Perforated Viscus + AF

Question 1

An elderly man who has long history of recurrent epigastric pain. Presented
with sudden generalised abdominal pain. He is confused. ECG & CXR in the
Q1. What is the 1st thing to look for in both X-ray and ECG?

Answer 1

Pt details and date

Question 2

3: How to read X-ray?

Answer 2

Check Pt details.
Film details
Penetration
Rotation
Inflation
air under diaphragm/ emphysema
Chest (Lungs – Heart borders – diaphragm cones – CPh angles – mediastinal area)
Trachea
Cardiac Vessels
Ext. devices
Skeleton and soft tissue
Given the following X-ray

Question 3

Q2. How to read ECG?

Answer 3

Check rate, rhythm, amplitidte, any abnormalities of P waves or QRS complex or T wave, any shortening or prolongation of PR/Qt intervals.

Question 4

Q4. Explain thc pathological findings?

Answer 4

Air under the rt dome of diaphragm

Question 5

Q5. Mention 4 deferential diagnosis?

Answer 5

Perforated viscus – malig. Pneumoperitoneum – NEC – Ischmic bowel

Question 6

Q7. In this age group what other cause of abdominal pain you should consider?

Answer 6

Inf. MI

Question 6

Q6. What’s management plan?

Answer 6

CCRISP – NPO – IV access – Blood testing – Abx acc. To protocol – operation laparotomy.
x

Question 7

Q. in Laparotomy you found a concomitant perforated gastric ulcer what will you do?

Answer 7

Omental patch repair + biopasy taking / Bypass in case of infected and necrotic tissue

Question 8

Q8. How to consent such a patient for surgery ( shocked and confused) ?

Answer 8

From the two consultants (Pt consent 4)
Given the following ECG

Question 9

Q9. Explain findings?

Answer 9

Absent P wave and Irregular rhythm – > AF

Question 10

Q10. Why heart rate value differs between machine and manual counting?

Answer 10

Due to the different in volume of the heart beats, some small and large, small cannot be counted by machine

Question 11

Q11.What could be the causes of Af in general, in surgical patient & in this patient?

Answer 11

In general; Cardiomyopathy, Cong. HD, HTN, IHD, PE, HyperThyroid
Surgical; Anathetic drugs, sepsis and hypothermia and electrolyte disturbance
in Pt; Sepsis, IHD, HypoK

Question 12

Q12. Principles of Af management ?

Answer 12

First, Correct the cause
beta blocker to correct the rate
Anticoagulation for prevention of thromboembolism

Question 13

Q. what’s the physiological impact of AF on body?

Answer 13

Mural thomrbus formation – > shooting emboli into anywhere of the body.
Fast AF – > affect preload – > affect blood pressure and perfusion.
On heart – > affect blood supply to heart – > IHD

Question 13

Q13. How do NSAIDs cause inhibit pain? & how do it cause peptic ulcer?

Answer 13

Inhibit the PG which are pain mediators by inhibiting COX2.
Inhibit PG