Emergency Surgery Flashcards
Treatment for mesenteric paniculitis
Oral steroids if symptomatic
Risk of malignant transformation in oral caustic injury
1000x from baseline
15-16%
In grade 3 (extensive necrosis) 80% will develop structures
Neutropenic enterocolitis
Typholitis is inflammation of caecum - usually in patients on tx for haem cancer
Usually present with bloody diarrhoea and abdo pain
In fulminant cases right hemi
Less severe - NG, IV Abx and sometimes consider closing perf and defunction
Size cut off for pancreatic necrosis
3 cm or greater
MYH associated polyposis
MYH associated polyposis may phenotypically resemble FAP. However, the APC mutation is absent and it is due to a recessive genetic defect (the only colonic polyposis syndrome to have this feature) of mut Y human homologue gene on chromosome 1p.
Volume of blood needed for malaena to be present
60ml
Risks for re bleeding
Causes of colo-vesical fistula
commonest cause of colovesical fistula (in order) are; diverticular disease, cancer, n’s, radiotherapy, foreign bodies. CT scanning is the investigation of choice. One e resectional surgery is the treatment of choice.
Amount of traction applied to gastric ballon in S-B tube
1kg
What pressure should S-B tube oesophageal ballon be inflated to
35-45mmHg isf bleeding persists
Once bleeding stops reduce by 5mmHg every 3 hours and maintain at 25mmHg for 24hrs
The ballon should be deflated every 6 hours to prevent necrosis
Causes of pancreatitis
Gallstones = 50%
Alcohol = 25%
Remainder (including idiopathic) = 25%
Predicting severe attack of pancreatitis
An APACHE score of >8 and obesity are strongly predictive of a severe attack.
Mechanism of action of TXA
Tanexamic acid inhibits plasmin and this prevents fibrin degradation.
Acute tubular necrosis
In acute tubular necrosis there is no response to intravenous fluids because the damage occurs from within the renal system rather than as a result of volume depletion.
Children with appendicitis
Children have a high incidence of appendiceal perforation and early surgery should be the norm, this is particularly true when the diagnosis is beyond doubt.
Low flow priaprism
Low flow priaprism is a urological emergency. Aspiration of bright red blood is more reassuring and may indicate high flow priaprism that may be actively monitored. Low flow priaprism should be decompressed with aspiration of blood from the corpus caveronsum.
Priapism
Prolonged unwanted erection, in the absence of sexual desire, lasting more than 4
Ionotropic agents
Dopamine
Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.
Dopamine
Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.
Haemorrhagic gastritis
Often diffuse bleeding
Targeted haemostatic therapy if specific focal bleeding point
Argon plasma coagulation if diffuse bleeding
Consider anti fibrinolytic (tranexamic acid)
Total gastrectomy if in extremis and endoscopic therapy fails
All should have PPI
Bleeding gastric ulcer
Dual therapy (e.g. endoclip and adrenaline)
PPI infusion post procedure
Biopsy to exclude cancer
If endoscopic therapy fails may require gastrotomy and over sewing of bleeding point
Distally sited large ulcers may require distal gastrectomy
Bleeding gastric cancer
Attempt conventional methods to stop bleeding, definitive cancer surgery best performed electively
Duodenal ulcers
Dual endoscopic therapy (e.g. adrenaline and clip)
High dose PPI infusion
Ulcer under-running may be required if endoscopy fails
Dopamine
Dopamine is known to have a vasodilator effect in the renal circulation, elsewhere it typically exerts a vasoconstrictive effect. This led to the previously popular concept of using ‘renal dose’ dopamine to improve renal function. This is now known to be ineffective.
