General surgery

A.Y. 2019/2020
Overall hours
Learning objectives
Educational training objectives are:
1) Lead the student to an overall view of pathological problems of surgical interest and to be able to clearly carry out a differential diagnostic procedure;
2) Lead the student to rationally make the choice of instrumental and laboratory test, based on the principles of sensitivity and specificity, and also with an evaluation of the cost / benefit ratio;
3) With the help of the discussion of simulate clinical cases, perfect the knowledge acquired in previous years and apply them to the understanding of complex clinical syndromes;
4) Provide the elements (notions and method) so that the student can manage the relationship with the patient and his/her family members, in order to help and if necessary guide the decisions that concern them, to make them aware of the benefits, risks, consequences and possible complications of the interventions proposed by the surgeon specialist and to ensure the necessary psychological and assistance support after the discharge of the patient from the hospital ward.
Expected learning outcomes
At the end of the course the student will have to:
1) Be able to formulate a diagnostic hypothesis, with particular regard to the differential diagnosis;
2) Know how to indicate the most useful and least expensive techniques of physical, laboratory and instrumental diagnosis;
3) Know how to indicate, for each pathology, a PUIGES type evaluation (from the terms Prevalence, Urgency, Medical Intervention, Severity case exemplarity, Social impact);
4) Be able to propose different therapeutic solutions (medical and surgical), evaluating the advantages, risks and possible consequences;
5) Know how to formulate a prognosis quad vita and quad valetudinem (literally "regarding life and health", expression used in the formulation of medical prognosis to express a judgement related to the recovery of a good state of health);
6) Getting to know how the issues of post-operative home care and curative or replacement therapeutic measures after common major surgery;
7) Know the necessary equipment and know how to implement the simplest surgical provisions that the family doctor can be called to perform.
Course syllabus and organization

Single session

Course syllabus
ABDOMINAL WALL: hernias (hernias and diaphragmatic eventrations; epigastric hernias; inguinal hernias; crural hernias; obturator hernias; laparoceles) and their complications.
ESOPHAGE: esophageal diverticula; hiatal hernias; benign tumors of the esophagus; carcinoma of the esophagus.
STOMACH AND DUODENUM: high intestinal bleeding; gastric cancer; surgical complications of peptic ulcer.
SMALL INTESTINE: the benign and malignant neoplasms of the small intestine; intestinal polyps and polyposis.
LARGE INTESTINE: appendicitis; benign and malignant neoplasms of the large intestine; intestinal polyposis; low intestinal bleeding; diverticular disease.
RECTUM AND ANO: tumors of the rectum and anal canal; anal fissures; hemorrhoidal disease; rectal prolapse; the rectocele.
ACUTE ABDOMEN: peritonism and peritonitis; hollow bowel perforation; bowel obstruction.
INFLAMMATORY BOWEL DISEASES: the surgical complications of the m. by Crohn; surgical complications of ulcerative rectocolitis; the toxic megacolon.
INTESTINAL STOMIES: general characteristics of packaging, function and care of intestinal ostomies.
Topics of surgical interest but of non-surgical didactic relevance:
esophageal dyskinesias, esophageal achalasia, gastro-oesophageal reflux disease, hemorrhagic gastritis, peptic ulcers, colic diverticulosis, colonic angiodysplasias.
LIVER AND BILIARY TRACT: benign liver tumors; primitive neoplasms of the liver; secondary liver tumors; portal hypertension; cancer of the gallbladder and biliary tract; gallbladder stones; cholecystitis; intra and extrahepatic biliary stones; cholestatic jaundice; cholangitis; liver abscesses.
PANCREAS: carcinoma of the pancreas; the carcinoma of the papilla of Vater; acute pancreatitis; chronic pancreatitis; pancreatic pseudocysts; endocrine neoplasms of the pancreas.
LUNG: pneumothorax; valve pneumothorax (or hypertension); the "flail chest"; the hydrothorax; the hemothorax; the primary malignant neoplasms of the bronchi and lungs and notes on the benign neoplasms of the lung (for the purpose of differential diagnosis)
Topics of surgical interest but of non-surgical didactic relevance:
pulmonary actinomycosis; tuberculous abscess; bronchiectasis.
ARTERIES: arteriosclerotic disease; aortic aneurysms and their complications; carotid artery stenosis; renal artery stenosis; acute and chronic obstructive peripheral arteriopathies; diabetic arterial disease; embolisms; arterial thrombosis.
VEIN: varicose veins of the lower limbs; superficial and deep phlebitis and their complications.
KIDNEY: kidney malformations; malignant tumors of the kidney.
URETER AND BLADDER: malformations of the urinary tract; ureteral neoplasms; bladder neoplasms; bladder diverticula.
TESTICLE: cryptorchidism; the mobile testicle; the orchiepididimite; twisting the rope; hydrocele; varicocele; neoplasms of the testicle.
PROSTATE AND SEMINAL VESICLES: prostate adenoleiomyoma (prostatic hypertrophy); prostate cancer.
PENIS AND URETHRA: urethral strictures; phimosis; paraphimosis; hypospadias; epispadias; balanoposthitis; penile cancer.
Prerequisites for admission
At the beginning of the Surgical Clinic course - 1st semester, year V - it is assumed that the student, having attended Semeiotics and systematic courses 1st and 2nd in the 3rd and 4th year of the course, is able to:
01. (S) draw up a complete anamnesis;
02. (S) clarify the meaning of the terms relating to respiratory, circulation, digestive processes, alvo, urination, indicating the most common manifestations and illustrating the pathophysiological mechanisms involved;
03. (F) perform a correct physical examination, detecting the general and local objective signs, relative to the individual organs and systems;
04. (S) report the characteristics which distinguish the masses and palpable nodules from each other;
05. (S) clarify the meaning of the terms: pain, tenderness, abdominal defense, peritonism, peritonitis;
06. (S) describe the characteristics of the manifestations indicated with the terms referred to in the previous point, reporting on the pathophysiological mechanisms and indicating their pathological significance.
Teaching methods
Teaching is provided through lectures with exercises and analysis of clinical cases.
The teacher, through the ARIEL platform, provides the slides of the lessons and iconography.
Teaching Resources
"Chirurgia generale"
Autt. De Toma, Montorsi, Bellantoni

"Test book of Surgery"
Aut. Sabiston

Aut. Dionigi
Assessment methods and Criteria
The effective achievement of the learning outcomes expected by the student is achieved through an oral test through the description of a clinical case. The student's ability to frame the pathology is assessed on the basis of the reported symptoms: differential diagnosis, drug and surgical therapy. In addition to the knowledge of the subject, the student's logical reasoning ability is assessed.
MED/18 - GENERAL SURGERY - University credits: 4
Lessons: 32 hours