Articles in General & Specialty Surgery (20)

La fibrillazione atriale è la tachiaritmia cardiaca sostenuta più comune al mondo, caratterizzata da un'attivazione elettrica atriale caotica e inefficace. La gestione clinica si basa sulla prevenzione tromboembolica tramite DOAC, sul controllo della frequenza o del ritmo cardiaco e sulla correzione dei fattori di rischio associati.

L'appendicite acuta (Acute appendicitis) rappresenta la più comune urgenza chirurgica addominale a livello globale, caratterizzata da un'infiammazione transmurale dell'appendice vermiforme causata prevalentemente da un'ostruzione luminale. La gestione clinica tempestiva si basa sulla stratificazione del rischio tramite il punteggio di Alvarado o AIR (Appendicitis Inflammatory Response) associata a diagnostica per immagini mirata, ponendo l'appendicectomia laparoscopica come trattamento chirurgico di riferimento.

La pancreatite acuta è un processo infiammatorio acuto del pancreas con coinvolgimento variabile dei tessuti peripancreatici e degli organi sistemici. La diagnosi richiede la presenza di almeno due dei tre criteri della Classificazione di Atlanta Rivista.

Necrotising fasciitis is a rapidly progressive, life-threatening bacterial soft tissue infection characterised by widespread necrosis of the subcutaneous fat and superficial fascia, requiring emergent surgical debridement and broad-spectrum antimicrobial therapy. The gold-standard diagnostic investigation is surgical exploration showing lack of fascia resistance, grey necrotic tissue, and 'dishwater' fluid, while first-line treatment involves urgent surgical intervention combined with intravenous meropenem, vancomycin, and clindamycin.

The American Society of Anesthesiologists (ASA) Physical Status Classification System is a globally standardized, 6-category pre-anesthetic grading tool used to evaluate a patient's baseline physiological status and systemic health before surgical procedures. The gold-standard diagnostic assessment involves a comprehensive preoperative multidisciplinary clinical evaluation, review of systems, and baseline laboratory/imaging investigations; first-line management centers on individualized anesthetic risk stratification, optimization of chronic comorbidities, and informed perioperative planning.

The Mallampati score and Cormack-Lehane classification are essential complementary airway assessment tools used to predict preprocedural intubation difficulty and grade laryngeal visualization during direct laryngoscopy. The gold-standard diagnostic assessment is direct or video laryngoscopy, while first-line adult management involves structured pre-oxygenation, optimal positioning (sniffing position), and videolaryngoscopy readiness or awake fiberoptic intubation for high-risk airways.

The Clavien-Dindo classification is a universally accepted, objective grading system for surgical complications based on the therapeutic intervention required to manage the deviation from the normal postoperative course, ranging from Grade I (minor bedside interventions) to Grade V (death). Gold-standard evaluation involves daily standardized prospective documentation and multidisciplinary morbidity-mortality conferences, while first-line protocol mandates immediate therapeutic escalation matched precisely to the lowest-tier invasive requirement needed to correct the adverse event.

The Caprini risk score is a validated venous thromboembolism (VTE) risk assessment model that stratifies surgical and medical inpatients into risk categories based on cumulative patient- and procedure-specific risk factors. The gold-standard diagnostic approach for suspected VTE comprises compression ultrasonography or computed tomography pulmonary angiography (CTPA), and first-line management involves tailored mechanical or pharmacological thromboprophylaxis.

The Parkland formula is a standardized fluid resuscitation calculation (4 mL/kg/%TBSA of lactated Ringer's) used to prevent burn shock in patients with severe thermal injuries. Gold-standard diagnostic assessment involves precise determination of total body surface area (TBSA) affected via the Rule of Nines, coupled with invasive and non-invasive hemodynamic monitoring. First-line therapy mandates immediate intravenous crystalloid administration, delivering half the calculated volume in the first 8 hours post-injury and the remaining half over the subsequent 16 hours.

The Tokyo Guidelines (TG13/TG18) provide international consensus diagnostic criteria and severity grading for acute cholangitis and cholecystitis, utilizing biliary obstruction, systemic inflammation, and imaging findings. The gold-standard diagnostic modalities are urgent transabdominal ultrasonography and magnetic resonance cholangiopancreatography (MRCP), paired with first-line empirical broad-spectrum intravenous antimicrobial therapy and timely biliary drainage or laparoscopic cholecystectomy.

The Hinchey classification of acute diverticulitis is an anatomically and radiologically validated staging system categorizing perforated diverticular disease from localized pericolic inflammation to generalized fecal peritonitis. Contrast-enhanced computed tomography (CT) of the abdomen and pelvis serves as the gold-standard diagnostic imaging modality, while management ranges from conservative outpatient observation and targeted percutaneous drainage to emergency surgical resection (such as Hartmann's procedure or primary anastomosis with diverting stoma) depending on the assigned anatomical stage.

The filarial dance sign (FDS) is a pathognomonic real-time high-resolution ultrasonographic finding characterized by rhythmic, random, rapid twirling movements of live adult filarial nematodes within lymphatic vessels or subcutaneous tissues. Gold-standard diagnosis is established via high-frequency color and pulsed-wave Doppler ultrasonography demonstrating the characteristic movement profile, while first-line management involves antifilarial chemotherapy such as diethylcarbamazine combined with albendazole or ivermectin.

Kehr sign is the classic referred pain to the left shoulder elicited by irritation of the undersurface of the diaphragm due to hemoperitoneum, splenic rupture, or ectopic pregnancy. Contrast-enhanced computed tomography (CE-CT) serves as the gold-standard diagnostic modality, while emergency exploratory laparotomy or splenectomy constitutes first-line therapy for hemodynamic instability.

Carnett sign is a physical examination maneuver used to differentiate abdominal wall pain from intra-abdominal visceral pain, where tenderness either remains unchanged or worsens when the patient tenses the abdominal musculature. The gold-standard diagnostic and therapeutic procedure is a targeted local anesthetic trigger point injection, and first-line conservative management involves patient reassurance, activity modification, topical analgesia, and targeted neural blockade.

Blumberg sign, commonly known as rebound tenderness, is a classical physical examination finding indicating acute peritoneal irritation, typically assessed by deep palpation followed by sudden release. The gold-standard diagnostic modality for identifying the underlying intra-abdominal pathology is contrast-enhanced computed tomography (CECT), while management generally requires emergent surgical intervention coupled with broad-spectrum antibiotic therapy.

Rovsing sign, psoas sign, and obturator sign are classic somatic and visceral peritoneal irritation signs elicited during physical examination to aid in the clinical diagnosis of acute appendicitis and localized peritonitis. The gold-standard diagnostic investigation is contrast-enhanced computed tomography (CT) of the abdomen and pelvis, while definitive first-line therapy consists of urgent laparoscopic appendectomy combined with intravenous broad-spectrum antimicrobial administration.

Mesenteric ischaemia is a life-threatening vascular emergency characterized by inadequate blood flow to the gastrointestinal tract, leading rapidly to transmural bowel necrosis, perforation, and septic shock if untreated. The gold-standard diagnostic modality is biphasic computed tomography angiography (CTA), and first-line therapy entails urgent fluid resuscitation, broad-spectrum intravenous antibiotics, systemic anticoagulation, and immediate endovascular or open surgical revascularisation alongside resection of non-viable bowel.

The Alvarado score is a 10-point clinical stratification tool utilized to evaluate patients presenting with suspected acute appendicitis, prioritizing prompt diagnosis through physical examination, migratory abdominal pain, and laboratory leukocytosis. The gold-standard diagnostic investigation is contrast-enhanced computed tomography (or graded-compression ultrasound in children and pregnant patients), and first-line therapy consists of prompt laparoscopic appendicectomy accompanied by weight-adjusted broad-spectrum intravenous antimicrobial therapy.

Acute mesenteric ischaemia (AMI) is a life-threatening vascular emergency characterized by sudden interruption of intestinal blood flow, precipitating transmural bowel necrosis and multiorgan failure. Diagnosis is established via biphasic CT mesenteric angiography, requiring emergent endovascular or open surgical revascularization alongside broad-spectrum antibiotics and heparinization.

Boerhaave syndrome is a life-threatening, full-thickness spontaneous rupture of the oesophagus typically resulting from sudden increases in intra-oesophageal pressure combined with negative intrathoracic pressure during forceful emesis. The gold-standard diagnostic modality is a CT thorax or oesophagography utilizing water-soluble oral contrast (Gastrografin), which identifies transmural leakage while avoiding the severe mediastinitis risks associated with barium. First-line management entails strict nil per os (NPO), aggressive nasogastric decompression, broad-spectrum intravenous antimicrobial coverage, and emergent primary surgical repair or endoscopic covered stenting within the first 24 hours to prevent septic shock and mortality.