Primary care and emergency room clinicians manage a complex array of disorders and are commonly the first to encounter a surgical or potentially surgical disorder. The purpose of this manual is to assist non-surgeons in determining when a patient should or need not be referred for surgical assessment.
This manual includes referral guidance on surgical disorders commonly cared for by adult and pediatric general surgeons with a focus on the thoracoabdominal domain. Chapters describe patient history and clinical examination findings relevant to the probable diagnosis. Guidance is then provided on the evaluation of these patients to include studies that should be performed prior to referral as opposed to those that should be reserved for after surgical assessment. Interpretation of relevant imaging and laboratory assessments as it relates to the decision to refer or not refer to a surgeon is included, and literature and guidelines, where available, are incorporated. Additionally, alternatives to surgical referral are provided when relevant. All chapters are written by experts in their fields and include the most up-to-date scientific and clinical information.
Part I. Symptoms.- Dysphagia.- Esophageal impactions and strictures.-
Hematemesis.- Substernal chest pain.- GERD.- Non-reflux emesis bilious and
non-bilious.- Pediatric emesis.- Left upper quadrant abdominal pain.- Right
upper quadrant abdominal pain.- Periumbilical pain.- Left lower quadrant
abdominal pain.- Right lower quadrant abdominal pain.- Chronic Groin Pain.-
Melena.- Rectal bleeding.- Change In stool caliber.- Constipation.-
Fissures/anal pain.- Part II. Examination findings.- Breast disease.- Thyroid
Diseas.- Parathyroid disease.- Severe obesity.- Pancreatitis.- Splenomegaly.-
Small bowel dilation/obstruction.- Appendix and appendicitis.- Supraumbilical
lumps and bulges (Epigastric hernias and diastasis).- Incisional hernias.-
Umbilical hernias.- Pediatric inguinal hernias.- Adult Inguinal hernias.-
Femoral bulge.- Rectal prolapse.- Hemorrhoids.- Perirectal/perianal abscess.-
Part III. Investigation finding.- Esophageal diverticulae.- Barretts
esophagus.- Esophageal varices.- Delayed gastric emptying.- Gastritis with
ulcer.- Gastric mass.- Gallbladder Polyps.- Cholelithiasis/Sludge.- Liver
lesions.- Pancreatic lesions.- Splenic lesions.- Adrenal Lesions.- Polyps on
colonoscopy.- Part IV. Miscellaneous.- Feeding tube placement.- Vascular
access.- Dialysis access (both hemo and peritoneal).
Geoffrey P. Kohn, MBBS(Hons), MSurg, FRACS, FACS, Department of Surgery, Monash University, Melbourne, VC, Australia
Bethany J. Slater, MD, MBA, Department of Surgery, University of Chicago, Chicago, IL, USA
Diane Alligood, MD, Alligood Medical Acupuncture, PLLC, Greenville, NC, USA
Danielle S. Walsh, MD, Department of Surgery, University of Kentucky, Lexington, KY, USA
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