General Surgery Flashcards
Diagnosis?
Why?
SBO
- dilated loops of bowel
- multiple fluid levels
- small bowel - central/3mm/valvular coneventes
what are the common causes of SBO obstruction and their examination findings?
- adhesions - old scars
- hernias - hernia on exam
- malignancy - systemic sx
what are the metabolic complications of SBO and why?
- metabolic alkalosis - loss of HCL from vomming
- hypoK - vomiting
- hypoNa - 3rd spacing to gut
- lactic acidosis - from iscahemia and hypoperfusion
abdo pain and guarding:
What ate the abnormalities?
Diagnosis?
IP free fluid
IP free air
fat stranding around stomach
gallstones
thick walled stomach
diagnosis
Perforated peptic ulcer
what is the initial management of perforated abdominal viscous?
IV fluid - bolus and aim over 100
Anagelsea eg fent
IV abx
urgent surgical input
diagnosis?
3 positive and two neg findings
gastric volvulus
Pos:
* hiatus hernia
* multiple bowel loops in intrathoraic region
* air fluid in lower loop suggesting obstruciton
* mediastinal shift
Neg
* no pneumothorax
* no free air under diaphragm
management priorities?
analgesia
antiemetic
fluid
abx
surgical input
?GOC
what clinical features of history and exam make appendicitis more likely in a child?
RIF pain
pain migrating to RIF
pain less than 3 days
anorexia
pain on coughing/moving/hopping
with suspected appendicits in child what tests could you do to rule out other things?
urine - UTI
US - mesenteric adenitis
CXR - LRTI
lipase - pancreatitis
glucose - DM
what is the maintennce fluid for kids?
normal saline plus 5% dextrose
what are the pros and cons of CT/US for RUQ pain?
key findings
Diagnosis
- high glob and low alb- in infection/inflammation, high glob and low albumin in negative acute phase reaction
- jaudince from biliary obstuction
- ductal enzymes high than intrahepatic suggesting post hepatic pathology
Diagnosis
Cholangitis with biliary obstruction
diagnosis and abnormal radiological findings
Sigmoid volvulus
- massively dilated sigmoid colon - coffee bean sign
- no rectal gas - dilated proximal large bowel
- Axis to LIF
what are the management options for sigmoid volvulus?
- PR deflation eg sigmoidoscope
- percutaneous deflation
- laparatomy
with elderly and bowel obstructions what are the considerations for treatment plans?
- Patients wishes if competent
- advanced care directive
- substitute decision maker if competent
- patients QOL
- reversibility of condition
- nature of intervention
- access to intervention eg in the sticks
key abnormalities and explanations?
overall clinical interpretation
- low na and Cl - GI losses
- HAGMA- renal failure or lactate from hypoperfusion
- renal failure - pre renal hypoperfusio
- low alb normal protein - negative acute phase
- high conj bili - hepatic obstruction
- obstructuve LFT pattern
Summary:
Ascending cholangitis with signs of multi organ failiure/sepsis
interpretation of wound
midline laparatomy wound with significant dehiscence
what are the advantages and disadvantages of common methods of wound closure in ED
