Section outline

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    General

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    Course Details

    Course Code:MCS 604

    Course Title: SENIOR CLERKSHIP IN SURGERY

    Lecturer Details

    The following faculty members will participate in the teaching of MCS 604

    Lecturer Name:Dr Caesar Bitta
    Lecturer Contact: 0736988980 cbitta@maseno.ac.ke


    Lecturer Name: Prof Stephen Ogendo  0722516098, swoogendo@gmail.com

    Lecturer Name : Dr Nyamohanga Marwa 0722485324 nyamopat@yahoo.com

    Lecturer Name: Dr Lee Ogutha 0723650907 logutha@gmail.com 

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    TOPIC 1- PRINCIPLES OF SURGERY

    • TOPIC - PRINCIPLES OF SURGERY>

      Topic Introduction

      The principles of surgical care guide the all rounded management of patients with any surgical pathology. These principles, though covering a diverse scope of surgery, collectively have the greatest impact on the outcomes of surgical intervention or care offered to our patients.

      The scope of the principles of surgical care includes

      Pre-operative evaluation; 

      Post- operative patient care and management of complications.

      Indications of surgery- elective & emergency

      Principles of emergency surgery

      Rational use of drugs

      Informed consent. 

      Counselling patients and their relatives.

      Psychosocial aspects of disease in surgery

      You must be conversant with each of the aspects of these principles 

      This topic shall cover the first two weeks of the course program. A mandatory quiz has been set at the end of the two weeks and shall constitute part of your CAT assessment mark for MCS 604

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Conduct preoperative evaluation of surgical patients scheduled for both elective and emergency surgical procedures
      2. Monitor, evaluate and reassess the management of the surgical patient after surgical intervention .
      3. Able to triage the surgical patients in the outpatient/ emergency unit.
      4. Comprehensively manage the surgical patient presenting with urgent or emergent conditions

      Topic Learning Activities/Tasks

      The learning activities for this topic shall include

      e.g

      1. Reading the lecture notes availed
      2. Reading teaching material from the references listed
      3. Group discussions
      4.  Drawing preoperative care plans with the clinical teams in the ward
      5. Being part of the team when consent seeking is being done by the clinical housemen in the surgical wards
      6. Discussing case procedures and peri-operative care with the patients, together with the consultants, in the surgical clinics

      Assignments and Activities

      The following lecture materials have been availed:

      1. Preoperative evaluation of the surgical patient . Lecture 1-  https://youtu.be/H_52W-bJtPw 

      Longitudinal lecture on preoperative management of the surgical patient offered on 28.10.2022

      2. Informed consent 

      Lecture 1. 

      Lecture 2

      3. Principles of emergency surgery

      Lecture https://youtu.be/56ae3tRtZCg 


       

    • Topic Discussion forum
    • Assessment on Principles of Surgery Quiz
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    INTESTINAL OBSTRUCTION

    • TOPIC - <INTESTINAL OBSTRUCTION

      Topic Introduction

      <Intestinal obstruction is one of the most common causes of presentation and subsequent admission into a surgical units. With improved understanding of the causes, pathophysiology and progression of intestinal obstruction as well as better diagnostic and management modalities for intestinal obstruction, the morbidity and mortality associated with intestinal obstruction has reduced globally. However this does not reduce the significant fact that a significant proportion of patients, especially in low and middle income countries still present late . 

      Patients presenting with intestinal obstruction have good outcomes if their management follows specific principles of surgery, they are adequately resuscitated, continuously monitored, undergo timely, appropriate and rational surgical interventions. 

      By understanding this topic, the learner will be enabled to better diagnose and ultimately manage patients presenting with features of intestinal obstruction. 

      The learner will be required to understand the epidemiology, risk factors, common causes, classification and diagnosis of intestinal obstruction while also proposing an appropriate management plan for the patients. 

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Discuss the epidemiology, risk factors and causes of intestinal obstruction
      2. Adequately and timely manage patients presenting with intestinal obstruction
      3. Be conversant with the sigmoid volvulus, intussusception and other specific causes of intestinal obstruction
      4. Appropriately diagnose and manage patients with adhesive small bowel obstruction
      5. To be able to manage complications of management of intestinal obstruction

      Topic Learning Activities/Tasks

      The student will be expected to

      1. Watch the provided lectures
      2. Review, clerk and outline management plans for the patients being managed for intestinal obstruction
      3. Participate in group discussions on intestinal obstruction
      4. Complete the quiz provided

      Assignments and Activities

      Lectures

      1. Adhesive Small Bowel Obstruction

      Lecture 1- https://youtu.be/CziEbRREOZ8

      Lecture 2- https://youtu.be/kEvX7VAJgUw

      2. Colonic volvulus - Lecture https://youtu.be/isUlsubEoII

      3. Intussusception - 

      https://youtu.be/Z9jx-K4Kk24

       

    • Topic Discussion Forum
    • Case scenarios for Intestinal Obstruction File
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    SURGICAL DISEASES OF THE PANCREATICOBILIARY SYSTEM

    • TOPIC - SURGICAL DISEASES OF THE PANCREATICOBILIARY SYSTEM

      Topic Introduction

      The understanding of conditions affecting the liver, biliary tract and gall bladder has rapidly increased over the last 30 years. With this understanding of their pathophysiology has also come better diagnostic modalities and minimally invasive interventions that have reduced the morbidity associated with surgery in the pancreaticobiliary system. 

      This chapter sets out to help the final year student have a better understanding on the clinical relevance of the pathophysiology of these diseases, type and choice of diagnostic modalities and the management of more common diseases in the system

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1. To understand the epidemiology of pancreaticobiliary diseases
      2. To understand the pathophysiology of common diseases of the pancreaticobiliary system
      3. To rationally set up the diagnostic pathway for a patient presenting with these conditions
      4. To be able to appropriately outline the treatment modalities for patients with pancreaticobiliary diseases
      5. To be conversant with current trends in the management of the diseases

      Topic Learning Activities/Tasks

      The learning activities in this chapter shall include

      e.g

      1. Self directed reading of the course material
      2. Watch the lecturer videos provided
      3. Participate in the class discussion
      4. Take part in the discussion of appropriate case discussion
      5. Clerk and present patients with these pathologies at clinical ward rounds and specialists outpatient clinics
      6. Complete the quizzes
      7. Timely complete the weekly write ups during the rotation

      Assignments and Activities

       Lecture videos availed 

      1. Cholelithiasis- https://youtu.be/FCdVoVqMcWc

      2. Pancreatitis- Acute panctreatitis https://youtu.be/Xz_mJ8ESbPI

                              Chronic pancreatitis- https://youtu.be/msMFeTWhSi4

      3. Malignant causes of obstructive jaundice - pending an upload

      We will also have case scenarios discussed at whole class sessions to evaluate the understanding of the topics studied in this section


       

    • Topic Discussion Forum
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    GASTROINTESTINAL BLEEDING

    • TOPIC - <GASTROINTESTINAL BLEEDING >

      Topic Introduction

      The incidence of gastrointestinal bleeding globally is increasing. Despite improved diagnostic and therapeutic modalities for both upper and lower GI bleeding, the in-hospital mortality for upper GI bleeding remains high. Lower GI bleeding remains an ominous sign for patients presenting with colorectal malignancies. 

      While undertaking this topic, the learner will be expected to be up to date with the course objectives , advances in the diagnosis and current management protocols for patients presenting with GI bleeding

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1. Be conversant with the anatomy and physiology of the gastrointestinal tract
      2. Outline the epidemiology, risk factors and causes of upper and lower gastrointestinal(GI) bleeding
      3. Outline the common presentation (signs and symptoms) of GI bleeding
      4. Elaborate on the current diagnostic modalities used in the diagnosis of GI bleeding
      5. Further define the role of endoscopy
      6. Discuss the emergent, urgent and non urgent management of GI bleeding

      Topic Learning Activities/Tasks

      Describe the learning activities for this topic

      e.g

      1. Read the topic notes
      2. Watch the lecturer video
      3. Participate in the class discussion

      Assignments and Activities

      The activities include

      1. Watching the two lecture videos attached

      - Lecture on Upper GI Bleeding https://youtu.be/uce2cRY3tC8 

       - Lecture on Lower GI Bleeding https://youtu.be/GotjrL9Vq6E

      2. Complete the two case scenarios 

      3. Undertaking the quiz


       

    • Topic Discussion Forum
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    CONGENITAL CNS ANOMALIES

    Congenital Anomalies of the CNS are relatively common in our setting. Unfortunately their occurrence is associated with fear, ignorance and superstition that often interferes with timely appropriate treatment for those affected.

    The scope of possible CNS anomalies is very broad and is an area of active research to determine whether they can be prevented or their effects mitigated.  

    In this series of lectures we will have a broad overview of the varieties of anomalies that occur, with a special focus on two common conditions; Spina Bifida and Hydrocephalus.

    The astute clinician must be able to identify mothers at risk, diagnose affected children and act appropriately to give them the best possible outcomes.

    This lecture series aims to equip the student with the knowledge that is fundamental for prevention, early diagnosis and treatment of congenital CNS anomalies.

    LEARNING OUTCOMES:

    At the end of this course the learner should be able:

    To understand the embryological origins of congenital CNS anomalies

    To classify congenital CNS anomalies

    To identify appropriate diagnostic methods for Congenital CNS anomalies both before and after birth of a baby.

    To identify the variety of clinical presentations of CNS anomalies and identify those that require emergent care

    To understand the treatment modalities available for patients with congenital anomalies; particularly Spina Bifida and Hydrocephalus

    To understand the prognosis for different anomalies and develop the capacity to discuss treatment and prognosis with mothers.

    LEARNING ACTIVITIES:

    Read topic notes in recommended literature

    Watch the lecture videos attached

    Participate in group discussions and present patients in the New Born Unit and Surgical Wards

    Participate in the care of affected patients and in the counselling of their mothers

    Attend clinic teachings

    ASSIGNMENTS AND ACTIVITIES

    As part of your learning activities, find attached

    Lecture Videos

    CONGENITAL CNS ANOMALIES:  https://youtu.be/gboUG7jTS0c

    HYDROCEPHALUS:  https://youtu.be/aRFza8R8nSw

    • TOPIC - <INSERT TITLE>

      Topic Introduction

      <Insert course script content.>

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Insert Objective.
      2. Insert Objective.

      Topic Learning Activities/Tasks

      Describe the learning activities for this topic

      e.g

      1. Read the topic notes
      2. Watch the lecturer video
      3. Participate inhe class discussion

      Assignments and Activities

      <Insert a description of the unit assignments, activities, and discussions to be completed as they progress through the unit.  Detailed instructions can be attached as Appendices to the course main body.>


       

    • Topic Discussion Forum
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    DISEASES OF THE CARDIOVASCULAR SYSTEM

    • TOPIC - <DISEASES OF THE CARDIOVASCULAR SYSTEM>

      Topic Introduction

      <Insert course script content.>

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Insert Objective.
      2. Insert Objective.

      Topic Learning Activities/Tasks

      Please address the following topics 

      Congenital cardiac lesions

      Acquired cardiac lesions

      Peripheral arterial disease, Aneurysms

      Varicose veins

      Surgery in heart disease

      Extracorporeal circulation

      e.g

      1. Read the topic notes
      2. Watch the lecturer video
      3. Participate inhe class discussion

      Assignments and Activities

      <Insert a description of the unit assignments, activities, and discussions to be completed as they progress through the unit.  Detailed instructions can be attached as Appendices to the course main body.>


       

    • Topic Discussion Forum
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    CONDITIONS AND DISEASES OF THE THORACIC CAVITY

    • TOPIC - CONDITIONS AND DISEASES OFTHE THORACIC CAVITY

      Topic Introduction

      <Insert course script content.>

      To include

      Empyema thoracis

      Oesophageal carcinoma

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Insert Objective.
      2. Insert Objective.

      Topic Learning Activities/Tasks

      Describe the learning activities for this topic

      e.g

      1. Read the topic notes
      2. Watch the lecturer video
      3. Participate inhe class discussion

      Assignments and Activities

      <Insert a description of the unit assignments, activities, and discussions to be completed as they progress through the unit.  Detailed instructions can be attached as Appendices to the course main body.>


       

    • Topic Discussion Forum
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    INFECTIONS OF SURGICAL RELEVANCE

    • TOPIC - INFECTIONS OF SURGICAL RELEVANCE

      Topic Introduction

      A number of infections are of surgical relevance in that they either require the surgical specialties as a primary modality of diagnosis or treatment or have a significant impact on the treatment and care of the surgical patient. They may not be exclusively managed by the surgical treat, but the team offers a key role in their managament. We will be coviering some of these infectious diseases in this topic. 

      Though not exhausting all of them, the key ones to be covered include:

      1. Tetanus

      2. Skin and soft tissue infections

      3. Necrotising fascitis, as a separate entity

      4. Parasitic infections, of surgical relevance - This is covered more exhaustively in subsequent separate topic

       

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1. Understand the epidemiology and pathophysiology of the surgical infections
      2. Be able to diagnose the infections of surgical relevance
      3. Be able to appropriately manage (both emergent and definitively) patients who present with these diseases

      Topic Learning Activities/Tasks

      Describe the learning activities for this topic

      e.g

      1. Read the topic notes
      2. Watch the lecturer videos provided
      3. Participate in the whole class discussion that will be held after the lectures
      4. Be able to clerk and participate in the management of patients presenting with these conditions in the surgical unit

      Assignments and Activities

       In this topic, we will go through the following

      1. Watch availed lectures in the topics

      - Tetanus lecture https://youtu.be/3EbUFUHUBXE

      - Necrotising fasciitis lecture https://youtu.be/e9ueNQRuSWY

         There will be an additional lecture reviewing necrotising fasciitis 

      3. Lecture on cellulitis . This shall be online on 28.01.2022

      4.  Parasitic infections- THis will be an online lecture on 25.02.2022


       

    • Topic Discussion Forum
    • Topic Quiz
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    BRAIN TUMOURS

    Highlighted

    Brain Tumors constitute a diverse collection of pathologies affecting people at all stages of life from the cradle to the grave.  Tumors may arise primarily from the brain or may be spread as metastasis from other parts of the body.

    Regardless of their origin, brain tumors present complex, challenging clinical scenarios and require a systematic, evidence based approach to diagnosis and treatment.  

    This lecture aims to introduce the wide variety of tumors, explain their clinical presentation and provide guidance for appropriate diagnosis and initial treatment.

    LEARNING OUTCOMES

    At the end of this topic the learner should be able to

    To discuss the functional organization of the brain

    To explain the various ways in which brain tumors can be classified

    To understand the anatomical and physiological basis for the clinical presentation of brain tumors

    To do a comprehensive neurological examination of a patient with a possible tumor

    To identify appropriate diagnostic tools for brain tumors, both primary and secondary

    To initiate appropriate initial management for a patient with a brain tumor

    To discuss the treatment modalities available for brain tumors

    To discuss the prognosis of the most common tumor types

    LEARNING ACTIVITIES:

    Read topic notes in recommended literature

    Watch Lecture videos attached

    Participate in group discussions

    Participate in pre-operative and post operative care of brain tumor patients in Surgical Unit

    Attend clinic teachings and participate in follow up of brain tumor patients

    ASSIGNMENTS AND ACTIVITIES:

    As part of your learning activities find attached 

    Lecture Video

    BRAIN TUMORS:   https://youtu.be/zV7ad_HLLLQ

    • TOPIC - BRAIN TUMOURS

      Topic Introduction

      Overview of brain tumours

      Classification, epidemiology

      Principles of diagnosis and management

      Topic Learning Outcomes

      Upon completion of this unit you will be able to:

      1.  Insert Objective.
      2. Insert Objective.

      Topic Learning Activities/Tasks

      Describe the learning activities for this topic

      e.g

      1. Read the topic notes
      2. Watch the lecturer video
      3. Participate inhe class discussion

      Assignments and Activities

      <Insert a description of the unit assignments, activities, and discussions to be completed as they progress through the unit.  Detailed instructions can be attached as Appendices to the course main body.>


       

    • Topic Discussion Forum
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    CHOLELITHIASIS AND CHOLECYSTITIS

    OBJECTIVES 

    1. TO UNDERSTAND THE CURRENT TRENDS IN DIAGNOSIS AND TREATMENT

    2. THE ROLE OF ENDOSCOPIC BILLIARY PROCEDURES

    3. DESCRIBE THE PATHOPHYSIOLOGY OF CHOLECYSTITIS AND CHOLELITHIASIS

    4. UNDERSTAND SALIENT FEATURES OF THE DISEASE PROCESS

    5. UNDERSTAND THE VARIOUS LABORATORY AND RADIOLOGICAL INVESTIGATIVE MODALITIES

    6.

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    MALIGNANT CAUSES OF OBSTRUCTIVE JAUNDICE

    1. DEFINE CHOLANGIOCARCINOMA AND CARCINOMA HEAD OF PANCREAS

    2. UNDERSTAND THE CLINICAL PRESENTATION OF BILLIRAY RELATED MALIGNANCIES

    3. UNDERSTAND THE VARIOUS INVESTIGATIVE MODALITIES IN OBSTRUCTIVE JAUNDICE INCLUDING THE TUMOUR MARKERS

    4. THE ROLE OF CURATIVE AND PALLIATIVE SURGERY IN OBSTRUCTIVE JAUNDICE

    5. THE ROLE OF INTERVENTION RADIOLOGY

    6. UNDERSTAND THE BENEFITS OF MULTIDISCIPLINARY TEAMS IN BILLIARY CANCER MANAGEMENT

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    BREAST CARCINOMA

    OBJECTIVES

    1. BE ABLE TO DEFINE BREAST CANCER

    2. UNDERSTAND THE RISK FACTORS ASSOCIATED WITH BREAST CANCER

    3. UNDERSTAND THE VARIOUS INVESTIGATIVE MODALITIES IN SUSPECTED BREAST CANCER

    4. UNDERSTAND THE CLINICAL PRESENTATION AND APPROACH TO A PATIENT WITH BREAST CANCER

    5. THE ROLE OF IMMUNOHISTOCHEMISTRY IN DETERMINING PROGNOSIS AND TREATMENT

    6. TREATMENT OPTIONS IN BREAST CANCER

    7. UNDERSTAND BREAST CANCER IN AN AFRICAN SETTING

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    COLORECTAL CARCINOMA

    OBJECTIVES

    1. DEFINITION OF COLON CARCINOMA

    2. UNDERSTAND THAT COLON CANCER IS A GENETIC DISEASE

    3. SALIENT CLINICAL FEATURES OF COLON CANCER

    4. LIFESTYLE RISK FACTORS, KNOWN RISK FACTORS AND HOW TO AVOID COLON CANCER

    5. HOW TO INVESTIGATE A PATIENT SUSPECTED TO HAVE COLON CANCER

    6. TREATMENT APPROACH TO COLON CANCER .

    7. THE ROLE OF CURATIVE AND PALLIATIVE SURGERY IN COLON CANCER

    8. THE CHANGING TRENDS IN COLON CANCER

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    PARASITIC SURGICAL INFECTIONS.

    OBJECTIVES

    1. UNDERSTAND THE VARIOUS PARASITES THAT ARE OF SURGICAL SIGNIFICANCE

    2. UNDERSTAND THE VARIOUS SURGICAL DISEASES CAUSED BY PARASITES AND HOW TO MANAGE THEM

    3. SURGICAL APPROACH TO HYDATID CYST DISEASE.

    4. ASCARIS LUMBRICOIDES AND THE SURGICAL PRESENTATION AND MANAGEMENT.

    5. MANAGEMENT OF PARASITIC SURGICAL INFECTIONS/INFESTATION

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    Group 4 starting from 29.08.2022

    All the online sessions held with Group 4 2022-2023 shall be housed under this topic

    As much as possible, the sessions shall be recorded to allow for access by the students, all all other students undertaking the course

    The sessions will also count as part of the attendance audit for the rotation

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    Group 3 starting 17.10.2022

    All online sessions held on the LMS with Group 3 will be hosted on this platform

    As much as possible, the sessions should be recorded to allow for reference later

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    Group 2 2022 starting 05.12.2022

    All sessions held with Group 2 Year 6 will be hosted in this folder

    As much as possible, moderators are advised to record the sessions so that they are accessible to the students for future reference

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    Topic 18

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    Topic 19

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    Topic 20

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    Topic 21

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    Topic 22

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    Topic 23