Consenting and explaining procedures Flashcards by Izzy Hope

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

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SE of OGD?

Sore throat, drowsiness (if sedated)
Bleeding, infection, perforation
Dental complications

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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

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Causes of epigastric pain after eating?

GORD/oesophagitis
Gastric/dusodenal ulcers
Biliary colic
Pancreatitis
Obstruction
Mesenteric ischaemia
Cardiac chest pain

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Initial investigations for someone with epigastric pain?

Obs (BP, HR, RR, temp)
ECG &amp; trop (cardiac)
LFTs, amylase (pancreatitis)
USS (gall stones)
AXR

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Why would a pt need an USS for abdo pain?

Look for gallstones and liver cysts/abnormalities

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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)

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Details of abdo USS

Nil by mouth
Radiologist does it
15-20mins
Cold gel on skin and probe pressing you

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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

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Signs of cholangitis?

Abdo pain
Jaundice
Fever

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Risks of cholecystectomy?

Immediate: Pain, bleeding, bile leak, damage to common bile duct, conversion to open, anaesthetic complications
Late: infection, retained stone

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Why do an appendicectomy?

Concerned about infection of appendix

To prevent pt getting more ill (sepsis) and perforation

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Risks of appendicectomy

General anaesthetic
Bleeding, pain, infection
Damage to surrounding structures (bowel)
Converting to open

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Details of appendicectomy

Put to sleep
Key hole surgery, small cuts RIF, belly button &amp; middle
Find and cut out appendix
Takes couple of hours
Home next day if well

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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)

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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

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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