PACES Flashcards
Antalgic gait
Antalgic- decreased time on painful leg
Leg length
True - asis to medial malleolus
Apparent - umbilicus to medial malleolus
Indications for joint replacement:
Pain not controlled by conservative or medical therapies
Significantly disability patient
Severe osteoarthritis, rheumatoid arthritis,
Avascular necrosis, NOF fracture, pathological fractures from metastatic disease, congenital joint diseases
Failure of previous surgeries/ non union
De quervains tenosynovitis
Painful condition affecting tendons on the thumb side of your wrist
Hurts when you make a fist, grasp anything,
Swelling and pain at base of thumb and wrist
Cause: Direct blow to thumb lifting something heavy eg. Child, shopping Repetitive movements eg. Gaming Rheumatoid arthritis
X ray HF acute
A - alveolar oedema (bat wing opacities) B - Kerley B lines C - cardiomegaly D - dilated upper lobe vessels E - pleural effusion
Acute pul oedema And hypotensive patient Mx
Cpap - push lung fluid out and into pulmonary vessels
Will allow IV diuretics to work without risk of further hypotension
Then oxygen
Whipple’s procedure
Pancreatic head
Gall bladder
Part of the duodenum
Stoma exam
Site
Spout or flush
Number of lumens: loop (2 holes), double barrelled vs end
Consistency - does the stoma look healthy, prolapse, and contents of bag
Para stoma- herniation, skin,
Palpate - cough (herniation)
digitalise the lumen for stenosis and assess latency
Examine the rectal stump if necessary
What is a stoma?
Examples
External opening to a luminated organ
Allows discharge of the luminal contents to outside the body
Gastrostomy, duodenostomy, jejunostomy Ileostomy Colostomy Nephrostomy Urostomy
Complications of stomas
Specific
- ischaemia, haemorrhage
- infection, necrosis
- skin erosions
- retraction, prolapse, herniation
- stenosis
General
- stomal diarrhoea resulting in hypoK
- stone disease incl gall stones and renal stones more common following ileostony
- residual disease
- psychological disease
- psychosexual disease
- risks of operation
stoma indications
loop (temporary, reversal intended, relieve the distal bowel for healing), end (permanent)
feeding - percutanoues endoscopic gastrostomy
infection - severe necrotised fascitis, fournier’s gangren, abdominal tuberculosis
inflammation - severe irritable bowel disease, diverticular disease, radiation enteritis, familial adenomatous polyposis
perforation, complex fistulas
malignancy with resection
trauma - gun shot/ stabs
congenital - imperforate anus, hirschprung disease, necrotising enterocolitis, intestinal atresias
hartman’s procedure
surgical resection of the rectosigmoid colon with closure of the anorectal stump and formation of an end colostomy
*occasionally reversed
indications:
- Localized or generalized peritonitis caused by perforation of the bowel secondary to the cancer
- Viable but injured proximal bowel that, in the opinion of the operating surgeon, precludes safe anastomosis
- Complicated diverticulitis
colorectal cancer operations
anterior resection - loop stoma for later rejoining to allow the distal anastomosis to heal
Hartman’s procedure - removal of rectosigmoid colon, anorectal stump, formation of an end colostomy
right or left hemicolectomy
suspected bowel perforation, which imaging modality?
If bowel perforation is being considered, you don’t usually require an abdominal film, instead you need an erect chest X-ray, as this allows free gas under the diaphragm to be identified (the patient needs to have sat upright for at least 15-20 minutes prior to the X-ray to allow time for the air to rise).
structure for abdominal X ray
erects vs supine AXR
BBC
Bowel & other organs
- small intestine: middle, valvulae conniventes transverse the entire width
- large intestine: peripheral, haustra DO NOT transverse entire width
- faeces (usually a mottled/ thumb print appearance)
- upper limit of bowel diameter: 3cm (small in), 9cm (caecum), 6cm (colon)
Bones - fractures, sclerosis (white), mets
Calcifications - renal stones, gall stones
