General surgery clinic online

Typical age

Adults; more common with age.

Background

Stones forming in the gallbladder.

Symptoms

Pain under the right ribs, nausea, indigestion, often after fatty food.

What the doctor looks for

The pattern of symptoms.

Investigations

The clinical picture; ultrasound through in-person care.

Diagnosis

The imaging findings.

Management

Depends on the symptoms, from watchful waiting to surgery.

Follow-up

According to symptoms.

Prognosis

Good; many cases cause no symptoms.

What you can do yourself

Cut down on fat for a while; attacks are often triggered by fatty meals.

When should you book?

For recurrent attacks. With fever, jaundice or continuous pain — emergency care.

Typical age

Adults.

Background

Widened blood vessels in the anal area.

Symptoms

Itching, pain, bleeding from the back passage.

What the doctor looks for

The symptom picture, and the pattern of bleeding.

Investigations

The clinical picture; a physical examination where there is doubt or the bleeding persists.

Diagnosis

The clinical picture.

Management

Lifestyle, over-the-counter treatment, sometimes a physical procedure.

Follow-up

If problems persist.

Prognosis

Good.

What you can do yourself

Fibre, fluids, and avoid straining or sitting on the toilet for long.

When should you book?

For blood in the stool — always, to rule out anything else.

Typical age

All adult ages; more common in men.

Background

Abdominal contents pushing out through a weakness in the abdominal wall.

Symptoms

Swelling in the groin, sometimes pain on exertion.

What the doctor looks for

The character of the swelling, and symptoms on exertion.

Investigations

The clinical picture; a physical examination for a secure assessment.

Diagnosis

The clinical picture, with or without a physical examination.

Management

Depends on symptoms — follow-up or surgery.

Follow-up

According to how the symptoms develop.

Prognosis

Good; surgery where needed is often effective.

What you can do yourself

Note whether the hernia can be pushed back in — that is the single most important piece of information.

When should you book?

For increasing problems. For a hard, tender hernia that will not go back — emergency care.

A hernia that becomes painful and hard and cannot be pushed back in can be an emergency — see the safety box.

Typical age

All adult ages.

Background

Benign lumps under the skin.

Symptoms

A soft, mobile lump, usually painless.

What the doctor looks for

The character, and how fast it is growing.

Investigations

Clinical assessment from images.

Diagnosis

The clinical picture.

Management

Follow-up, or surgical removal if it causes problems.

Follow-up

If it changes.

Prognosis

Good; benign in the great majority of cases.

What you can do yourself

Measure the lump and photograph it at regular intervals — the rate of growth is what matters.

When should you book?

For a lump that grows, becomes tender, or is fixed to the tissue beneath.

Typical age

All ages.

Background

A local infection forming pus.

Symptoms

A painful, red, warm swelling.

What the doctor looks for

The size, and signs of spread.

Investigations

Clinical assessment from images.

Diagnosis

The clinical picture.

Management

Sometimes drainage, sometimes antibiotics.

Follow-up

If it does not improve.

Prognosis

Good with the right treatment.

What you can do yourself

Warm compresses can help at an early stage; never squeeze it.

When should you book?

For a growing, tender swelling, or a fever.

Typical age

All ages, after surgery.

Background

Infection in a surgical wound.

Symptoms

Redness, pain, fever, sometimes fluid from the wound.

What the doctor looks for

Signs of spread, or of serious infection.

Investigations

Clinical assessment from images.

Diagnosis

The clinical picture.

Management

Wound care, sometimes antibiotics.

Follow-up

Close until it has healed.

Prognosis

Good with early treatment.

What you can do yourself

Draw a line around the redness to see whether it is spreading.

When should you book?

For spreading redness, increasing pain or fever after surgery.

A high fever or rapidly increasing swelling after surgery requires urgent assessment — see the safety box.

Typical age

Adults.

Background

Stomach acid leaking up into the oesophagus, sometimes needing surgical assessment where problems are pronounced or resistant to treatment.

Symptoms

Heartburn, acid regurgitation.

What the doctor looks for

How severe the symptoms are, and the response to treatment.

Investigations

A review of previous treatment and investigations.

Diagnosis

The clinical picture, with or without previous investigation.

Management

Lifestyle, medication, and in selected cases surgery.

Follow-up

According to the treatment plan.

Prognosis

Good at the right level of treatment.

What you can do yourself

Raise the head of the bed and don't eat during the last three hours before bedtime.

When should you book?

When medication has not worked well enough after several months.

Typical age

All adult ages.

Background

A small tear at the anal opening.

Symptoms

Pain and bleeding on opening the bowels.

What the doctor looks for

The pattern of symptoms.

Investigations

The clinical picture.

Diagnosis

The clinical picture.

Management

Diet, topical treatment.

Follow-up

If problems persist.

Prognosis

Good; often heals within a few weeks.

What you can do yourself

Softening the stool matters most — the fissure will not heal if the strain continues.

When should you book?

For problems lasting more than a few weeks despite a change of diet.

Typical age

Adults; more common with age.

Background

Small pouches in the wall of the large bowel that can become inflamed.

Symptoms

Abdominal pain, often in the lower left abdomen, and a change in bowel habit.

What the doctor looks for

Where the pain is, and fever.

Investigations

The clinical picture, with imaging where problems are pronounced.

Diagnosis

The clinical picture, with or without imaging findings.

Management

Diet; sometimes antibiotics when inflamed.

Follow-up

For persistent or recurrent problems.

Prognosis

Good; manageable for most people.

What you can do yourself

A high-fibre diet between flare-ups; a lighter diet may be needed during an acute flare.

When should you book?

For recurrent flare-ups, or for fever with abdominal pain.

Typical age

All ages.

Background

An umbrella term for sudden, significant abdominal pain that may require surgical assessment.

Symptoms

Severe abdominal pain, sometimes with fever and vomiting.

What the doctor looks for

The pattern of pain, and the general condition.

Investigations

Often requires urgent in-person assessment.

Diagnosis

Requires a physical examination for a secure diagnosis.

Management

According to the cause.

Follow-up

According to the diagnosis once established.

Prognosis

Varies greatly with the cause.

What you can do yourself

No self-care — avoid painkillers before the assessment, they can mask the picture.

When and where should you seek care?

This is emergency care, not a booked appointment.

Severe or sudden abdominal pain is always an emergency — see the safety box.

Typical age

All adult ages.

Background

Benign lumps — lipomas, sebaceous cysts, ganglions — are very common and usually need nothing done. What decides whether something should be looked at more closely is not the size but the rate of growth, how mobile it is, and whether it is tender.

Common symptoms

A soft or firm lump under the skin, usually painless.

What the doctor looks for

Whether the lump moves against the tissue beneath (a benign sign), how fast it is growing, and whether the skin over it has changed.

Investigations

Clinical assessment from images; ultrasound where there is doubt.

How the assessment is made

From the character of the lump and how it develops over time.

Management

Often none; surgical removal if it causes problems or where there is doubt.

Follow-up

If it changes.

Risk factors to know

Rapid growth, being firmly anchored to the tissue beneath, a size over five centimetres, sitting deep — each of these justifies closer investigation.

Common misconception

That every lump should be removed. Most are benign and can be left alone if they cause no trouble.

What you can do yourself

Photograph it next to a ruler every few months — growth is hard to judge from memory.

When should you book?

For a lump that grows, is tender, is fixed in place, or is more than five centimetres.

Prognosis

Very good — the great majority are benign.

Typical age

All ages.

Background

Where the pain sits is surgery's single most useful clue, because the organs of the abdomen produce pain in characteristic areas. Being able to describe where it hurts — and whether the pain has moved — often changes the assessment completely.

Common symptoms

Pain in the upper or lower abdomen, on the right or left side, sometimes moving.

What the doctor looks for

Where the pain started, whether it has moved, and any connection with meals or opening the bowels.

Investigations

Clinical assessment; blood tests and imaging as needed.

How the assessment is made

Location plus the time course guides the direction of the investigation.

Management

Depends on the cause.

Follow-up

According to the findings.

Risk factors to know

Age, previous abdominal surgery, gallstones, inflammatory bowel disease.

Common misconception

That abdominal pain which moves means it is not serious. On the contrary, pain migrating from the navel towards the lower right abdomen is classic for appendicitis.

What you can do yourself

Point with one finger to where it hurts most — being able to point precisely is more informative than a vague description.

When should you book?

For abdominal pain lasting more than a few days. For severe, sudden pain — emergency care.

Prognosis

Good once the diagnosis is correctly located.

Typical age

All adult ages.

Background

What a patient does in the weeks before an operation affects the outcome more than many people think. Stopping smoking four weeks beforehand considerably lowers the risk of wound infection and lung complications — one of the most effective single measures there is.

Common symptoms

Not applicable — this is preparation.

What the doctor looks for

Medicines that need pausing, smoking, blood sugar control and physical fitness.

Investigations

A review of the medication list and other conditions.

How the assessment is made

From the scale of the procedure and the patient's risk profile.

Management

Not applicable — this is optimisation before the procedure.

Follow-up

Up until the date of surgery.

Risk factors to know

Smoking, poorly controlled diabetes, anticoagulant medication, excess weight, low physical activity.

Common misconception

That it is too late to stop smoking shortly before an operation. Four weeks without smoking has a measurable effect — it is never too late to start.

What you can do yourself

Stopping smoking, physical activity and good blood sugar control — all three have a documented effect on the risk of complications.

When should you book?

As soon as you have a date for surgery, to go through what you can do yourself.

Prognosis

A considerably lower risk of complications with good preparation.

Typical age

All adult ages in people who have had abdominal surgery.

Background

An incisional hernia happens when the abdominal wall weakens at an old surgical scar. It is common — particularly after major abdominal surgery — and tends to grow over time, which means an early assessment often leaves more treatment options open than a late one.

Common symptoms

A bulge in or near a surgical scar, often clearer on exertion or coughing.

What the doctor looks for

The size, whether it can be pushed back in, and whether it causes symptoms.

Investigations

Clinical assessment; CT for larger hernias when planning.

How the assessment is made

From the size, the symptoms and the patient's general health.

Management

Observation for small, symptom-free hernias; surgery for symptoms or growth.

Follow-up

If it grows or new symptoms appear.

Risk factors to know

Excess weight, smoking, a wound infection after the first operation, repeated abdominal surgery, a chronic cough, heavy lifting too soon after an operation.

Common misconception

That small incisional hernias always grow and must be operated on straight away. Many can be watched — but they rarely get smaller.

What you can do yourself

Stopping smoking and losing weight reduces both the risk of growth and the risk of recurrence after surgery.

When should you book?

For a bulge in a surgical scar, particularly if it grows or is uncomfortable. For a hard, tender hernia — emergency care.

Prognosis

Good with planned surgery; worse with acute strangulation.

Typical age

All adult ages.

Background

A considerable part of the development of surgery over recent decades has been about operating less, not more. Several conditions that were routinely operated on in the past are treated just as well or better today without surgery — and it is often in that discussion that a second opinion has the greatest value.

Common symptoms

Varies — this is about the choice of treatment.

What the doctor looks for

How severe the symptoms are, the expected benefit of surgery, and the risks in relation to the patient's general health.

Investigations

A review of the previous investigation and the proposed operation.

How the assessment is made

By weighing the expected gain in function against the risk and the alternatives.

Management

Conservative treatment where the evidence supports it.

Follow-up

According to the chosen strategy.

Risk factors to know

Older age, heart or lung disease, smoking, poorly controlled diabetes — each raises the threshold for surgery.

Common misconception

That a referral for surgery means an operation is the only option. There is almost always a choice, and you have a right to understand the alternatives.

What you can do yourself

Always ask: what happens if we wait? What are the alternatives? How likely is it that I will get better?

When should you book?

Ahead of a decision about planned surgery, for an independent review.

Prognosis

Often just as good with conservative treatment where the indication is right.

Typical age

Adults. In most regions surgery is considered from the age of 18; it is always an individual assessment.

Background

Obesity is also called obesitas. The three methods in use are gastric sleeve, which is the most common, gastric bypass and duodenal switch. In a sleeve, about two thirds of the stomach is removed. In a bypass, a large part of the stomach and the first part of the small intestine are bypassed.

Common symptoms

Not a disease symptom — this is about what the operation does. Afterwards you feel full sooner. In the first days, abdominal pain and nausea are common.

What the doctor looks for

How severe the obesity is, other diseases, medicines and age. It is always a surgeon specialised in obesity surgery who decides whether you can be operated on.

Investigations

An individual assessment. What is required differs between regions — often a BMI over 40, or over 35 together with a disease caused by the excess weight, plus serious attempts to lose weight.

How the assessment is made

From the degree of obesity, coexisting disease, and whether you are prepared to change your eating habits before and after the operation.

Management

Keyhole surgery under general anaesthesia, most often 40 to 90 minutes. You usually stay in hospital for one to two days.

Follow-up

Checks and vitamin supplements for the rest of your life — see the card on follow-up after bariatric surgery.

Risk factors to know

Early complications are bleeding and leakage from a join, and also blood clot and pneumonia. After gastric bypass, a bowel twist can occur later, particularly after weight loss.

Common misconception

That the operation takes you down to a normal weight. Most people do not reach a BMI under 25, but often lose 25 to 30 percent of their weight. Another misconception is that it is only about a smaller stomach — the hunger signals decrease as well.

What you can do yourself

Stop smoking before the operation, eat slowly and chew thoroughly afterwards, take the vitamins you have been prescribed every day, and move — a daily walk is enough to start.

When should you book?

When you want to go through whether surgery is an option, or get a second opinion on the method and what is required in your region.

Prognosis

After five years the weight loss is most often 20 to 30 percent after sleeve or bypass. Many people with type 2 diabetes can reduce or stop their medication.

High fever or rapidly increasing swelling after surgery requires urgent assessment — see the safety box.

Typical age

All adult ages after obesity surgery.

Background

The operation impairs the absorption of vitamins and minerals. Everyone who has been operated on needs supplements of calcium, vitamin D, B vitamins and iron for the rest of their life, and to attend checks so that deficiencies are found in time.

Common symptoms

Tiredness with iron deficiency, dumping — nausea, cold sweats and feeling faint if you eat too fast — and later weight regain in some people. With a bowel twist there is severe pain throughout the abdomen, with nausea and vomiting.

What the doctor looks for

Whether you are taking the supplements, blood values for iron, B12, vitamin D and calcium, your weight, and whether you have abdominal pain after meals.

Investigations

Yearly blood tests: blood count, iron status, B12, folate, vitamin D and calcium. For the first two years the checks are most often at the clinic that performed the operation.

How the assessment is made

Lifelong follow-up. After two years primary care often takes over the yearly tests, while the operating unit does the longer checks.

Management

Daily supplements as prescribed — calcium with vitamin D, B12 and iron, plus a multivitamin. Normal test results do not mean you may stop.

Follow-up

For the rest of your life. It is important to detect a deficiency of, for example, B12, vitamin D and iron early.

Risk factors to know

Stopping the supplements. After gastric bypass a bowel twist can occur for the rest of your life. Sleeve more often causes heartburn. Alcohol is absorbed faster than before the operation.

Common misconception

That you can stop the vitamins when the blood tests are normal. Normal values do not mean the supplements may be stopped — the need is lifelong.

What you can do yourself

Take the tablets and vitamins you have been prescribed every day. Eat slowly, chew thoroughly, and avoid eating too much fat or sugar at once. Attend the checks you are called to.

When should you book?

For a review of supplements, weight or tests after the operation. For severe, sudden pain — emergency care.

Prognosis

Most people keep a lower weight for many years. Some regain a little after a few years. Deficiencies can be prevented if supplements and checks are kept up.

Typical age

Both children and adults. In children under four years, an umbilical hernia most often disappears without surgery.

Background

Hernia in the abdomen is most common near the navel. A weakness in the abdominal wall lets the peritoneum push forward as a bulge — an umbilical hernia.

Common symptoms

A soft bulge under the skin at the navel. It can feel tender and can often be pushed back with the fingers.

What the doctor looks for

Whether the bulge can be pushed back, whether it causes trouble, and whether it has become hard or swollen.

Investigations

Clinical assessment. Most people need no treatment.

How the assessment is made

From the trouble it causes, not only from the hernia being there. Major trouble speaks for surgery; minor trouble can be watched.

Management

Most people need none. With major trouble the hernia is operated on, most often by keyhole surgery. In adults the abdominal wall is reinforced with a mesh. Children under four years are not usually operated on.

Follow-up

It varies whether a return visit is needed after the operation. You will be told at the clinic what applies to you.

Risk factors to know

A hernia that becomes hard or swollen, with severe pain, nausea or vomiting, may be strangulated.

Common misconception

That an umbilical hernia must always be operated on. Most people need no treatment, and in small children the hernia most often disappears on its own.

What you can do yourself

If you have only a little trouble you can now and then push the hernia back with your fingers, if it goes easily. Note if it stops going back.

When should you book?

If you think you have an umbilical hernia and it causes trouble. For a hard, tender hernia that will not go back — emergency care.

Prognosis

Good. In children under four years an umbilical hernia most often disappears without surgery. In adults the mesh reinforces the abdominal wall so that the hernia should not come back.

A hernia that becomes painful, hard and cannot be pushed back may be an emergency — see the safety box.

Typical age

Most common between 15 and 30 years, more often in men.

Background

A pilonidal cyst is also called a pilonidal sinus. It sits in the midline of the lower back, where the buttocks divide. Hairs and inflammation in a hair follicle can form a tract under the skin and sometimes an abscess.

Common symptoms

Foul-smelling fluid from the lower back, swelling and tenderness, a lump or abscess that hurts and feels warm, and sometimes small pits where fistulas open. A slight fever can occur but is uncommon.

What the doctor looks for

The site in the lower back, openings in the skin, and whether hair is visible at the base. The typical site most often gives the diagnosis.

Investigations

The clinical picture — the typical site is most often enough.

How the assessment is made

From whether it is an acute abscess, mild trouble, or recurring trouble once the infection has settled.

Management

Sometimes it heals on its own. An abscess that hurts a great deal is drained of pus. With recurring trouble the area can be removed surgically, but that is uncommon. Antibiotics are rarely needed.

Follow-up

After drainage or surgery, wound care is needed until it has healed.

Risk factors to know

Prolonged sitting with pressure on the lower back. Recurrence is more common without hair removal; smoking and excess weight are also mentioned.

Common misconception

That a pilonidal sinus must always be operated on or treated with antibiotics. Many heal without surgery, and antibiotics are rarely indicated.

What you can do yourself

Shave the hair in the area, keep it dry and clean and let it air-dry. Wear loose clothing and avoid sitting still for long periods.

When should you book?

For an abscess, or if fluid or pus comes from the lower back.

Prognosis

Many people get rid of the trouble. Recurrence and wound-healing problems are common, though, which means surgery should be done by a surgeon used to the procedure.

Typical age

Most common between ten and twenty-five years, but you can become ill at any age.

Background

It is not the caecum itself that is inflamed, but the small appendix on it. Another word is appendicitis.

Common symptoms

Pain around the navel that often moves to the lower right part of the abdomen, more pain when you move, cough or sneeze, nausea and poor appetite. Fever often comes after a day or so and is usually fairly low, around 38 degrees.

What the doctor looks for

The pain pattern — particularly whether the pain has moved towards the right lower abdomen — tenderness there, and the general condition.

Investigations

Requires an urgent in-person assessment. The doctor examines the abdomen and takes blood tests; sometimes ultrasound or a CT scan.

How the assessment is made

Primarily clinical. Imaging is used when the picture is unclear, not routinely for every abdominal pain.

Management

Most often surgery, usually by keyhole, a few hours after the diagnosis is made. Sometimes antibiotics instead, for example if you should not be given an anaesthetic.

Follow-up

Most often no return visit after keyhole surgery. After a ruptured appendix a return visit may be needed.

Risk factors to know

The appendix can rupture. In adults it can take up to three days from the first symptoms; in children it can happen much faster. A ruptured appendix can cause peritonitis.

Common misconception

That the pain must be on the right from the start, otherwise it is not the appendix. It often starts around the navel and then moves.

What you can do yourself

Contact a primary care clinic or an out-of-hours clinic at once if you think you have appendicitis. If it is closed, seek care at an emergency department.

When and where should you seek care?

This is emergency care, not a booked visit.

Prognosis

Very good with early treatment. After keyhole surgery most people are fully recovered after about a week.

Suspected appendicitis is always an emergency — see the safety box.