How is a medication

Tylenol® 500 mg tablet

prescription written?

Disp (dispense): 100 tablets

sig: 1–2 PO q 4 hrs PRN pain

a

Before

AAA

Abdominal aortic aneurysm; “triple A”

ABD

Army battle dressing

ABG

Arterial blood gas

ABI

Ankle to brachial index

AKA

Above the knee amputation

a.k.a.

Also known as

Ao

Aorta

APR

Abdominoperineal resection

ARDS

Acute respiratory distress syndrome

ASA

Aspirin

AXR

Abdominal x-ray

B1

Billroth 1 gastroduodenostomy

B2

Billroth 2 gastrojejunostomy

BCP

Birth control pill

BE

Barium enema

BIH

Bilateral inguinal hernia

BKA

Below the knee amputation

BRBPR

Bright red blood per rectum

BS

Bowel sounds; Breath sounds; Blood sugar

BSE

Breast self-examination

c

With

CA

Cancer

CABG

Coronary artery bypass graft (“CABBAGE”)

CBC

Complete blood cell count

CBD

Common bile duct

c/o

Complains of

COPD

Chronic obstructive pulmonary disease

CP

Chest pain

CTA

Clear to auscultation; CT angiogram

CVA

Cerebral vascular accident

CVAT

Costovertebral angle tenderness

CVP

Central venous pressure

CXR

Chest x-ray

Dx

Diagnosis

DDx

Differential diagnosis

DI

Diabetes insipidus

DP

Dorsalis pedalis

DPL

Diagnostic peritoneal lavage

DPC

Delayed primary closure

DT

Delirium tremens

DVT

Deep venous thrombosis

EBL

Estimated blood loss

ECMO

Extracorporeal membrane oxygenation

EGD

Esophagogastroduodenoscopy (UGI scope)

EKG

Electrocardiogram (also ECG)

ELAP

Exploratory laparotomy

EOMI

Extraocular muscles intact

ERCP

Endoscopic retrograde cholangiopancreatography

EtOH

Alcohol

EUA

Exam under anesthesia

EX LAP

Exploratory laparotomy

FAP

Familial adenomatous polyposis

FAST

Focused abdominal sonogram for trauma

FEN

Fluids, electrolytes, nutrition

FNA

Fine needle aspiration

FOBT

Fecal occult blood test

GCS

Glasgow Coma Scale

GERD

Gastroesophageal reflux disease

GET(A)

General endotracheal (anesthesia)

GU

Genitourinary

HCT

Hematocrit

HEENT

Head, eyes, ears, nose, and throat

HO

House officer

Hx

History

IABP

Intra-aortic balloon pump

IBD

Inflammatory bowel disease

ICU

Intensive care unit

I & D

Incision and drainage

I & O

Ins and outs, in and out

IMV

Intermittent mandatory ventilation

Chapter 1 / Introduction 17

IVC

Inferior vena cava

IVF

Intravenous fluids

IVP

Intravenous pyelography

IVPB

Intravenous piggyback

JVD

Jugular venous distention

L

Left

LE

Lower extremity

LES

Lower esophageal sphincter

LIH

Left inguinal hernia

LLQ

Left lower quadrant

LR

Lactated Ringer’s

LUQ

Left upper quadrant

MAE

Moving all extremities

MAST

Military antishock trousers

MEN

Multiple endocrine neoplasia

MI

Myocardial infarction

MSO4

Morphine sulfate

NGT

Nasogastric tube

NPO

Nothing per os

NS

Normal saline

OBR

Ortho bowel routine

OCTOR

On call to O.R.

OOB

Out of bed

ORIF

Open reduction internal fixation

p

After

PCWP

Pulmonary capillary wedge pressure

PE

Pulmonary embolism; Physical examination

PEEP

Positive end-expiratory pressure

PEG

Percutaneous endoscopic gastrostomy (via EGD and skin

incision)

PERRL

Pupils equal and react to light

PFT

Pulmonary function tests

PICC

Peripherally inserted central catheter

PGV

Proximal gastric vagotomy (i.e., leaves fibers to pylorus intact

to preserve emptying)

PID

Pelvic inflammatory disease

PO

Per os (by mouth)

POD

Postoperative day

PR

Per rectum

PRN

As needed, literally, pro re nata

PT

Physical therapy; Patient; Posterior tibial; Prothrombin time

PTC

Percutaneous transhepatic cholangiogram (dye injected via a

catheter through skin and into dilated intrahepatic bile duct)

PTCA

Percutaneous transluminal coronary angioplasty

PTX

pneumothorax

q or q

Every

R

Right

RIH

Right inguinal hernia

RLQ

Right lower quadrant

Rx

Treatment

RTC

Return to clinic

s

Without

SBO

Small bowel obstruction

SCD

Sequential compression device

SIADH

Syndrome of inappropriate antidiuretic hormone

SICU

Surgical intensive care unit

SOAP

Subjective, objective, assessment, and plan

S/P

Status post

STSG

Split thickness skin graft

SVC

Superior vena cava

Sx

Symptoms

TEE

Transesophageal echocardiography

T & C

Type and cross

T & S

Type and screen

Tmax

Maximal temperature

TPN

Total parenteral nutrition

TURP

Transurethral resection of the prostate

UE

Upper extremity

UGI

Upper gastrointestinal

UO

Urine output

U/S

Ultrasound

UTI

Urinary tract infection

VAD

Ventricular assist device

VOCTOR

Void on call to O.R.

WSD

Wet-to-dry dressing

XRT

X-ray therapy

Abscess

Localized collection of pus anywhere in

the body, surrounded and walled off by

damaged and inflamed tissues

Chapter 1 / Introduction 19

Achlorhydria

Absence of hydrochloric acid in the

stomach

Acholic stool

Light-colored stool as a result of

decreased bile content

Adeno-

Prefix denoting gland or glands

Adhesion

Union of two normally separate surfaces

Adnexa

Adjoining parts; usually means ovary/

fallopian tube

Adventitia

Outer coat of the wall of a vein or artery

(composed of loose connective tissue)

Afferent

Toward

-algia

Suffix denoting pain

Amaurosis fugax

Transient visual loss in one eye

Ampulla

Enlarged or dilated ending of a tube or

canal

Analgesic

Drug that prevents pain

Anastomosis

Connection between two tubular organs

or parts

Angio-

Prefix denoting blood or lymph vessels

Anomaly

Any deviation from the normal (i.e., con-

genital or developmental defect)

Apnea

Cessation of breathing

Atelectasis

Collapse of alveoli

Bariatric

Weight reduction; bariatric surgery is

performed on morbidly obese patients to

effect weight loss

Bifurcation

Point at which division into two branches

occurs

Bile salts

Alkaline salts of bile necessary for the

emulsification of fats

Bili-

Prefix denoting bile

Boil

Tender inflamed area of the skin

containing pus

Bovie

Electrocautery

Calculus

Stone

Carbuncle

Collection of boils (furuncles)

with multiple drainage channels

(CARbuncle car big)

Cauterization

Destruction of tissue by direct

application of heat

Celiotomy

Surgical incision into the peritoneal cavity

(laparotomy celiotomy)

Cephal-

Prefix denoting the head

Chole-

Prefix denoting bile

Cholecyst-

Prefix denoting gallbladder

Choledocho-

Prefix denoting the common bile duct

Cleido-

Prefix denoting the clavicle

Colic

Intermittent abdominal pain usually

indicating pathology in a tubular organ

(e.g., small bowel)

Colloid

Fluid with large particles (e.g., albumin)

Colonoscopy

Endoscopic examination of the colon

Colostomy

Surgical operation in which part of the

colon is brought through the abdominal

wall

Constipation

Infrequent or difficult passage of stool

Chapter 1 / Introduction 21

Cor pulmonale

Enlargement of the right ventricle caused

by lung disease and resultant pulmonary

hypertension

Curettage

Scraping of the internal surface of an

organ or body cavity by means of a

spoon-shaped instrument

Cyst

Abnormal sac or closed cavity lined

with epithelium and filled with fluid or

semisolid material

Direct bilirubin

Conjugated bilirubin (indirect

unconjugated)

-dynia

Suffix denoting pain

Dys-

Prefix: difficult/painful/abnormal

Dyspareunia

Painful sexual intercourse

Dysphagia

Difficulty in swallowing

Ecchymosis

Bruise

-ectomy

Suffix denoting the surgical removal of a

part or all of an organ (e.g., gastrectomy)

Efferent

Away from

Endarterectomy

Surgical removal of an atheroma and the

inner part of the vessel wall to relieve an

obstruction (carotid endarterectomy

CEA)

Enteritis

Inflammation of the small intestine,

usually causing diarrhea

Enterolysis

Lysis of peritoneal adhesions; not to be

confused with enteroclysis, which is a

contrast study of the small bowel

Eschar

Scab produced by the action of heat or a

corrosive substance on the skin

Excisional biopsy

Biopsy with removal of entire tumor

(Think: Excisional Entire removal)

Fascia

Sheet of strong connective tissue

Fistula

Abnormal communication between two

hollow, epithelialized organs or between

a hollow organ and the exterior (skin)

Foley

Bladder catheter

Frequency

Abnormally increased frequency (e.g.,

urinary frequency)

Furuncle

Boil, small subcutaneous staphylococcal

infection of follicle (Think: Furuncle

follicle car carbuncle)

Gastropexy

Surgical attachment of the stomach to

the abdominal wall

Hemangioma

Benign tumor of blood vessels

Hematemesis

Vomiting of blood

Hematoma

Accumulation of blood within the tissues,

which clots to form a solid swelling

Hemoptysis

Coughing up blood

Hemothorax

Blood in the pleural cavity

Hepato-

Prefix denoting the liver

Herniorrhaphy

Surgical repair of a hernia

Hesitancy

Difficulty in initiating urination

Hiatus

Opening or aperture

Hidradenitis

Inflammation of the apocrine glands,

usually caused by blockage of the glands

Icterus

Jaundice

Chapter 1 / Introduction 23

Ileostomy

Surgical connection between the lumen

of the ileum and the skin of the

abdominal wall

Ileus

Abnormal intestinal motility (usually

paralytic)

Incisional biopsy

Biopsy with only a “slice” of tumor

removed

Induration

Abnormal hardening of a tissue or organ

Inspissated

Hard

Intussusception

Telescoping of one part of the bowel into

another

-itis

Suffix denoting inflammation of an organ,

tissue, etc. (e.g., gastritis)

Lap appy

Appendectomy via laparoscopy

Laparoscopy

Visualization of the peritoneal cavity via a

laparoscope

Laparotomy

Surgical incision into the abdominal cavity

(laparotomy celiotomy)

Lap chole

Cholecystectomy via laparoscopy

Leiomyoma

Benign tumor of smooth muscle

Leiomyosarcoma

Malignant tumor of smooth muscle

Lieno-

Denoting the spleen

Melena

Black tarry stool (melenic, not melanotic

stools)

Necrotic

Dead

Obstipation

Failure to pass flatus or stool

Odynophagia

Painful swallowing

-orraphy

Surgical repair (e.g., herniorrhaphy)

-ostomy

General term referring to any operation

in which an artificial opening is created

between two hollow organs or between

one viscera and the abdominal wall for

drainage purposes (e.g., colostomy) or for

feeding (e.g., gastrostomy)

-otomy

Suffix denoting surgical incision into an

organ

Percutaneous

Performed through the skin

-pexy

Suffix denoting fixation

Phleb-

Prefix denoting vein or relating to veins

Phlebolith

Calcification in a vein—a vein stone

Phlegmon

Diffuse inflammation of soft tissue,

resulting in a swollen mass of tissue

(most commonly seen with pancreatic

tissue)

Plica

Fold or ridge

Plicae circulares

Circular (complete circles) folds in the

lumen of the small intestine (a.k.a.

valvulae conniventes)

Plicae semilunares

Folds (semicircular) into lumen of the

large intestine

Pneumaturia

Passage of urine containing air

Pneumothorax

Collapse of lung with air in pleural space

Pseudocyst

Fluid-filled cavity resembling a true cyst,

but not lined with epithelium

Pus

Liquid product of inflammation,

consisting of dying leukocytes and

other fluids from the inflammatory

response

Chapter 1 / Introduction 25

Rubor

Redness; a classic sign of inflammation

Steatorrhea

Fatty stools as a result of decreased fat

absorption

Stenosis

Abnormal narrowing of a passage or

opening

Sterile field

Area covered by sterile drapes or prepped

in sterile fashion using antiseptics (e.g.,

Betadine®)

Succus

Fluid (e.g., succus entericus is fluid from

the bowel lumen)

Tenesmus

Urge to defecate with ineffectual

straining

Thoracotomy

Surgical opening of the chest cavity

Transect

To divide transversely (to cut in half)

Trendelenburg

Patient posture with pelvis higher than

the head, inclined about 45 (a.k.a.

“headdownenburg”)

Urgency

Sudden strong urge to urinate; often seen

with a UTI

Wet-to-dry dressing

Damp gauze dressing placed on a

wound and removed after the dressing

dries to the wound, providing

microdébridement

SURGERY SIGNS,TRIADS, ETC. YOU SHOULD KNOW

What are the ABCDs of

Signs of melanoma:

melanoma?

Asymmetric

Border irregularities

Chapter 1 / Introduction 27

Beck’s triad

Seen in patients with cardiac tamponade:

1.

JVD

2.

Decreased or muffled heart sounds

3.

Decreased blood pressure

Bergman’s triad

Seen with fat emboli syndrome:

1.

Mental status changes

2.

Petechiae (often in the axilla/thorax)

3.

Dyspnea

Blumer’s shelf

Metastatic disease to the rectouterine

(pouch of Douglas) or rectovesical pouch

creating a “shelf” that is palpable on

rectal examination

Boas’ sign

Right subscapular pain resulting from

cholelithiasis

Borchardt’s triad

Seen with gastric volvulus:

1.

Emesis followed by retching

2.

Epigastric distention

3.

Failure to pass an NGT

Carcinoid triad

Seen with carcinoid syndrome (Think:

“FDR”):

1.

Flushing

2.

Diarrhea

3.

Right-sided heart failure

Charcot’s triad

Seen with cholangitis:

1.

Fever (chills)

2.

Jaundice

3.

Right upper quadrant pain

(Pronounced “char-cohs”)

Chvostek’s sign

Twitching of facial muscles upon tapping the

facial nerve in patients with hypocalcemia

(Think: CHvostek’s CHeek)

Courvoisier’s law

Enlarged nontender gallbladder seen with

obstruction of the common bile duct,

most commonly with pancreatic cancer

Note: not seen with gallstone obstruction

because the gallbladder is scarred

secondary to chronic cholelithiasis

(Pronounced “koor-vwah-ze-ay”)

Cullen’s sign

Bluish discoloration of the periumbilical

area due to retroperitoneal hemorrhage

tracking around to the anterior abdominal

wall through fascial planes (e.g., acute

hemorrhagic pancreatitis)

Cushing’s triad

Umbilicus

Signs of increased intracranial pressure:

1. Hypertension

2. Bradycardia

3. Irregular respirations

Dance’s sign

Empty right lower quadrant in children

with ileocecal intussusception

Fothergill’s sign

Used to differentiate an intra-abdominal

mass from one in the abdominal wall; if

mass is felt while there is tension on the

musculature, then it is in the wall (i.e.,

sitting halfway upright)

Fox’s sign

Ecchymosis of inguinal ligament seen

with retroperitoneal bleeding

Goodsall’s rule

Anal fistulae course in a straight path

anteriorly and a curved path posteriorly

from midline (Think of a dog with a

straight anterior nose and a curved

posterior tail)

Grey Turner’s sign

Ecchymosis or discoloration of the flank

in patients with retroperitoneal

hemorrhage as a result of dissecting

blood from the retroperitoneum (Think:

TURNer’s TURN side-to-side flank)

Hamman’s sign/crunch

Crunching sound on auscultation of the

heart resulting from emphysematous

mediastinum; seen with Boerhaave’s

syndrome, pneumomediastinum, etc.

Homans’ sign

Calf pain on forced dorsiflexion of the

foot in patients with DVT

Howship-Romberg sign

Pain along the inner aspect of the thigh;

seen with an obturator hernia as the

result of nerve compression

Kehr’s sign

Severe left shoulder pain in patients

with splenic rupture (as a result of

referred pain from diaphragmatic

irritation)

Kelly’s sign

Visible peristalsis of the ureter in

response to squeezing or retraction;

used to identify the ureter during

surgery

Krukenberg tumor

Metastatic tumor to the ovary (classically

from gastric cancer)

Laplace’s law

Wall tension pressure radius (thus,

the colon perforates preferentially at the

cecum because of the increased radius

and resultant increased wall tension)

McBurney’s point

One third the distance from the anterior

iliac spine to the umbilicus on a line

connecting the two

McBurney’s sign

Tenderness at McBurney’s point in

patients with appendicitis

Meckel’s diverticulum

2% of the population have a Meckel’s

rule of 2s

diverticulum, 2% of those are symptomatic,

and they occur within 2 feet of the

ileocecal valve

Mittelschmerz

Lower quadrant pain due to ovulation

Murphy’s sign

Cessation of inspiration while palpating

under the right costal margin; the

patient cannot continue to inspire

deeply because it brings an inflamed

gallbladder under pressure (seen in

acute cholecystitis)

Obturator sign

Pain upon internal rotation of the leg

with the hip and knee flexed; seen in

patients with appendicitis/pelvic abscess

Pheochromocytoma

Think of the first three letters in the

SYMPTOMS triad

word pheochromocytoma—“P-H-E”:

Palpitations

Headache

Episodic diaphoresis

Pheochromocytoma rule

10% bilateral, 10% malignant, 10% in

of 10s

children, 10% extra-adrenal, 10% have

multiple tumors

Chapter 1 / Introduction 31

Psoas sign

Pain elicited by extending the hip with

the knee in full extension, seen with

appendicitis and psoas inflammation

Raccoon eyes

Bilateral black eyes as a result of basilar

skull fracture

Reynold’s pentad

1.

Fever

2.

Jaundice

3.

Right upper quadrant pain

4.

Mental status changes

5.

Shock/sepsis

Thus, Charcot’s triad plus #4 and #5; seen

in patients with suppurative cholangitis

Rovsing’s sign

Palpation of the left lower quadrant

resulting in pain in the right lower

quadrant; seen in appendicitis

Saint’s triad

1.

Cholelithiasis

2.

Hiatal hernia

3.

Diverticular disease

Silk glove sign

Indirect hernia sac in the pediatric

patient; the sac feels like a finger of a silk

glove when rolled under the examining

finger

Chapter 2 / Surgical Syndromes 33

What is blind loop syndrome?

Bacterial overgrowth of intestine caused

by stasis

What is Boerhaave’s

Esophageal perforation

syndrome?

What is Budd-Chiari

Thrombosis of hepatic veins

syndrome?

What is carcinoid syndrome?

Syndrome of “B FDR”:

Bronchospasm

Flushing

Diarrhea

Right-sided heart failure (caused by

factors released by carcinoid

tumor)

What is compartment

Compartmental hypertension caused by

syndrome?

edema, resulting in muscle necrosis of

the lower extremity, often seen in the

calf; patient may have a distal pulse

What is Cushing’s syndrome?

Excessive cortisol production

What is dumping syndrome?

Delivery of a large amount of

hyperosmolar chyme into the small

bowel, usually after vagotomy and a

gastric drainage procedure (pyloroplasty/

gastrojejunostomy); results in autonomic

instability, abdominal pain, and diarrhea

What is Fitz-Hugh-Curtis

Perihepatic gonorrhea infection

syndrome?

What is Gardner’s

GI polyps and associated findings of

syndrome?

Sebaceous cysts, Osteomas, and Desmoid

tumors (SOD); polyps have high malig-

nancy potential (Think: A Gardner

plants SOD)

What is HITT syndrome?

Heparin-Induced Thrombocytopenic

Thrombosis syndrome: Heparin-induced

platelet antibodies cause platelets to

thrombose vessels, often resulting in loss

of limb or life

Site of breast cancer?

Upper outer quadrant

Vessel involved with a

Gastroduodenal artery

bleeding duodenal ulcer?

Cause of common bile

Choledocholithiasis

duct obstruction?

Cause of cholangitis?

Bile duct obstruction resulting from

choledocholithiasis

Cause of pancreatitis?

EtOH

Bacteria in stool?

Bacteroides fragilis (“B. frag”)

Cause of SBO in adults in

Postop peritoneal adhesions

the United States?

Cause of SBO in children?

Hernias

Cause of emergency

Acute appendicitis

abdominal surgery in the

United States?

Site of GI carcinoids?

Appendix

Abdominal x-ray (AXR)

Air-fluid levels

finding with SBO?

Electrolyte deficiency

Hypokalemia

causing ileus?

Cause of transfusion

Clerical error

hemolysis?

Cause of blood transfusion

Clerical error (wrong blood types)

resulting in death?

Site of distant metastasis

Lungs

of sarcoma?

Cause of shock in a

Hypovolemia

surgical patient?

Position of anal fissure?

Posterior

Chapter 3 / Surgical Most Commons 37

Cause of large bowel

Colon cancer

obstruction?

Type of colonic volvulus?

Sigmoid volvulus

Cause of fever 48 post-

Atelectasis

operative hours?

Bacterial cause of urinary

Escherichia coli

tract infection (UTI)?

Chest x-ray (CXR) finding

Widened mediastinum

with traumatic thoracic

aortic injury?

Abdominal organ injured

Liver (not the spleen, as noted in recent

in blunt abdominal

studies!)

trauma?

Abdominal organ injured

Small bowel

in penetrating abdominal

trauma?

Benign tumor of the liver?

Hemangioma

Malignancy of the liver?

Metastasis

Pneumonia in the ICU?

Gram-negative bacteria

Cause of epidural

Middle meningeal artery injury

hematoma?

Cause of lower GI

Upper GI bleeding

bleeding?

Hernia?

Inguinal hernia (right more than left)

Cause of esophageal

Iatrogenic instrumentation (e.g., EGD)

perforation?

Cancer in females?

Lung cancer

Cancer in males?

Prostate cancer

Chapter 4 / Surgical Percentages 39

What percentage of patients

5%

undergoing laparotomy

develop a postoperative

small bowel obstruction at

some time later?

What percentage of

10%

American women develop

breast cancer?

What percentage of patients

Only about 5%

with acute appendicitis will

have a radiopaque fecalith

on abdominal x-ray (AXR)?

What percentage of patients

10%

with gallstones will have ra-

diopaque gallstones on AXR?

What percentage of kidney

90%

stones are radiopaque on

AXR?

At 6 weeks, wounds have

90%

achieved what percentage of

their total tensile strength?

What percentage of patients

40%

with ARDS will die?

What percentage of the

2%

population have a Meckel’s

diverticulum?

What is the risk of

25%

appendiceal rupture

24 hours after the onset of

symptoms?

What percentage of colonic

40% (Think: VILLous VILLain)

villous adenomas contain

cancer?

One unit of packed RBCs

3%

increases the hematocrit by

how much?

Chapter 5 / Surgical History 41

Developed the cardio-

Gibbon

pulmonary bypass

Identify the year the follow-

ing procedures were first

performed and the physician

who performed them:

Renal transplant

1954; Murray

CABG

1962; Sabiston

CEA

1953; DeBakey

Heart transplant

1967; Barnard

Artificial heart valve

1960; Starr

Liver transplant

1963; Starzl

Total parenteral nutrition

1968; Rhoades

(TPN)

Vascular anastomosis

1902; Carrel

Lung transplant

1964; Hardy

Pancreatic transplant

1966; Najarian

Heart-lung transplant

1982; Reitz

AAA Rx

1951; Dubost

First lap chole

1987; Mouret and Dubois in France

First appendectomy

1848; Hancock

First gastric resection

1881; Billroth

First lap appy

1983; Semm (GYN DOCTOR!)

Who was the only surgeon to

Cushing (for his biography on Osler)

win the Pulitzer Prize?

Chapter 6 / Surgical Instruments 43

How should a pair of

Like a pencil

forceps be held?

What are forceps also

“Pickups”

known as?