Surgery: An Index to the Morning Rounds Series for NEET-PG

Oesophagus, stomach, and duodenum through five clinical vignettes. Covers achalasia with the bird-beak barium sign, aperistalsis on high-resolution manometry, Heller's cardiomyotomy with partial fundoplication, and the pseudoachalasia trap for patients over 55. Corrosive oesophageal injury with the Zargar grading system and the critical prohibitions against vomiting and neutralisation. Peptic ulcer disease with the Modified Johnson's classification in full — Type I at the incisura (normal acid, H. pylori) through Type IV near the GEJ (highest malignancy risk, mandatory biopsy). Dumping syndrome distinguishing early (vasomotor, normal glucose, 15–30 minutes post-meal) from late (neuroglycopenic, low glucose, 1.5–3 hours post-meal). Upper GI variceal bleeding with terlipressin versus the PPI trap, endoscopic band ligation, and prophylactic antibiotics in cirrhotics. Three SVG diagrams including the achalasia pathophysiology table and the Johnson's classification grid.

Small bowel, colon, and appendix in five cases spanning the commonest emergencies in lower GI surgery. Intussusception in a 14-month-old with Dance's sign, the target sign on USS, and pneumatic enema as first-line — not surgery. Crohn's disease with the cardinal principle that surgery is never curative, the transmural skip-lesion pathology, and why IPAA is contraindicated. Peutz-Jeghers syndrome with the STK11/LKB1 mutation, arborising hamartomatous polyps, and the frequently underestimated extra-intestinal cancer risk including breast (54%) and pancreatic (36%). Sigmoid volvulus with the coffee-bean sign pointing toward the RUQ, endoscopic decompression as first-line, and the contrast with caecal volvulus which goes directly to surgery. Acute appendicitis with the Alvarado/MANTRELS score, the threshold for proceeding to theatre without imaging in males, and the Ochsner-Sherren regimen for appendicular mass. Three SVG diagrams including the Crohn's versus UC surgical comparison table and the Alvarado scoring grid.

Five cases across the liver, biliary tree, and pancreas — a system that produces some of surgery's most consequential diagnostic and management decisions. Acute cholangitis with Charcot's triad, Reynold's pentad, Tokyo grading, and ERCP versus surgical CBD exploration. Acute pancreatitis with Ranson's eleven criteria, the 48-hour calculation rule, the early enteral nutrition evidence, and the prohibition against prophylactic antibiotics and early necrosectomy. Biliary atresia in a six-week-old infant with the conjugated jaundice-acholic stool picture, HIDA scan non-excretion, and the Kasai hepatoportoenterostomy timing rule (before 60 days). Hydatid cyst with the Gharbi classification, PAIR procedure with albendazole cover, and surgical indications including biliary communication. Carcinoma of the pancreatic head with Courvoisier's sign, the double-duct sign, resectability criteria, and Whipple's procedure with its complications. Three SVG diagrams including the Ranson's criteria table and the pancreatic carcinoma resectability grid.

Lumps, hormones, and the sequences that keep patients alive. Single-duct blood-stained nipple discharge with intraductal papilloma versus duct ectasia versus Paget's disease — and microdochectomy as the definitive treatment. Papillary thyroid carcinoma on FNAC with Orphan Annie nuclei, nuclear grooves, and Psammoma bodies — and why FNAC is reliable for papillary carcinoma but cannot diagnose follicular carcinoma (capsular invasion requires excision histology). Post-thyroidectomy hypocalcaemia with Chvostek and Trousseau signs, IV calcium gluconate, and the distinction between unilateral and bilateral RLN injury. Phaeochromocytoma with the Rule of 10s, 24-hour urinary metanephrines, and the alpha-before-beta pre-operative preparation rule that cannot be violated. MEN 2A with RET proto-oncogene mutation, the three-component syndrome, and the sequence of surgery: phaeochromocytoma first, thyroidectomy second — always. Three SVG diagrams including the thyroid carcinoma comparison table, phaeochromocytoma preparation protocol, and MEN classification grid.

Anatomy, timing, and the Triangle of Doom. Carcinoma bladder from a textile worker with T2 muscle-invasive disease — the TURBT-plus-BCG trap versus radical cystectomy with ileal conduit, and occupational carcinogen exposure as a distinct risk factor from smoking. Testicular torsion at 11 PM in a 14-year-old with the bell-clapper deformity, absent cremasteric reflex, and the 6-hour window for 100% salvage — with the instruction not to wait for Doppler USS when the clinical diagnosis is confident. Inguinal hernia repair in the laparoscopic field: the Triangle of Doom (vas deferens, testicular vessels, external iliac vessels) and Corona Mortis as the two anatomical dangers in TEP/TAPP, alongside the Hesselbach's triangle definition that separates direct from indirect. Cryptorchidism with the 6-to-18-month orchidopexy window and why hormonal therapy fails for inguinally palpable testes. BPH and TUR syndrome with the glycine irrigation mechanism, hyponatraemia management, and IPSS scoring. Two SVG diagrams: inguinal anatomy comparison table and BPH versus carcinoma prostate differentiator.

Pressure, flow, and the golden hour. Blunt abdominal trauma with the FAST scan decision framework: haemodynamically unstable with free fluid in Morrison's pouch goes directly to damage control laparotomy without CT. Proximal DVT from a long-haul flight with provoked risk factors: LMWH-to-DOAC for three months, IVC filter indications, and why thrombolysis is not appropriate for routine proximal DVT. Burns fluid resuscitation: the Parkland formula calculated through a real case (45% TBSA, 70 kg, two-hour pre-hospital delay) with the time-of-burn rule that catches most candidates, Ringer's lactate versus saline, no colloid in the first 24 hours, and the urine output target. Peripheral arterial disease with Fontaine staging, ABPI interpretation including the diabetic trap of non-compressible vessels above 1.3, and supervised exercise therapy as first-line for claudication. Abdominal aortic aneurysm comparing EVAR and open repair on 30-day mortality, long-term survival, endoleak surveillance, and reintervention rates, with Laplace's law as the physiological explanation for repair thresholds. Two SVG diagrams: Rule of 9s with Parkland table, and AAA diameter-to-rupture-risk grid.

The series closer, covering the breadth of surgical practice beyond the abdomen. Extradural haematoma in a cricketer with the lucid interval, biconvex CT collection, pterion fracture, and middle meningeal artery as source — with Kernohan's notch as the false localising sign that reverses the expected laterality of weakness. Soft tissue sarcoma of the thigh with the pseudocapsule danger (never shell through it), core needle biopsy along the long axis, wide local excision plus radiotherapy achieving limb salvage in 90% of cases, and haematogenous spread to the lungs as the metastatic pattern. Carcinoma of the lower lip with T2N1M0 staging, V-plasty reconstruction, and ipsilateral supraomohyoid neck dissection for N1 disease. Post-splenectomy OPSI with the SHiN encapsulated organisms, three-vaccine protocol with timing, lifelong penicillin V prophylaxis, and Howell-Jolly bodies as the haematological signature. Surgical site infection after right hemicolectomy: Class II wound classification, superficial SSI management by opening and secondary intention, and the case against routine antibiotics for drained superficial wounds. Three SVG diagrams: EDH versus SDH comparison, OPSI vaccination protocol, and the four-class wound classification table.