Acute Surgery Flashcards
Following removal of the spleen, what things should the patient be advised?
Pneumococcal vaccination
Meningococcal vaccination
H. Influenzas vaccination
Long term Penicillin V
Higher risk of malaria
- caution when traveling
What are the four main investigations you want to conduct into someone presenting with symptoms of peritonitis without a definitive diagnosis?
Serum amylase
Erect chest x-ray
US of abdomen
CT scan of Abdomen
What other conditions can raise your amylase slightly? and why might someone have moderate amylase in pancreatitis?
Amylase can rise with:
- acute cholecystitis
- Mesenteric infarction
- Duodenal perforation
A cause for a low amylase that is due to pancreatitis may be because the initial attack happened a few days ago
What additional examination out with an abdominal examination would you want to conduct into a child presenting with suspected appendicitis and why?
ENT examination
One of the major differentials is mesenteric adenitis which may present following URTI
What is the most common cause for pneumoperitoneum following surgery?
Normal finding after surgery
How should someone be fed if they have >48 hours ileus and list some important monitoring required for it:
TPN
Monitoring:
- Blood glucose
- Daily electrolytes
- Accurate fluid balance recording
- 4 hourly checks on temperature and observations
- daily check of line for infection
Delivered:
- Peripherally Inserted Central Venous Catheter (PICC)
What important vitamin substitute must be given prior to starting someone on TPN and why?
Pabrinex
- to ensure thiamine is on board in preparation for reintroducing the food
If there is a mass felt in the RUQ in a patient with pancreatic carcinoma, what is it likely to be?
Distended gallbladder
What is the name of the x-ray finding where the large bowel is seen in front of the liver and is it normal?
Chilaiditi’s finding
it is normal
Outline the signs and symptoms of emphysematous gallbladder?
More common in diabetics
often signs and symptoms are minor to begin with but develop and can lead to overwhelming sepsis
What may cause a mass to be felt in the LLQ in symptoms in keeping with diverticular disease and how is a non-serious version of this treated?
Pelvic abscess due to diverticular disease.
Simple abcess formation can be managed with:
- IV fluids
- IV antibiotics
- NIL by mouth
*CT follow up is needed. if not resolved CT drainage may be needed
In the setting of someone you suspect may have fistula formation into the bladder from diverticulitis - what investigations do you want?
CT Abdomen
Cystoscopy
Flexible Sigmoidoscopy
What are the advantages of laproscopic surgery for cholysectomy?
Reduced hospital time
Quicker recovery time
If someone comes in with an object inserted in their backside, what important other condition must you consider and how would you test for this?
Bowel perforation
Erext chest xray
What is an important symptom to be aware on in acute urinary retention?
Delirium
How is acute urinary retention diagnosed and what is the management?
Bloods:
- FBC
- U&Es - assess for obstruction to kidney (abnormal U&Es demonstrates abnormality)
- CRP for infection
*PSA levels shouldn’t routinely be done in acute retention because it is likely they will be high due to the obstruction
Orifices:
- Digital rectal examination
X-rays:
- Bladder US - >300cc is diagnostic
- Kidney US - assess for dilation
Treatment:
- catheterise
- 3 way catheter may need to be used if you suspect clots.
- Suprapubic catheter if unable to pass catheter
- take urine sample of urine to assess for UTI
Following urinary tract obstruction what should be done?
Monitoring of the U&Es closely
Monitoring of weight
Trial without catheter following days
What are some of the complications following relieving a patient with urinary retention?
Post obstructive diuresis
Metabolic acidosis
UTI
- urine should always be sent for analysis
What are the types of priapism and how are they investigated and treated?
Ischemic and non-ischemic
Corpus cavernous blood Gas
Management:
- aspiration of the blood
- surgical management
What advice would you give to someone post TURP?
Avoid driving for 2 weeks Avoid sex for 2 weeks Expect blood to pass for 2 weeks Will pass more urine to begin with - stay hydrated If feverish contact dr
How is prostate cancer staged?
MRI
