Surg GI admission

Question 1

Epigastric pain

Answer 1

HPI

• colicky, radiate to back
• n/v
• BO
• belching, fullness, heartburn
• tarry stool, PRB
• fever
• urinary sx
• anemic sx
• constitutional sx
• women: menopaused, PV bleed/discharge

PE

• BP P T
• alert and conscious
• P J cLN
• Abd
• No mass felt
• No hernia
• PR empty

Ix

• CXR: no free gas under diaphragm
• AXR: no dilated bowel loops
• KUB: no stones

Mx

• NPOEM
• Obs q4H
• IVF 1/2 1/2 q6H
• Bld x CBC LRFT bone clotting amylase VBG Rg TnI
• Urine x multistix
• Panadol
• Tramadol prn

Question 2

IO

Answer 2

HPI

• NBO
• vomiting, undigested food
• hemetemesis, CG vomiting
• abd pain
• fever, chill, rigor
• urinary sx

PE

• BP P T
• alert and conscious
• P J cLN
• abd
• No mass felt
• No hernia
• PR empty

Ix

• CXR: no free gas under diaphragm
• AXR: dilated bowel

Mx

• NPOEM
• Obs q4H
• R/T to BSB, asp q4H
• Foley to BSB, UO q4H
• IVF NS q2H x1, then 1/2 1/2 q12H
• Bld x CBC LRFT clotting bone VBG amylase RG
• Urine x multistix, C/S
• Fleet PR stat x1

Question 3

PRB

Answer 3

HPI

• fresh PRB during BO
• dripping
• abd pain
• urinary sx
• anemic sx
• women: menopause, PV discharge

PE

• BP P T
• alert and conscious
• P J cLN
• abd
• no mass felt
• no hernia
• PR empty
• Proctoscopy: old blood, active bleeding, hemorrhoid

Ix

• CXR: no free gas
• AXR: no dilated bowel

Mx
 - NPO
 - Obs q4H
 - Bld x CBC LRFT amylase RG VBG INR
 - Hemorrhoidal
 >>>> PO daflon 3tabs BD x4/7 then 2tabs BD x 3/7 then 1tab x 1/7
 >>>> PO lactulose 10ml
 >>>> PR faktu daily

Question 4

UGIB

Answer 4

HPI

• abd/chest pain
• anemic sx (dizziness, SOB, palpitation)
• chronic NSAID/ steroid use
• fever/chills

PE

• BP P T
• alert and conscious
• P J cLN
• abd
• no mass felt
• no hernia
• PR: old melena, mass, fresh blood

Mx

• NPO
• R/T to BSB, asp q4h
• UO q4H
• obs q4H
• IV 1/2 1/2 q4H x1, then q8H
• Urine x dipstix, C/S
• Bld x CBC LRFT amylase VBG, C/S
• CXR, AXR
• IV pantoloc 40mg q12-24H/ IV pantoloc 40mg make up to 100mL 0.9%NS, 20mL/H (8mg/H)

Question 5

Prepuce inection

Answer 5

/

Question 6

Epididymo orchitis

Answer 6

/

Question 7

Epiglottitis

Answer 7

HPI

• Cough
• Stridor
• Fever
• SOB
• Dysphagia/ odynophagia

Mx

• NPO
• IVF
• Obs q1H, monitor SpO2 and T
• Prop up 30 degress
• IV augmentin
• Bld x CBC LRFT clotting bone
• U consult ENT

Question 8

FBI

Answer 8

HPI

• Ingested___ at what time
• Tolerated diet and fluid afterwards
• FB sensation at central neck, mid neck level
• cough, blood stained saliva
• hemetemesis
• SOB/ stridor
• fever
• last meal/ drink

PE

• Neck soft, no surgical emphysema
• Intraoral: no FB
• Direct larygoscopy in AED: no FB seen

Ix
- Neck XR: no radioopaque FB seen, no prevertebral soft tissue swelling

Mx

• NPO
• IVF
• Obs q4H
• Bld x CBC LRFT clotting

Question 9

RUQ pain

Answer 9

HPI

• jaundice
• tea colored urine, clay stool
• fever chills
• chest discomfort SOB
• back pain
• Last BO