Clinical decision support that reasons like a general surgeon: grade the acute abdomen, weigh operate-versus-observe, time the operation — with the decision rule and exactly what would change it. Built for verified surgeons.
Two real general-surgery questions, each reasoned the way HeyHippocrates answers: the skills fire, the answer is cited, the decision rule is explicit, and what's missing is flagged. Scroll to each.
45-year-old, right-upper-quadrant pain, a positive Murphy sign, fever, WBC 15, ultrasound shows gallstones with a thickened wall — management?
This meets acute cholecystitis by the Tokyo Guidelines (local signs, systemic inflammation, imaging). Start IV fluids and antibiotics, and plan early laparoscopic cholecystectomy — within about 72 hours to a week — which lowers complications versus delayed surgery. Grade the severity; organ dysfunction (Grade III) shifts toward gallbladder drainage and stabilization first.
Decision ruleAcute cholecystitis (Grade I–II) → antibiotics + early laparoscopic cholecystectomy; Grade III (organ dysfunction) → resuscitate, drain, delay surgery.
Not established from this alone — severity grade, comorbidity, bilirubin/duct status and fitness for surgery change the plan.
24-year-old, migratory right-lower-quadrant pain, anorexia, fever, rebound tenderness, WBC 14 — Alvarado and next step?
That maps to an Alvarado of about 8 — high probability of appendicitis. Confirm with imaging (ultrasound first in a young patient, CT if inconclusive), start fluids and antibiotics, and plan appendectomy. Non-operative antibiotic management is an option only for selected uncomplicated cases after shared decision-making; a fecalith or perforation favors surgery.
Decision ruleAlvarado ≥7 → high probability, image to confirm and operate; 5–6 → imaging; ≤4 → observe; antibiotics-first only for selected uncomplicated cases.
Not established from this alone — imaging, the exact score, perforation or a fecalith and comorbidity change the plan.
Illustrative simulations. The physician always decides.
The exact questions your field searches for — answered in the format the knowledge base speaks: the answer, the decision rule, what's missing, and the source.
The Tokyo Guidelines diagnose acute cholecystitis from local signs (a positive Murphy sign, right-upper-quadrant pain), systemic inflammation (fever, raised white count/CRP) and imaging. Grade I is mild, Grade II moderate with marked local inflammation, and Grade III severe with organ dysfunction. For Grade I–II, early laparoscopic cholecystectomy (within about a week) is preferred; Grade III is resuscitated and often drained first.Tokyo Guidelines
Decision ruleDiagnose by local + systemic + imaging; Grade I–II → early laparoscopic cholecystectomy; Grade III → resuscitate, drainage, interval surgery.
Missing data: the severity grade, bile-duct status, comorbidity and operative fitness change the timing.
Alvarado sums migratory pain, anorexia, nausea, right-lower-quadrant tenderness, rebound, fever, leukocytosis and a left shift. A score of 7–10 is high probability, 5–6 is intermediate (image), and 0–4 is low. Ultrasound is first-line in young and pregnant patients; CT resolves inconclusive cases. Appendectomy is standard; antibiotics-first is reserved for selected uncomplicated appendicitis.Alvarado score
Decision ruleAlvarado ≥7 → image and operate; 5–6 → imaging; ≤4 → observe; antibiotics-first only for selected uncomplicated cases.
Missing data: imaging findings, perforation, a fecalith and the patient profile refine the decision.
Most adhesive small-bowel obstruction without strangulation is trialled non-operatively: nasogastric decompression, fluids and correction of electrolytes, with a water-soluble contrast study that both predicts resolution and can be therapeutic. Operate for signs of strangulation or a closed loop — ongoing pain, peritonitis, rising lactate, or CT signs of ischemia — and for failure to resolve within roughly 48–72 hours.guideline synthesis
Decision ruleAdhesive SBO without strangulation → non-operative trial + water-soluble contrast; strangulation / closed loop / failure → surgery.
Missing data: the cause, strangulation signs, ischemia on CT and the response to decompression change the decision.
Resuscitate in parallel with assessment. A focused history and exam localize the pain and look for peritonitis; labs and imaging (usually CT) identify the source and separate surgical from non-surgical causes. Generalized peritonitis, perforation, ischemia or an unstable patient go to the operating room; a contained or non-surgical process is managed medically with close reassessment.guideline synthesis
Decision ruleResuscitate → localize + look for peritonitis → labs/CT → peritonitis/perforation/ischemia/instability → operate; otherwise treat and reassess.
Missing data: hemodynamics, peritoneal signs, imaging and the trajectory drive the operative decision.
Your whole practice, one specialist brain — grounded in champion-authored, cited knowledge.
A generalist surgical colleague across biliary, the acute abdomen, obstruction, hernia and trauma — cited, non-directive, always with the decision rule.
Deep specialist agents for hepatobiliary, colorectal, surgical oncology and trauma & acute-care surgery — each its own soul and knowledge base — plus your own uploaded materials.
In the acute abdomen the margin is thin. Only one of these reasons like a surgical colleague whose every claim you can trace.
The waitlist is a founding cohort. Members shape the general surgery build, get in before anyone else, and lock the founding price for good.
Leave your name and work email. We'll reach out the moment general surgery opens — with your Founding Surgeon offer.
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It reasons in the tools you use — the Alvarado score, the Tokyo Guidelines and the acute-abdomen exam — and always shows the reasoning, the decision rule and what would change it. The decision always stays your call.
Both. Residents use it to pressure-test a plan and learn the decision rule; attendings use it as a fast, cited second opinion on call and before the operating room. Access is gated to verified physicians.
Hepatobiliary, colorectal, surgical oncology and trauma & acute care each have their own deep specialist agent on the Pro plan, on top of the full general-surgery scope on Basic.
No. It is physician-facing clinical decision support — a cited thinking partner. It does not diagnose, does not treat, and gives no patient-facing advice. The decision always stays with you.
Every answer is grounded only in champion-authored, cited surgical knowledge — traceable, not hallucinated — and always states the decision rule plus what data is missing, instead of a confident guess.
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