Abdominal/Surgery Flashcards
When is it safe to discharge blunt , isolated abdominal trauma?
Stable patient
Normal CT with contract
What risk stratification does NICE recommend for UGI bleed? (2)
Blatchford first assessment
Rockall post OGD
What does NICE recommend in UGI bleed in platelets <50
Replace if bleeding actively, otherwise withhold
What are the NICE recommend targets and how they should be managed in UGI bleeding re:
1. plts
2. APPT/PT
3. Fibrinogen
- Plts >50, replace if actively bleeding
- APTT/PT < 1.5 x normal - give FFP
- Fibrinogen >1.5, if still low post FFP give cryoprecipitate
What does NICE recommend re: PPI in non-variceal bleeding?
Only give if bleeding seen on OGD, not before
In addition to the usual management of UGI bleeding, what extra treatment should be initiated in a variceal bleed? (2)
- Terlipressin
- IV abx
What does NICE recommend about restarting low dose aspirin post UGI bleed?
Continue once haemostasis achieved
What dose NICE say re: clopidogrel post UGI bleed?
D/w risk/benefit with specialist
What is the treatment for acute limb ischaemia initially in all adult patients?
5000 units IV heparin
What is a normal ABPI and what suggests ischaemia?
- 1.0-1.2
- <0.5
What is more common inguinal or femoral hernias?
Inguinal
What gender is more likely to get inguinal hernias and who is more likely to get femoral hernias?
Inguinal = men
Femoral = women
What are the 2 types of gangrene?
Type 1 - polymicrobial, aerobic and anaerobic organisms
Type 2 - monomicrobial
Who does type 1 and type 2 necrotising fasciitis tend to affect respectively?
Type 1 - elderly and co-morbid
Type 2 - anyone
Which type of necrotising fasciitis usually produces gas in tissues?
Type 1
What organism is most likely to cause type 2 necrotising fasciitis?
Group A Strep
What is the most common site of renal calculi to get stuck?
Vesico-ureteric junction
Under what size should renal stones usually pass spontaneously?
< 5mm
What medicine can be given to aid the passage of renal stones?
Alpha-blockers
What makes up the Glasgow pancreatitis score? (8)
1 point for each
- Pa02 <7.9
- Age > 55
- WCC >15
- Calcium < 2.0
- Urea > 16
- LDH > 600
- Albumin < 32
- Glucose > 10
What score in the Glasgow Pancreatitis Score means it is severe?
3 or more
What size constitutes a AAA and what size mandates operative management (where appopriate)?
- > 3cm
- 5.5cm or more
What makes up the Alvarado scoring system? (8)
- Migration of pain
- Anorexia
- N/v
- RIF tenderness
- Rebound pain
- Temp > 37.3
- Leucocytosis > 10
- Neutrophilia >75%
What is the most common causative organism in SBP?
E.coli
What scoring system is used to help identify necrotizing fasciitis?
LRINEC (Lab Risk Indicator for Nec Fasc)
