First Incision

This episode explores blunt and penetrating neck trauma with special guest Ben Finlay.
We discuss:
Blunt cerebrovascular injury including:
- the grading system
- Denver screening criteria
- diagnosis
- management
Penetraing neck trauma
- zones of the neck
- hard and soft signs of vascular and aerodigestive tract injuries
- approaches to management including the 'zonal approach' and 'no-zone' approach
- exposures of zone I, II and II injuries
- repair of carotid and aerodigestive tract injuries
- the dreaded exposure of subclavian injuries

Links:
Kenji Inaba's talk on Subclavian Artery Injuries for the Arizona Trauma Association: https://arizonatrauma.org/subclavian-injuries/
'DSTC' is the Definitive Surgical Trauma Care course which is fantastic and we highly recommend doing if possible! https://dstc.com.au/
And the Top Knife chapter on neck trauma we mentioned is a book entitled 'Top Knife: the Art and Craft of Trauma Surgery' by Hirshberg and Mattox. Another great trauma resource.

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this document.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2022

This week's episode introduces us to some concepts in trauma with our new guest host Ben Finlay!
We cover a wide range of topics including:
- Primary and secondary survey
- Trauma adjuncts
- Fast exam
- Pathophysiology of trauma and shock
- Massive transfusion protocol
- Principles of damage control surgery and resuscitation
- Teg and ROTEM
And more!

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this document.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This week's guest episode features Dr Michael Crawford who is a hepatobiliary, hernia and liver transplant surgeon from Sydney.

We cover a wide range of operative topics including:
How to perform gastroenterostomy
Difficult laparoscopic cholecystectomy
-       Features preoperatively that make you suspicious it will be difficult
-       Mirrizi syndrome
-       Bail out options for difficult gallbladder including subtotal cholecystectomy
-       Bile duct injury and how to avoid it.
-       We talked about this video of a bile duct injury that was circulated online last week. This video can be viewed at: https://www.youtube.com/watch?v=I0AtJqCj2dI and as Dr Crawford mentioned provides a rare opportunity to learn from this injury. Definitely worth a watch
-       Routine versus selective cholangiography 
Laparoscopic splenectomy: tips, tricks and pitfalls.
Chronic liver failure: tips for operating on patients with ascites, and what to do with umbilical hernias in cirrhotic patients
Transcystic bile duct exploration and laparoscopic choledochotomy

 Dr Crawford’s youtube channel where there are some fantastic operative videos and descriptions can be found at: https://www.youtube.com/channel/UCLzesA4ZAxYpFbuFCRO__uA

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This week's guest episode is with Dr Laurence Webber, a hepatobiliary surgeon from Western Australia.

We cover a wide range of topics including:

Practicalities of post-fellowship exam life including:
- Pathways in surgical training 
- How to get a job after surgical training
00:00 - 00:25 mins

Clinical topics including:
Colorectal liver metastases:
- What to do with disappearing liver metastases
- Chemotherapy
- Liver first?
- Liver remnant and functional assessment
- Criteria of when to resect
MRI liver and when to use gadolinium and primovist
When to operate on patient’s with HCC and cirrhosis
Anatomical factors that determine resectability of hilar cholangiocarcinoma and pancreatic cancer
Pancreatic cancer:
- Neoadjuvant chemotherapy
- Arterial resection 
- ABC of resectability of pancreatic cancer (the MD Anderson model)
- Broad steps of a Whipple’s operation
Bile duct injury
- How to avoid them
- How to identify them
- What do to with them

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode has everything you need to know about genetic conditions that predispose to endocrine tumours. We cover:
- Multiple endocrine noeplasia (MEN) type 1
- MEN types 2a and 2b
- SDH syndromes
- Von Hippel-Lindau Syndrome
- Neurofibromatosis type I (and brief mention about type 2)
- Hyperparathyroidism-jaw tumour syndrome

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode looks at the adrenal gland:
- adrenal incidentalomas
- the important questions to ask about adrenal lesions - is it cancer and is it functional?
- workup of adrenal lesions
- functional tests for corticosteroid hypersecretion (cushing's), catecholamine hypersecretion (pheochromocytoma), primary hyperaldosteronisms (Conn's syndrome) and sex hormone excess
- screening, confirmatory and localisation tests for functional lesions
- imaging characteristics of malignant versus benign lesions
- preoperative optimization of functional tumours
- management of adrenal lesions 

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode covers everything you need to know about pancreatic neuroendocrine tumours
- what they are
- classification into functional and non-functional
- risk factors and associated genetic syndromes
- the different types of functional tumours, how they present and their biochemical testing
- how to image localise and stage these tumours
- WHO grading and TNM staging
- management including which ones are suitable for surveillance, surgery, management of unresectable or metastatic disease, and medical management of the functional syndromes
- surveillance

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode covers a range of topics related to calcium:
- pathophysiology of calcium homeostasis
- causes of hypercalcaemia
- workup of hypercalcaemia
- presentation including symptoms and signs of hypercalcaemia
- primary, secondary and tertiary hyperparathyroidism
- diagnostic tests for diagnosis of primary hyperparathyroidism
- imaging modalities to localise parathyroid adenomas
- medical and surgical management of hyperparathyroidism and hypercalcaemia
- and management of postoperative hypocalcaemia

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode follows on from last week's episode on thyroid nodules and an introduction to thyroid cancer.

We cover:
- surgery for thyroid cancer
- what to do with the lymph nodes
- tumour markers (calcitonin, thyroglobulin and anti-Tg antibodies)
- risk stratification
- radioactive iodine
- TSH suppression with thyroxine therapy
- treatment of recurrent and palliative disease

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021

This episode covers the presentation and workup of thyroid nodules. It includes a targeted history, examination, blood tests, and imaging modalities. We also discuss the TI-RADS reporting system for thyroid nodule ultrasound scanning, and the Bethesda classification of thyroid FNA cytology.
The end of this episode introduces us to the different types of thyroid cancer including
- papillary
- follicular
- medullary
- anaplastic
- lymphoma
And summaries the different types, what differentiates them from each other, and a short summary on the management of anaplastic thyroid cancer and lymphoma.

This episode is a precursor to next week's episode on the management of thyroid cancer!

Disclaimer
The information in this podcast is intended as a revision aid for the purposes of the General Surgery Fellowship Exam.
This information is not to be considered to include any recommendations or medical advice by the author or publisher or any other person. The listener should conduct and rely upon their own independent analysis of the information in this podcast.
The author provides no guarantees or assurances in relation to any connection between the content of this podcast and the general surgical fellowship exam.  No responsibility or liability is accepted by the author in relation to the performance of any person in the exam.  This podcast is not a substitute for candidates undertaking their own preparations for the exam.
To the maximum extent permitted by law, no responsibility or liability is accepted by the author or publisher or any other person as to the adequacy, accuracy, correctness, completeness or reasonableness of this information, including any statements or information provided by third parties and reproduced or referred to in this document. 
To the maximum extent permitted by law, no responsibility for any errors in or omissions from this document, whether arising out of negligence or otherwise, is accepted.
The information contained in this podcast has not been independently verified.

© Amanda Nikolic 2021