HeyHippocratesCholecystitis, appendicitis, obstruction — a colleague who cites every call.
Clinical decision support that reasons like a general surgeon while you decide: 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.
Watch it think — in general surgery.
Two worked examples, reasoned the way it answers: the relevant clinical checks run, the answer is cited, the decision rule is explicit, and what is missing is flagged.
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 answers surgeons actually look up.
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.
Acute cholecystitis — how do I grade it and time the cholecystectomy?
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.
Suspected appendicitis — the Alvarado score and imaging?
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.
Small-bowel obstruction — operate or manage conservatively?
Most adhesive small-bowel obstruction without strangulation is trialed 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.
The acute abdomen — the diagnostic approach?
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.
What it knows in general surgery
Your whole practice, one specialist brain — grounded in specialist-written, 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 specialist voice and knowledge base — plus your own uploaded materials.
Why not just use OpenEvidence or ChatGPT?
A large language model answers any clinical question with total confidence and no idea whether it is right. A search engine finds papers. HeyHippocrates reasons inside your specialty from a knowledge base a specialist in your field wrote and signed, and tells you the decision rule and what is missing.
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Questions surgeons ask
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 specialist-written, cited surgical knowledge — traceable to a named source — and always states the decision rule plus what data is missing, instead of a confident guess.