27-01-2020 Wards, General surgery

Question 1

What does the position of the colostomy bag tell you about the nature of the patients disease?

Answer 1

Colostomy- RHS- reversible

Ileostomy- LHS- non reversible

Question 2

You see air on a scan report of the abdomen, what do you think of?

Answer 2

Surgical emphysema, Perforated bowel

Question 3

What is a Pick line?

Answer 3

A line that goes through the subclavian and into the IVC. can be used for total parental feeding.

Question 4

What is total parental feeding?

Answer 4

Feeding that can not be constituted through the GI tract is instead done through total paternal nutrition. This way the essential components still make their way into the body

Question 5

A patient has had their large intestine removed. What complications does this cause?

Answer 5

First do a stool culture for infection, then:
Anti-diarrhoeal- loperamide
Dihydrocodeine- constipates, also gives laxatives esp. in elderly people.

Question 6

What is ileus?

Answer 6

A lack of movement in the bowels. They go to sleep and dont work for a while. An NG tube is put on free flowing and allows drainage. IV fluid, anti emetics and good analgesia is also admitted.

Question 7

What are different medical causes of abdominal pain?

Answer 7

Pacreatitis-look at glsagow scoring score
Gastritis-caused by non-steroidals, omeprazole helps
Gastro-enteritis- infections
Cholycistitis-manage with antibiotics and fluids
IBD-Crohns and UC (can present up to 30’s)
Peptic ulcer- NSAIDS, autoimmune, h.pylori
IBS-
GORD-
Ischeamic bowel (clots), A-fib
Hepatitis-
Diverticulitis- sharp abdominal pain, pain, fever. Manage with IV antibiotics and fluids. Look out for perforation.
Urinary retention-

Question 8

What are some surgical causes of abdominal pain?

Answer 8

appendicitis
obstruction- tumours, strictures
Hernia- diaphragmatic, umbilical, inguinal, surgical sites, femoral. Strangulation or not Can you reduce them or not? Cough impulse
Ectopic pregnancy
AAA
Volvulus- different signs look them up