Responsibilities of General Surgery

While going through this class, I found that the surgeries that I feel the lest comfortable with are the ones that fall under general surgery. This category of surgeries can be a rather large one. Mainly General surgeons will be doing procedures on structures in the abdominal cavity, but they are also not confined to only doing things in only this cavity. These surgeons could also be the trauma surgeon on call meaning that they will have to be able to stabilize the patient and do things that might not directly fall under their specialty.

The main categories that fall under general surgery are bowel and gastrointestinal procedures, biliary, liver and gallbladder procedures, and breast biopsy; however like I said above this doesn’t mean that this is the only type of procedures that they are expected to do this is just the more comment types of procedures that you will see in this specialty. According to the American college of surgeons, “A general surgeon has specialized knowledge and experience related to the diagnosis, preoperative, operative, and postoperative management, including the management of complications, in nine primary components of surgery, all of which are essential to the education of a broadly based surgeon.” (facs.org)

These nine components of surgery include things like, the alimentary tract other wise known as the gastrointestinal tract can have procedures that include anything with the esophagus, stomach, small intestine, large intestine, or the rectum. The abdomen as well as its contents are the second component, this includes hernias and appendectomies. The third component is breast, skin and soft tissue; these could include procedures for biopsy for benign or malignant tumors just about anywhere in the body. The next component is that of head and neck this also includes trauma, vascular, endocrine, as well as congenital and oncologic procedures.

Next up is that of the vascular system, which includes intracranial and hear vessels. The sixth component is that of the endocrine system, mainly the thyroid, parathyroid, adrenal, and the endocrine part of the pancreas. Number seven of general surgery is a comprehensive management of trauma. The responsibility of all phases of care of the injured patient is an essential component of general surgery. Finally the last component for general surgery is the complete care of critically ill patient with underlying surgical conditions, this could start in the emergency room and follow the patient up to the care unit that will be receiving them; such as an intensive care unit, or possible a trauma/ burn unit. (facs.org)

In some hospitals the general surgeon can become certified to provide care for different disease areas, however knowledge and management of these conditions will most likely fall to a trained specialist after initial treatment. The first area is vascular surgery, this could involve things like treating aortic aneurism or could be treating patient who have suffered from a stroke. The next area is pediatric surgery, although the more substantial procedures would go to a pediatric specialist a general surgeon is able to perform different procedures on a pediatric patient as they would with an adult. Thoracic surgery is next up, this could be anything from minor heart procedures or lunch procedures. Burns are another area that a general surgeon could work in, this would mostly be getting a skin graft and then placing the skin over the burn area however this could also fall under plastic surgery depending on the situation. The last specialty area is solid organ transplant, this mainly involves organs in end stage failure. These organs are kidney, liver, pancreas, heart and lungs. (absurgery.org)

There is an area of general surgery that I do not feel very familiar with and that is surgery of the liver, biliary tract, pancreas, and the spleen I will be going over a few different procedures for each of these types of surgery. To start off with some general anatomy of the biliary tract, this includes the liver, gallbladder, and pancreas. Coming from the liver you have the common hepatic duct that connects with the gallbladder to form the common bile duct. The common bile duct combines with the cystic duct from the pancreas to form the ampulla, or the papilla of Vater. The liver produces about 600 to 1000 mL of bile each day and the gallbladder holder anywhere from 40 to 70 mL that can be secreted into the duodenum as needed depending on the food that is passing though the stomach. (Alexander’s Surgical Procedures)

A few procedures that are very similar but differ on what part are being connected are procedures named “ Cholecystoduodenostomy, and Cholecystojejunostomy” these procedures create an anastomosis between the gallbladder and duodenum or the jejunum to relive an obstruction in the distal end of the common bile duct. Two more procedures that are closely related are  Choledochoduodenostomy, and Choledochojejunostomy” these to procedures are anastomosis between he common bile duct and the duodenum or the jejunum. These procedures may be necessary for post cholecystectomy patients to circumvent an obstruction and to restore the normal flow of bile to the gastrointestinal system. Another procedure is called the Whipple Procedure, the full name of this procedure is a pancreaticoduodenectomy. This procedure is the removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach, the lower half of the common bile duct, and the procedure concludes with a reestablishment of biliary, pancreatic, and the gastrointestinal tract. (Alexander’s Surgical Procedures)

The most common procedures of the biliary tract is a cholecystectomy, this is a complete removal of the gallbladder. Most of the time this is because of gallstones that become to large to pass through the common bile duct. These stones can be classified based off their color, brown stones are usually fatty acids, and black stones are composed of inorganic salts. A few diagnostic tests that can be performed to see if you have gallstones are a CT scan and a HIDA scan, care is taken when preparing contrast because air will look like stones on the scans. (Berry & Kohn’s Operating room technique)

The supine position is one of the most common positions used in the operating room, this is no exception with general surgery as most of the procedures use this position. While the patient is laying on their back the arms are secured to arm boards that are abducted less than 90 degrees with pads for the arms to rest on. If there is a medical reason to keep the arms at their sides a sheet is placed around the arms and tucked under the patient not the bed to prevent the arms from falling or resting on the metal frame of the or bed. Depending on the procedure the surgeon may also need the patient to be in Trendelenburg or reverse Trendelenburg. Trendelenburg is where the bed is tilted with the patient’s head down, and reverse Trendelenburg is where the bed is tilted so the feet of the patient are lower. (clinicalpainadvisor.com)

Becoming a general surgeon is no easy task there is a lot of schooling involved before you can even apply to a medical school you need to complete some prerequisite college courses that can take anywhere form 2 to 4 years after you move into general medical school that takes 4 years and finally after that you can apply to the general surgery residency that will take at a minimum 5 years to complete. However, after you finish school you must also receive continuing medical education “CME” to maintain license and board certification after residency as well as be DEA registered to prescribe controlled substances. (Study.com)