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DIPLOMA IN CLINICAL MEDICINE”p-ij

MODULE 15: CS4 SURGERY

Hours: Theory – 134 hours

Practical – 570 hours

AIM
The aim of this module is to provide students with knowledge, skills
and attitudes to enable them provide surgical care.

BROAD OBJECTIVE:
By the end of the module the student should be able to diagnose
common surgical conditions and diseases for the provision of
appropriate management.

UNIT 1: GENERAL SURGERY

TIME ALLOCATION: Theory: 104 Hours
Practical: 410 Hours

SUB UNIT 1: ORGANIZATION OF A SURGICAL SERVICE

Time Allocation: 10 hours

SPECIFIC OBJECTIVES
By the end of this sub-unit the student should be able to:

1. Outline the surgical services

2. Outline disaster situations
3. Develop a disaster plan
4. Explain the trauma triage

CONTENT:
1. Surgical services
 Casualty
 Wards
 Minor theatre
 Major theatre
 Orthopaedics
 High Dependence Unit
 Intensive Care Unit
 Anaesthesia
 Laboratory
 Radiography
2. Disaster situations
  Trauma
 Public health disaster.
 Natural disasters.
 War and civil unrest.

3. Disaster plan
 General Disaster Planning
 Trauma Disaster Planning

4. The trauma triage

 Goal of triage
 Steps in establishing a trauma team
 Responsibilities of trauma team leader

SUB UNIT 2: SURGICAL DOMAIN “CREATING A SAFE

ENVIRONMENT FOR SURGERY”

Time allocation: 6 hours

SPECIFIC OBJECTIVES

By the end of this sub-unit the student should be able to:

1. Explain infection control measures and asepsis in surgery.

2. Explain the appropriate use and care of basic surgical
instruments and equipment.
3. Outline the basic requirements and standard procedures for the
correct use of the operating room.

CONTENT

1. Infection control measures and asepsis in surgery.

 Hand washing
 Aseptic technique
 Prevention of transmission of infectious diseases
 Operative procedure list
 Disinfection, Cleaning and Sterilization

2. Appropriate use and care of basic surgical instruments and

equipment
 Care and repair
 Use
3. Requirements and standard procedures for the correct use of
the operating room.

 Basic requirements of an operating room

  Standard procedures for the correct use of an operating
room.

SUB UNIT 3. FUNDAMENTALS OF SURGICAL PRACTICE

Time allocation: 12 Hours

SPECIFIC OBJECTIVES

By the end of this sub-unit the student should be able to:

1. Outline the approach to the care of a surgical patient.

2. Describe the activities involved in the care of a surgical patient
3. Describe the common post-operative complications

CONTENT

1. Approach to the care of a Surgical Patient

 Pre-operative care
 Intra-operative care
 Post –operative care

2. Activities involved in the care of a surgical patient

 Diagnostic work-up
 Pre-operative evaluation
 Pre-operative preparation
 Anaesthesia and operation
 Post-anaesthetic observation

3. The Common Post-operative Complications

 Wound complication
 Respiratory
 Intra-peritoneal
 Gastro-intestinal
 Renal
 Cardiovascular

SUB UNIT 4.0: BASIC SURGICAL TECHNIQUES

Time allocation: 4Hours

SPECIFIC OBJECTIVES
By the end of this unit the student should be able to: -

1. Outline the basic surgical techniques.

2. Describe incision making.
3. Explain the methods of homeostasis.
4. Describe suture materials and suturing technique

CONTENT

1. Basic surgical techniques.

 Incisions
 Haemostasis
 Tissue handling
 Suturing
 Suture Technique

2. Incision making.

 Principles of incisions
 Types of incisions

3. Methods of haemostasis.

 Pressure over gauze

 Ligation
 Cautery

4. Suture materials and suturing technique

 Sutures materials
 Suturing techniques

SUB UNIT 5.0: INFLAMMATION, INFECTIONS AND SUPERFICIAL

CONDITIONS

Time allocation: 12 hours

SPECIFIC OBJECTIVES

By the end of this unit the student should be able to: -

1. Describe fundamentals of surgical infections
2. Describe common surgical infections and inflammatory
conditions.
3. Describe surgical superficial conditions
4. Manage common surgical infections, inflammatory conditions
and superficial conditions

CONTENT

1. Fundamentals of surgical infections

 Pathogenesis of surgical infections

 Complications and spread of surgical infections.
 Diagnostic studies.
 General principles of treatment

2. common surgical infections and inflammatory

conditions

 Abscess in general
 Cellulitis
 Fournier’s Gangrene
 Hand Infections
 Clostridial Infections
o Gas Gangrene
 Gas abscess (Welch’s abscess)
 Crepitant clostridial cellulitis
 Localised clostridial myositis
 Oedematous gangrene
o Tetanus

2. Superficial conditions
 Ganglion
 Cyst
 Lipoma

4. Management of common surgical infections, inflammatory

conditions and superficial conditions
 Conservative
 Chemotherapy
 Surgical :- incision
Excision
UNIT 6: GASTRO INTESTINAL CONDITIONS AND DISEASES

TIME ALLOCATION: 20 Hours

SPECIFIC OBJECTIVES

By the end of this unit the student should be able to: -

1. Describe common congenital neonatal conditions and

diseases.
2. Manage common neonatal conditions and diseases.
3. Describe common surgical abdominal conditions and
diseases.
4. Manage common surgical abdominal conditions and diseases.
5. Describe the anal rectal conditions.
6. Manage common anal rectal conditions

CONTENT

1. Common congenital neonatal conditions and diseases

 Oesophageal Atresia
 Hypertrophy Pyloric Stenosis
 Cleft Lip and Palate
 Spinal Bifida (Meningomyelocele)
 Imperforate Anus

2. Management of common neonatal conditions and

diseases.

 Conservative
 Surgical

3. Common surgical abdominal conditions and diseases.

 Pancreatitis
 Peptic Ulcerations
 Appendicitis
 Bowel Obstruction
 Cholecytitis
 Peritonitis

4. Management common surgical abdominal conditions and

diseases.

 Conservative
  Surgical

5. Common anal rectal conditions.

 Haemorrhoids
 Anorectal Abscesses
 Ano-fistula
 Fissure in- ano
 Colorectal carcinoma

6. Management of anal rectal conditions

 Conservative
 Chemotherapy
 Surgical

UNIT 7: OESOPHAGEAL, THYROID AND BREAST PATHOLOGY

TIME ALLOCATION: 16 Hours

SPECIFIC OBJECTIVES

By the end of this unit the student should be able to:

1. Describe oesophageal diseases and conditions

2. Manage oesophageal diseases and conditions
3. Describe thyroid diseases and conditions
4. Manage thyroid diseases and conditions
5. Describe breast diseases and conditions
6. Manage breast diseases and conditions

CONTENT

1. Oesophageal diseases and conditions

 Carcinoma of the Oesophagus

 Reflux Oesophagitis
 Achlasia Cardia

2. Management of oesophageal diseases and conditions

 Conservative
 Surgical
 Palliative

3. Thyroid diseases and conditions

  Goitre
 Carcinoma of thyroid

4. Management of thyroid diseases and conditions

 Conservative
 Surgical
 Radiotherapy and chemotherapy
 Palliative

5. Breast diseases and conditions

 Physiological
 Infections
 Benign
 Malignant

6. Management of breast diseases and conditions

 Conservative
 Surgical
 Radiotherapy and chemotherapy
 Palliative

UNIT 8.0: MALE GENITAL URINARY CONDITIONS

Time allocation: 14 hours

By the end of this unit students should be able to:

1. Describe the male genital urinary diseases and conditions.

2. Manage the male genital urinary diseases and conditions.

Content

1. Male genital urinary diseases and conditions.

 Hydrocele
 Bladder Carcinoma
 Prostatic Enlargement
 Urethral Stricture
 Inguinal Scrotal Swellings
 Hernia
 Torsion of the testis
 Phimosis and Paraphimosis
 Hypospadias

2. Management of male genital urinary diseases and

conditions.

Conservative
Surgical
Chemotherapy

UNIT 9.0: TRAUMATOLOGY

Time allocation: 20 hrs

By the end of this unit the student should be able to:

1. Explain the principles of primary trauma care management

2. Describe phases of trauma care management
3. Describe trauma conditions
4. Manage trauma conditions

CONTENT

1. Principles of primary trauma care management

 ABC management.

2. Phases of trauma care management

 Triage
 Primary survey
 Secondary survey
 Stabilisation
 Transfer
 Definitive care

3. Trauma conditions

 Haemorrhage
  Shock
 Head Injury
 Chest Injury
 Abdominal Injury
 Pelvic Injury
 Burns
 Bites and stings

4. Management of trauma conditions

 Conservative
 Surgical

UNIT 2 ORTHOPAEDICS

Time Allocation: Theory -30 hours

Practical- 80 hours

By the end of the unit the student should be able to:

1. Outline the approach to the care of an orthopaedic patient.

2. Classify orthopaedic conditions
3. Manage orthopaedic conditions

CONTENT

1. Approach to the care of an orthopaedic patient.

 History
 Physical examination
 Investigations

2. Classification of orthopaedic conditions

  Trauma
 Fractures
 Dislocations
 Sprains
 Strains
 Subluxations

 Infection and inflammation

 Acute osteomyelitis
 Chronic osteomyelitis
 Tuberculosis
 Pyomyositis

 Arthritis

o Osteoarthritis
o Gout arthritis

 Congenital and developmental conditions

o Club foot

 Neoplasitic conditions

o Benign
o Malignant

 Metabolic and endocrine

 Sensory disturbances and muscle weakness

3. Management of orthopaedic conditions

 Management principles of fracture and dislocation

 Management of specific orthopaedic conditions.

TEACHING METHODS
 Lecture/discussion
 Group discussion
 Demonstration /return demonstration
 Case studies
 Clinical attachments
 Role plays
 Presentations
 Tutorials
  Question and answers

TEACHING MATERIALS
 Chalk board
 Overhead projector/transparencies
 Slides and projector
 Wall charts
 Power Point projector
 Hand outs
 Flip charts
 Human models
 Realia

ASSESMENT
 Objective structured clinical examination
 Quizzes
 Written examination
 Case studies
 Assignment
 Observations

PRESCRIBED REFERENCE:

Mann C.V., Russell R.C.G. and Williams N.S. (), Bailey and Love’s
Short practice of Surgery Chapman and Hall Medical, London
Kings M., and Bewes, P., Primary Surgery (Trauma and Non
Trauma) (2000), Oxford Medical Publications, Oxford
Louis, S., David, J.W., and Selvadurai, J. (2001), Apley’s system of
Orthopaedics and Fractures, Vol. 1 and 2 , 8th Edition, Oxford University
Press Inc. New York
World Health Organisation (2003), Surgical Care at the District
Hospital, Interprint limited, Malta.

RECOMMENDED REFERENCE:
.
Hardy, J.D. Hardy's Text Book of Surgery. 2nd Edition, J.B. Lippincolt
Company, Philadelphia, 1988.
Macfarlane, D.A. and Thams, L.P, Textbook pf Surgery, Longman
Edinburgh, 1972.
Way, L.N. (Editor) Current Surgical Diagnosis and Treatment, 8th
edition, Mange Medical Book, Sanfrancisco, 1988.