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GenSurgCall 1.1 now available

GenSurgCall 1.1 is now available for download or update from the App store. 

Known bug in GenSurgCall 1.0

The laparoscopic appendicectomy video is not playing. This has been fixed in version 1.1 which should be released in an update later this week. 

Information about GenSurgCall

Welcome to the support page for the iPhone app GenSurgCall.

If you scroll through the preceding posts, you will find useful links, and also some sample short answer questions pertaining to General Surgery which have appeared in the written section of previous part 2 Fellowship examinations of the Royal Australasian College of Surgeons. The answers provided are examples only and no guarantee is made regarding their accuracy. 

Useful links

Some useful links:

Link to surgical tutor


Link to Royal Australasian College of Surgeons

Link to summary of Cochrane review of Laparoscopic vs Open appendicectomy


Surgical mortality risk prediction

American cancer information site

Adjuvant Online: Guide for adjuvant therapy for breast, colon and lung cancers.

American Society of Colorectal Surgeons

Royal College of Surgeons Edinburgh Educational site

Websurg-laparoscopic surgical site


Let me know if you know any other good sites.

May 2006, Q7

A 38 year old woman is admitted under your care 3 days after a laparoscopic cholecystectomy at another hospital with severe abdominal pain, a fever of 38.0 and elevated liver function tests including a bilirubin of 34. An operative cholangiogram was not performed. Discuss your management of this lady.

Most likely concern is a bile leak.

After history, examination and initial resuscitation, blood tests for FBC, U&E, LFTs, Coags and lipase should be done. IV antibiotics for sepsis.

Need to establish diagnosis of bile leak. U/S abdo to look for collections in the first instance. If no collections, then HIDA scan can be done to look for a small leak.

Next need to establish drainage of any collections. Preferably percutaneosly under radiological guidance, but if not feasable, then laparoscopic drainage.

Then need to identify anatomy of injury and if any concomitant vascular injury.
Therefore, ERCP probably reasonable first test and if minor injury which can be dealt with by stenting then this may be all that is needed. However,if more complex injury, and proximal ducts not visualised, then MRCP. Then, CT angiogram to look for vascular injury.

If high injury or complete transection of CBD (i.e. any Strasberg E type), then should plan for Roux-en-Y hepatico-jejunostomy.

Regular long-term follow-up including LFTs to look for any stricturing. Endoscopic CBD stents should be removed/replaced at about the 6 week mark.

Colorectal question 2

2. What is the purpose of a diverting intestinal stoma? What complications may occur and how are they managed?

The purpose of a diverting intestinal stoma is to channel the faecal stream away from a more distal site in the gastro-intestinal tract.

Potential complications and their management include:
Retraction: May need revision
Mucocutaneous separation can usually be treated conservatively if minor
Ischaemia: May need revision if severe
Stricture/stenosis: Revise if severe
Bowel obstruction from food bolus: may be amenable to manual disimpaction
Skin irritation: need good stoma care
Prolapse: May need revision. Purse string can also be considered
Parastomal hernia: Repair if symptomatic and patient can tolerate GA. Local repair or resiting of stoma.
Parastomal abscess: Drainage
High output: Loperamide
Bleeding: Treat underlying cause
Fistula: Early ones can be treated by closing internal opening.

Source: Textbook of surgery by Tjandra et al. Second edition Page 247