Other Flashcards
UGI bleed
High urea
Stomas and mx
Colostomy- LHS, formed stool, no spout
Ileostomy- RHS, loose stool, spouted due to alk conts irrit skin, dehyd risk, often give loperamide and fluid restric.
Anterior resection
Can anast immed.
Indics- L side CA, healthy bowel
Temp stoma somet
Diversion stoma
Eg for clean surg
Temp or perm
Hartmanns
Ant resection and end colostomy
Indications- L side CA, diverticulitis
Stoma as cant anast with inflamm/contam, decr BS, pt facs (imm comprom, steroids, DM etc).
Might be perm
Fentanyl AE
Drop BP
base excess
Metabolic alkalosis
Right hemicolectomy
Reomove ileum to part of TC
Indication- R side CA
sub total colectomy
Rectum preserved
Can anast
pan procto colectomy
Remove rectum and anus
End ileostomy
APER
Abdomino perineal excision of rectum
Indication- very distal rectal CA
Stitched back passage
colonoscopy indications
Bleed
Anaemia, Fe defic
Volvulus
Susp polyp/CA for remov/biop
colonoscopy risks
Perforation- higher risk if colitis, large polpectomy, heavy sedat
Bleed- more comm than perf esp with polypectomy
Missing a small CA or polyp
Fail to reach caecum
polypectomy
Injec dye, adrenaline and gelofusine
Lifts away from musc layer
Then snare.
This is endoscopic mucosal resection (EMR)
Bowel CA screening
Low pick up rate Age 60 plus FOB test ev 2 yr til 75yo Positive result then go for colonoscopy Now bowel scope screen for over 55s
WHO screen criteria
Important prob Recognisable latent or early symp stage Nat hx known Accepted tx Accurate test Acceptable Policy on who to tx Facils for dx and tx Econ balanced Contin process
Adjuvant chemo
Us only if dukes C
Epidural risks
N damage, bruising
Epidural haematoma esp if eg anticoag, can cause comp
Hypot, more comm with spinals. Give phenylephirine infus to vasocontrict.
Infec eg abcess. More comm in epi than spinal.
Subdural space- patchy block.
Dural punc- CSF leak, reduc press, postural headache. Mx- PK, hydration, epidural blood patch.
LA s/e
Allergy
Toxicity- if too much abs eg BV damage. Fits, LOC, RSD, CVS collapse.
Opiate s/e
Nausea
Constipat
RSD
Itching
Epidural and spinal
Numb from T4 down Spinala ccording to dose and posit T4 blocks some of chest wall musc Total spinal block if too high CSC- combined, lasts longer
LA
Regional
N block
Local infilt
NG loss
Aspiration to check abs levels
Sepsis
Vasodilat
Give fluid resus and vasocontrictors
Resulting oedema, then need to mx this, alb and diuretics.
CPAP
Press ag exhalation
Opens collapsed small airways
Ionotropes and pressins
-
ECG
Axis- leave/reach in V1 and aVF
Central venous catheter
R IJV shorter than L Can do R subclavian- more risk pneumothorax Rarely femoral- risk infec and hidden Flush and head down to prev air embol CXR- check for pneumothorax, psoit Stay in max 10d
PIC line
Peripherally inserted cannula
Used mainly for TPN
Also chemo
Stay in for up to 6wk
midline
Shorter
Used for eg AB, fluids, drugs if LT admission.
hickman
Porter cath under skin
IPE ischaemic bowel
Hx- eld, CVS hx (AF, PVD, atherosclerosis), bloody diarr due to nec, diffuse or non specif pain, high lactate
Can lead to perf then peritonitis and sepsis
High mort
Early sign cramp after eat
blood gas
Arterial gas if resp fail
Venous gas if no concern resp fail- diff interp of pO2, pCO2 and sats.
Base excess- very neg means TOO MUCH ACID
Important things- pH 7.35-45, pCO2, pO2, lactate, base excess, HCO3.
PH low and CO2 high means resp acidosis
Both low means metab acidosis
Lactate norm 0.4-0.8- indics tiss perfus. High in eg sepsis, isch bowel, DKA.
Look at base excess with lactate
HCO3 slow resp by kidn to chronic CO2 reten
Hypoxia
Hypoventil- reduc hypox drive, RD, CVA
Resp causes- asthma, pneum, PE, consolid, pthorax, sepsis.
acidosis mx
Fluid
BP
Infec source control
Chest drains
Safe space- 2nd ICS mid clavic fo tension pthroax, 5th ICS mid ax.
NV bundle in on underside of rib, so insert over top of rib.
Seldinger tech uses guide wire.
C diff
Gram pos
RF- clindamycin, cephalosporins
Mx- metronidazole, vanco 2nd line
R colon CA px
Bleeding
Anaemia
Not us bowel change
L colon CA px
Hard stool
Then overflow diarr
Cyclical
LI obstruc causes
Neoplasia- benign or malig Stricture- inflamm eg divertic, IBD Volvulus Infec Impaction Hernia Intussusception Ext comp
LI obstruc mx emergency
Mx framework for everything
Hx, exam
Resus
Init assess- reviwe images, prev surg etc, NBM, NGT, analgesia, fluids
Imaging- AXR, erect CXR, CT abdo pelvis plus IV dye
Splenectomy
Risk encaps infec eh pneumococcus, haemphilus, meningococcus.
Mx- vaccines for the above, prophylactic penV
High risk malaria if travel.
Prep before colonoscopy
Bowel prep laxative- stimulant or osmotic
Prep before siggy
Enema
bowel N supply
No pain Rs
Stretch Rs so inflation and str causes pain
Endoscopy meds
Midazolam- amnesia
Fantanyl short acting
Occas use entonox- but delay onset and reduc coop
Bowel prep caution if
Renal disease
HF
Immobile
pyloric sten causes
CA
Duod ulcer
Hypertrophy in babies
ZE
NV and diarr
Hypochloraemic alkalosis
HypoK
Gastric outlet obstruc signs
Distension
Projectile high vol vomit
Succussion splash
Stomach region functions
Body and cardia produce acid
Antrum prods gastrin
HypoK causes
Chronic kidney dis Diuretics Vomiting Aldosteronism DKA Diarr Excesisve alc
Tympanitic on percussion
Resonant throughout
Gas in LI
Pneumoperitoneum
