General Surgery

Acute inflammation of the appendix usually causes migrating abdominal pain and right iliac fossa peritonism, but atypical presentations and complications require early senior assessment, targeted imaging and timely source control.

Bowel obstruction stops intestinal contents passing, so gas and fluid pile up above the block. The distended bowel leaks litres into its own lumen and can strangle its own blood supply.

A full-thickness breach of the gut wall spills gas and enteric contents into a sterile cavity, so chemical irritation is followed by bacterial peritonitis and sepsis.

Abdominal contents push through the narrow, rigid femoral canal below and lateral to the pubic tubercle, and because that canal is tighter and less compliant than the inguinal canal, femoral hernias carry a much higher risk of strangulation and are treated as surgical emergencies until proven otherwise.

A groin-wall defect allows fat or bowel to protrude through the inguinal canal; the key clinical decisions are whether it is reducible, whether it is symptomatic, and whether obstruction or strangulation makes it an emergency.

Bacteria or gut contents reach the peritoneal cavity, which cannot clear them, so infection spreads across its huge surface and drives ileus, third-space fluid loss and sepsis.

The acute abdomen is a high-risk presentation rather than a diagnosis: assess physiology, pregnancy and surgical red flags in parallel with analgesia, targeted tests and imaging, then obtain early senior review and source control when needed.