General surgery

A.Y. 2020/2021
Overall hours
Learning objectives
The core objectives of the Course of General Surgery and Surgical Therapy are the knowledge and the understanding of the most frequent and demonstrative diseases which need a surgical therapy. The first step is to be able to recognize the type of disease, whether or not it is based on anatomic, functional, metabolic, infectious, inflammatory or neoplastic features.
The learner should be able to prescribe the best diagnostic tests on the basis of their sensitivity and specificity to reach a conclusive diagnosis.
The indications for the surgical operation should be recognized on the basis of the possibility of complications ( acute or chronic) and the prognosis of the disease under the different therapeutic conditions.
The student should understand the general principles of the surgical treatment, the possibility of a mini-invasive approach, the main technical characteristics of the operation, the possibility of complications, the need of complementary therapies. It is also important a good knowledge of the tests to be performed during follow-up and of the long term prognosis.
These objectives are reached by full frequency (>70%) of the lessons, as lectures, clinical case presentation, interactive discussion and problem-solving sessions. The learner can approach the patients under tutor supervision in the outpatients clinic, operative room, emergency department, and in-house daily visits and consults. During the clerkship, the learner will perform all the procedures listed in the core curriculum of the program of the Medicine and Surgery Course.
Expected learning outcomes
At the end of the course, the student must be able to:
- Recognize the clinical picture of the main surgical diseases and to classify them into the main diagnostic macro-categories.
- Prescribe, examine and discuss the the results of the tests and investigations useful to reach the right diagnosis, and to classify the neoplastic diseases.
- Identify the cases which need a surgical operation instead of medical therapy, endoscopic, radiologic or radio-therapeutic measures.
- Describe the surgical principles and the main steps of the surgical treatment of the most common surgical diseases, with evidence on the mini-invasive approach when appropriate.
- Categorize and describe the risk of post-operative complications and long-term side effects.
- Establish the prognosis and long-term follow-up of the patients.

To access to the final examination, the student needs a positive judgement on his clerkship by the tutor. The examination consists on the reporting of a clinical case assigned by the Professor the same day of the test.
Course syllabus and organization

Single session

The lessons of the first semester will take place in mixed mode:
- in presence in the classroom with a limited number of students, who have booked themselves using Google Form and at the same time in synchrony through the "Teams platform" for students not present;
- the student is obliged to wear the surgical mask for the entire duration of his stay in the classroom and to sit in the free seats respecting the alternation of one occupied seat, one free seat, one occupied seat per single row;
- the lessons will also be video-recorded to allow students unable for documented needs to follow them in sync and made available on the teacher's Ariel / Teams website;
- the lessons will take place at the Vialba center as usual

Students must enter from the main atrium of the Lita Vialba teaching pavilion and undergo body temperature measurement using a Thermo-scanner. The entry / exit routes are differentiated and marked
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: 48 hours