General Surgery Flashcards
Surgical Causes of RUQ
- cholecystitis
- biliary colic
- ascending cholangitis
epigastric pain
duodenal ulcers
pancreatitis
gastritis
RIF pain causes
appendicitis
ovary
LIQ pain - causes
constipation
diverticulitis
Cholecystitis- presentation
RUQ pain
fever
previous sx of biliary colic
Murphy’s sign (palpate RUQ, get pt to breathe, if painful indicative of cholecytisis_
bloods in ?cholecystitis
LFTs
IFM
Surgical bloods (clotting etc)
Ix for ?cholecystitis
Bloods
USS gallbladder
MRCP (if +ve, can do ERCP which can also be therapeutic)
Mx of cholecystitis
fluids
abx
analgesia
Hot GB list for first 48h, then on elective list
ascending cholangitis presentation
RUQ pain + fever + jaundice (Charcots triad)
previous gallstone disease or hx suggestive of malignancy
o/e in ascending cholangitis
tender RUQ, jaundiced, may be septic
Charcot triad, which consists of RUQ pain, fever, and jaundice, is the classical clinical manifestation of acute cholangitis though not all patients manifest with the triad
ix
bloods
USS GBS -> CBD dilatation -> ?MRCP
mx ascending cholangitis
empirical abx (broad spectrum) - Piperacillin / tazobactam (or gentamicin + metronidazole in penicillin-allergic patients)
supportive management
urgent biliary drainage
Sepsis 6
analgesia
Bowel obstruction causese
adhesions (e.g. from previous surgery)
mass e.g. malignancy
inflammatory stricture (IBD, diverticulitis etc)
mx of bowel obstruction
drip and suck -> NGT, IVF, NBM
analgesia
gastrograffin
Surgery
may be terminal event in palliative patients
ix in bowel obstruction
bloods
CTAP
gastrograffin + CTAP / AXR - d/w radiologist (can also be therapeutic)
sx in appendicitis
initially central pain migrates to RIF
+/- RUQ / subrapubic
diarrhoea
vomiting
tachypnoea
fever
O/E
tender RLQ
Rosving’s sign
rebound tenderness
mx of appendicitis
analgesia
abx
lap or open appendicectomy
ix for pancreatitis
bloods
ABG
amylase
lipase
US to look for gallstones
CT if deteriorating ?necrotising pancreatitis
Mx of pancreatitis
IV fluids (input/output monitoring)
analgesia
if gallstone related -> ERCP, cholecystectomy
Abx if needed
IR drain / necrosectomy if infected necrosis (abx are also indicated if it becomes necrotising)
maintain good lung function because of risk of ARDS
opioid to use when worried about a patients renal function
What is sigmoid volvulus associated with?
- older patients
- chronic constipation
- Chagas disease
- neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
- psychiatric conditions e.g. schizophrenia
Coffee bean sign
indicates sigmoid volvulus
seen on plain abdo film
What is volvulus
Volvulus may be defined as torsion of the colon around it’s mesenteric axis resulting in compromised blood flow and closed loop obstruction.
What is catcall volvulus associated with?
all ages
adhesions
pregnancy
