Cerrahi

Question 1

All 9 abdo regions differentials for acute abdomen

Answer 1

Ruq pain: hepatitis, biliary colic, cholangitis, cholecystitis, pneumonia
Epigastic pain: pud, pancreatitis, gastritis, gerd, cardiac/inf mi/ruptured aaa/pericarditis
Luq pain: pneumonia, splenic infarct/abscess, gastritis, gastric ulcer
R flank: renal colic, sciatica, pyelonephritis, bony mets
Umbilical: uti, appendicitis, small bowel obstruction-sbo
L flank: renal colic, pyelonephritis, sciatica, bony mets
RIF: appendicitis, ovarian cyts rupture, ovarian torsion, pid, ectopic pregnancy, renal colic, inguinal hernia, ibd, psoas abscess
Suprapubic: uti, prostatitis, pid, ibd, osteitis pubis, urine retention
LIF: diverticulitis, ovarian cyts rupture, ovarian torsion, pid, ectopic pregnancy, renal colic, inguinal hernia, ibd, psoas abscess

Question 2

Acute abdomen investigations

Bedside:
Vitals
Urine output
Urine dipstick
ECG
Capillary glucose

Urine:
Urine culture and sensitivity
β-hCG
Amylase

Stool/Swab:
Culture and sensitivity

Blood:
FBC
CRP
Blood culture and sensitivity U&E
Ca2+
LFTs
Coagulation screen
Type and screen
Amylase, lipase
Troponin
Glucose
ABG
β-hCG

Answer 2

Bedside:
Vitals
Urine output
Urine dipstick
ECG
Capillary glucose
Urine:
Urine culture and sensitivity
β-hCG
Amylase
Stool/Swab:
Culture and sensitivity
Blood:
FBC
CRP
Blood culture and sensitivity
U&E
Ca2+
——cevaplar
Shock
Hypovolaemia, retention
UTI, haematuria, bilirubinuria
MI
DKA
UTI
Ectopic pregnancy
Pancreatitis
If indicated

FBC
Hb: Anaemia
WCC: Infection Platelets: Surgery prep

Infection
Sepsis/SIRS
Urea and creatinine: AKI, dehydration
Ureteric stone, pancreatitis
———
LFTs:
Hepatobiliary causes, pancreatitis (may be deranged, more commonly in obstructive causes of pancreatitis [e.g. gallstone disease])
Bilirubin: Liver damage, bile duct obstruction, haeme breakdown
ALT: Liver, skeletal muscle, kidney (small amounts) AST: Liver, kidney, cardiac muscle, brain
ALP: Liver, bile ducts, bone
GGT: Bile duct obstruction, alcohol, drugs Albumin: Malnutrition, pancreatitis
PTT: Coagulation screen
LD: Anaemia, kidney disease, liver disease, cardiac
muscle injury, pancreatitis, infections, cancer
Total protein
——————
Coagulation screen
Type and screen
Amylase, lipase
Troponin
Glucose
ABG
β-hCG
——cevaplar
Surgery prep, liver dysfunction
Surgery prep, blood loss
Pancreatitis (3× upper limit of normal)
Myocardial Infarction
Diabetic Ketoacidosis (DKA)
Lactate: Ischaemia, sepsis
Pregnancy, ectopic pregnancy