General Surg

Question 1

Abdo Compartment Syndrome (normal IAP = 5-7)

Answer 1

IAH = >12
Abdo compartment syndrome = >20 with new organ failure

Causes
1 - Reduced abdo wall compliance - surgery, trauma, burns, proning
2 - Increased abdominal contents - ileus, ascities, haemopertioneum
3 - Capillary leak - sepsis, pancreatitis, massive transfusion
4 - Other - mech ventilation, PEEP >10

ACS effects resp (atelectasis, VQ mismatch), CVS (decreased preload and increased afterload), neuro (increase ICP), renal (reduces renal blood flow), gastro/hepatic (bowel ischaemia)

Mx

• ABCDE
• Monitoring
• improve abdo compliance - sedation, analgesia
• Optimise fluids
• Evac intraluminal contents
• Evac fluid collections
• Organ support
• Surg decompression

Question 2

Open Abdo

Answer 2

Often used in severe trauma or acute abdominal catastrophe
- Severe nec pancreatitis, abdo sepsis, damage control surgery

Complications:
1 - Nursing issues
2 - Significant fluid loss
3 - Malnutrition
4 - Infection risk
5 - Visceral injury
6 - Ileus
7 - Hernias and fistula 

Mx - pain control, avoid hypothermia, acidosis and coagulopathy, lung protective vent, NMB, RASS -4, nutritional support with added protein, Abx,

Use negative pressure techniques, Bogotá bag, synthetic mesh

Question 3

Pancreatitis

Answer 3

Hx - gallstones, ETOH - abdo pain, constant, severe, dull, N&V, anorexia
Exam - fever, tachy, pallor, guarding, reduced BS
Organ failure
Inx - lipase, amylase, deranged LFTs, high WCC/CRP, low calcium

CT findings: diagnosis and prognostication - assess for local complications
- Inflammation, fluid, abscess, necrosis

Early phase - acute necrosing pancreatitis- MOF
Later phase - > 1 week - new organ failure, local complications, Abdo compartment syndrome, pseudo cyst

Glasgow Score:
- age, PaO2, WCC, Ca, Urea, LDH/AST/ALT, alb, glucose
- score 3 or more —- HDU/ICU
Ranson
- At 0 hours - age, WCC, Gluc, LDH, AST
- At 48 hrs - Haematocrit, Urea, Ca, PaO2

Causes: gallstones, ETOH, trauma (surgery/ERCP), infections (mumps/EBV), DKA, SLE, Drugs (thiazides, tetracyclines)

Atlanta criteria:
1 - Mild - most common, no organ failure or complications, usually resolves within 1 week <1%
2 - Mod - transient organ failure, local complication or exac of co-morbidity <10%
3 - Severe - persistent organ failure for > 48hrs 25%

Mx:
ABCDE
Support organ failures
Early enteral feed

Surgery: reserved to manage complications - minimally invasive preferred - delayed if able to
Emergency surgery: haemorrhage, bowel complications

Prognosis: Mort < 1