
Indication : predominantly storage urinary symtoms, low post void residual volume, avoid in
postresidual volume >200mL
Inhibit bladder contraction
Oxybutynin 3.9mg/day path
Oral oxybutynin2.5 mg 2-3 times daily,
Propantheline 15 mg 2-3 times daily
Side effect : dry mouth,

Beta 3-adrenoreceptor agonist

For overactive bladder syndrome
Mirabegron 25mg/day, up to 50mg/day
Side effect : increased BP, nasopharyngitis, UTI

ADH
Desmopressin 50 ug/day up to 675 m/day
For men with nocturnal polyuria as predominant symptoms
Reduced sodium level, need monitoring

Varicose Vein – VARIX

Patient complain of varicosities on both legs since ^

Feels pain on the affected leg. There’s also report of intermittent swelling
No report of bleeding, ulceration nor skin discolouration

PMH : No previous leg nor pelvic fractures, no superficial nor deep vein thrombosis
Obstetrics : ^ Intended future pregnancy : ^
FH : no varicose vein, no DVT nor PE
SH :
Work as : ^ standing ^ hours per day, ^ days per week
Exercise : ^
No recent change in weight
Examination :
BP : ^ HR :^
Weight : ^ Height : ^ BMI : ^
Legs :
Varicose vein : ^
-ve bipedal oedema
-ve skin pigmentation
-ve lipodermatosclerosis, -ve fat necrosis, -ve eczema
-ve atrophie blanche, -ve active nor healed ulceration

Reason for contact :

Varicose vein

Diagnostic :
Duplex ultrasound scan

Management :
Conservative measures explained :
- Elevate foot during lying down
- Increase level of exercise and walking to improve calf muscle pump
- Reducing weight
- Avoid prolong standing unless effective hose is worn
Advise to use Graduated compressions stocking below-knee with minimum compression of 20-
300mmHg at ankle.

Medications :
Advise use of simple analgesics such as Panadol or NSAID
Paroven forte

Advise referral to General surgeon for possible sclerotherapy, ligation or stripping

Notes :
Types of vein
Telangiectasia (<1mm diameter, intracutaneous
Venules (1-2mm)
Reticular vein (2-4 mm, zigzag)
Tributary varicosities
Truncal varicosities : great and short saphenous trunks

Dupuytren - DUPUYTRENX
Complain of dupuytren contracture of ^ since ^ , gradually getting worse
Catches finger at work.
Unabale to wear leather gloves
No Peyronie's or Ledderhose disease
FHx : ^
Examination :
^ deg MCPJ contracture little finger
^ deg PIPJ contracture little finger
Pre tendinous cord with pitting +++
Ulnar paresthesia noted
Precentra cord to middle finger noted withouth contracture
+ve Garrods Pads
at BH

Management :
Xiaflex injection

•Patients will be seen if there is a Hideflexion contracture of > 60° of the MCP joint or flexion
contracture of > 45° of the PIP joint.
Surgery performed when the MCP joint contracture is > 40° or when PIP joint contracture is > 20°.
For practical reasons, surgery must be performed before the contracture reaches a fixed flexion
deformity of 90° at MCP or 60° at PIP.
Splinting and hand therapy are needed after surgery. A night splint is normally worn for 3 months.