Common General Surgical Emergencies Flashcards
What are the broad categories of general surgical emergencies?
- Acute abdomen (some presentations)
- Perforation
- Obstruction
- GI bleeds
- Incarcerated Hernias
- HPB emergencies
- Abscesses
Where can a GI perforation occur?
Essentially anywhere along the GI tract
What is the most common cause of upper GI perforation?
Gastric ulcer
What are the symptoms of gastric ulcer?
Dyspepsia (after eating suggests duodenal)
What is the surgical management for an upper GI perforation?
Closure
What is the surgical management of a lower GI perforation?
Resection
How may a bowel obstruction present?
Colicky pain Abdominal distension Vomiting Lack of bowel movements
What parts of the bowel can become obstructed?
Small and Large
What are the common causes of small bowel obstruction?
- Adhesions
- Hernias
What can cause a large bowel obstruction?
- Colorectal cancer
- Diverticular disease
- Sigmoid volvulus
What can sigmoid volvulus cause?
Ischaemia of the bowel
What can be seen on examination of a patient with an obstruction?
- Distension
- Visible scars/hernias?
- Dehydrated
- Tachycardia
- Hypotensive
- Bloating pain
- (Any focal tenderness suggests bowel ischaemia)
What will an AXR show if there is a bowel obstruction?
- Dilated bowel loops
- Visible valvulae conniventes in small bowel
How are valvulae conniventes distinguishable from haustra?
Haustra are incomplete lines crossing the bowel lumen
How should an obstruction be managed?
- NBM
- IV fluids
- Catheter
- Analgesia and antiemetics
- Surgery (except in adhesions of SB or volvulus)
When are hernias an emergency?
When they are strangulated
How do strangulated hernias appear?
- Erythematous
- Tender
- Irreducible
How are strangulated hernias managed?
Surgical repair
What systemic symptoms can a strangulated hernia cause?
- Abdominal distension
- Vomiting
What imaging modality can be used to diagnose a femoral hernia?
USS
Of all abdominal wall hernias, which is the most concerning?
Femoral
Why are femoral hernias most concerning?
Most likely to become incarcerated and thus strangulated
Why are femoral hernias most likely to become incarcerated?
They are bound by solid ligamentous and bony structures
How does a perianal abscess present ?
Area of painful inflammation around the anus
