Consenting and explaining procedures Flashcards
What is an OGD?
Oesophagogastroduodenoscopy
Camera test, tube goes through mouth, down gullet, through stomach into small intestines
Looking for ulcers/swelling/polyps and reasons for your symptoms/bleeding
May take biopsies, painless
SE of OGD?
Sore throat, drowsiness (if sedated)
Bleeding, infection, perforation
Dental complications
Plan for after OGD?
Can go home after a few hrs
May be drowsy
Cannot drive, must be picked up
F/u with GP, sent report in a few weeks
Causes of epigastric pain after eating?
GORD/oesophagitis Gastric/dusodenal ulcers Biliary colic Pancreatitis Obstruction Mesenteric ischaemia Cardiac chest pain
Initial investigations for someone with epigastric pain?
Obs (BP, HR, RR, temp) ECG & trop (cardiac) LFTs, amylase (pancreatitis) USS (gall stones) AXR
Why would a pt need an USS for abdo pain?
Look for gallstones and liver cysts/abnormalities
How do you describe US to a pt?
Invisible and silent sound waves
Look at reflections of organs in abdomen
Creates image on screen
Like sonar (bats, whales, ships)
Details of abdo USS
Nil by mouth
Radiologist does it
15-20mins
Cold gel on skin and probe pressing you
Explanation of gallstones and management
Gall stones are stones formed in you gall bladder, near your liver
When you eat fatty food, the gall bladder squeezes and stones press against it causing pain
Can lead to pancreatitis or cholecystitis
If found, reduce fatty food consumption and will need surgery at some point to remove them
Surgery within 3 days or after 6weeks no pain from biliary colic
Signs of cholangitis?
Abdo pain
Jaundice
Fever
Risks of cholecystectomy?
Immediate: Pain, bleeding, bile leak, damage to common bile duct, conversion to open, anaesthetic complications
Late: infection, retained stone
Why do an appendicectomy?
Concerned about infection of appendix
To prevent pt getting more ill (sepsis) and perforation
Risks of appendicectomy
General anaesthetic
Bleeding, pain, infection
Damage to surrounding structures (bowel)
Converting to open
Details of appendicectomy
Put to sleep Key hole surgery, small cuts RIF, belly button & middle Find and cut out appendix Takes couple of hours Home next day if well
How do you explain a colonoscopy to a patient?
Camera test where a thin tube is passed into the back passage to look at the bowel
Look for causes of anaemia/change in bowel habit/pain/bleeding
May see inflammation, ulcers, polyps, growth
May take biopsies (painless)
How would you explain the procedure of a colonoscopy?
Take sachets mixed with water night before and morning of test
Don’t eat breakfast, need to clear out bowel
Given sedation and pain relief beforehand
Lie in fetal position on side and doctor put tube in, can see images on screen
May take biopsies (painless)
Can go home after a few hrs but will be drowsy so cannot drive
F/U in opt clinic
Give leaflet
Risks of colonoscopy?
Pain, bleeding, infection, perforation
See Dr if: temperature, excessive PR bleeding, abdo pain
What tumour markers do you test for in suspected colon cancer?
AFP
CEA
What does ERCP stand for?
Endoscopic retrograde cholangio-pancreatography
How do describe ERCP to a pt?
A long thin tube is put into your mouth-stomach-gut until the area where the pancreas & CBD enter the gut
Contrast medium is released and Xrays taken
Looks for gallstones and tumours
Can get rid of gallstones and take biopsies of growths
Could have a stent put in temporarily to keep opening patent
SE of ERCP?
Drowsiness Sore throat Bleeding, infection, perforation of gut Damage to bile/pancreatic ducts Pancreatitis, death
Other info to give to someone undergoing ERCP
Sedation NBM 6hrs May not always work MRCP alternative to diagnose but not treat Probably go home tomorrow if all is well
SE of TURP
Urinary incontinence, urinary retention
Erectile dysfunction, retrograde ejaculation
Bleeding, infection, pain
Damage to bladder
TURP syndrome of fluid overload and hyponatraemia due to irrigation
Anaesthetic risks
Ix for BPH
DRE PSA Biopsy USS Urodynamics
Describe CVS
Chorionic villus sampling
Done between 11-14th week of pregnancy
Offered if higher risk of Down’s syndrome, Edward’s syndrome, Patau syndrome or FH and abnormality seen for sickle cell, CF, thalassaemia
Sample of cells from placenta
Abdominally or cervically
0.5-1% risk of miscarriage
Done for diagnosis and given support +/- option of TOP
Describe amniocentesis
Done between 15-20 weeks
Offered if higher risk of Down’s syndrome, Edward’s syndrome, Patau syndrome or FH and abnormality seen for sickle cell, CF, thalassaemia
Sample of cells from fluid around baby
USS to avoid baby, needle through abdomen
0.5-1% risk of miscarriage
Done for diagnosis and given support +/- option of TOP
Risks of amniocentesis
Failure Miscarriage Infection Injury to baby Rhesus disease in the newborn
Red flags after amniocentesis/CVS
Severe abdo pain Contractions PV bleeding Watery loss from vagina Fever
Describe a liver biopsy
Sample of cells taken from area in liver Diagnose cysts/cancer/parasite Needle through abdomen, guided by US Gel and US probe on skin, clean skin, local anaesthetic, biopsy needle Observed for bleeding then home same day F/U in clinic once lab results are back
Advice for after biopsy
Risks: bleeding, pain, infection
See doctor if evidence of infection or fever or abdo pain
No contact sports for a few days
What tests need to be done before liver biopsy?
Clotting, LFTs, platelets
G&S
Complications of a lap chole?
Pain, bleeding, infection, damage to local structures
Bile leak
Conversion to open
After care for lap chole?
Should take at least a week off work
Observed for a few hrs then home that day or next day
Seek help if wound looks infected or abdo pain
What is murphey’s sign?
Inspiratory catch observed during palpation of the RUQ when asking pt to breathe in
Absence of it on the other side
What is courvoisier’s law?
A non-tender enlarged gall bladder is unlikely to be gallstones (more likely malignancy)
Where is a chest drain inserted?
5th intercostal space
Slightly anterior to mid axillary line
Post chest drain procedure
Drain bottle needs to be kept below level of insertion
Kept in overnight
Removed when stopped/slowed drianing
Sample will be taken and sent to lab to investigate cause
What should pleural aspirate be investigated for?
Transudate versus exudate
Transudate clear, low protein, due to heart failure, liver failure, nephrotic syndrome
Exudate cloudy, high protein, due to infection or malignancy
Measure protein level & LDH
Microscopy & culture (gram stain & Acid fast bacilli stain)
How would you explain an LP?
Happens under local anaesthetic
Needle put through space in spine into space around spinal cord
Small sample of fluid taken and sent to lab
To diagnose/exclude SAH
What do you ask for on the CSF lab form?
MC&S, PCR, protein, WCC, glucose
List 3 categories for causes of urinary retention and 2 examples of each
Obstructive: BPH, calculi
Drugs: opioids, anticholinergics
Neuro: cauda equina, spinal stenosis
