Surg OSCE

Question 1

Abdo Compartment Syndrome (normal IAP = 5-7)

Answer 1

IAH = >12Abdo compartment syndrome = >20 with new organ failureCauses1 - Reduced abdo wall compliance - surgery, trauma, burns, proning 2 - Increased abdominal contents - ileus, ascities, haemopertioneum3 - Capillary leak - sepsis, pancreatitis, massive transfusion4 - Other - mech ventilation, PEEP >10ACS effects resp (atelectasis, VQ mismatch), CVS (decreased preload and increased afterload), neuro (increase ICP), renal (reduces renal blood flow), gastro/hepatic (bowel ischaemia)Mx- ABCDE- Monitoring- improve abdo compliance - sedation, analgesia- Optimise fluids- Evac intraluminal contents- Evac fluid collections- Organ support- Surg decompression

Question 2

Open Abdo

Answer 2

Often used in severe trauma or acute abdominal catastrophe- Severe nec pancreatitis, abdo sepsis, damage control surgery

Complications:1 - Nursing issues2 - Significant fluid loss3 - Malnutrition4 - Infection risk5 - Visceral injury6 - Ileus7 - Hernias and fistula

Mx - pain control, avoid hypothermia, acidosis and coagulopathy, lung protective vent, NMB, RASS -4, nutritional support with added protein, Abx, Use negative pressure techniques, Bogotá bag, synthetic mesh

Question 3

Pancreatitis

Answer 3

Hx - gallstones, ETOH - abdo pain, constant, severe, dull, N&V, anorexiaExam - fever, tachy, pallor, guarding, reduced BSOrgan failureInx - lipase, amylase, deranged LFTs, high WCC/CRP, low calciumCT findings: diagnosis and prognostication - assess for local complications- Inflammation, fluid, abscess, necrosis Early phase - acute necrosing pancreatitis- MOFLater phase - > 1 week - new organ failure, local complications, Abdo compartment syndrome, pseudo cystGlasgow Score: - age, PaO2, WCC, Ca, Urea, LDH/AST/ALT, alb, glucose - score 3 or more —- HDU/ICURanson- At 0 hours - age, WCC, Gluc, LDH, AST- At 48 hrs - Haematocrit, Urea, Ca, PaO2Causes: gallstones, ETOH, trauma (surgery/ERCP), infections (mumps/EBV), DKA, SLE, Drugs (thiazides, tetracyclines)Atlanta criteria:1 - Mild - most common, no organ failure or complications, usually resolves within 1 week <1%2 - Mod - transient organ failure, local complication or exac of co-morbidity <10%3 - Severe - persistent organ failure for > 48hrs 25%Mx:ABCDESupport organ failuresEarly enteral feedSurgery: reserved to manage complications - minimally invasive preferred - delayed if able to Emergency surgery: haemorrhage, bowel complicationsPrognosis: Mort < 1