Surgery: General Flashcards
Ddx for Young Female RIF Pain
GI: appendicitis, mesenteric adenitis, terminal ileitis, constipation, IBS
GU: ureteric calculus + UTI
Gyn: ectopic preg, tubo-ovarian pathology abscess/cyst/torsion, endometriosis, PID, mittelschmerz
Ddx of Appendicitis
GI: mesenteric adenitis, terminal ileitis, caecal diverticulitis, Meckel’s diverticulum
GU: testicular torsion, ureteric calculus, UTI
Gyn: ectopic preg, tubo-ovarian pathology abscess/cyst/torsion, endometriosis, PID, mittelschmerz
Ddx of Terminal Ileitis
Inflammation: CD + backwash ileitis
Infection: yersinia, salmonella, c difficile, mycobacterium
Malignancy: adenocarcinoma, metastatic, lymphoma, carcinoid
Plus spondyloarthropathies + vasculitides
RFs for PONV
Patient: female, younger, non-smoker, prev ep, motion sickness
Surgical: prolonged, abdo lap, intracranial, middle ear, squint, gynae, poor pain control after
Anaesthetic: prolonged, intraop bleed, inhalational agents, overuse of bag and mask ventilation, spinal, opioids
Alternative causes of PONV
Infection, GI (ileus or obstrc), metabolic (hyperCa, uraemia, DKA), meds, raised ICP, anxiety
Mx of PONV
Prophylactic - antiemetics, dex at induction, anaesthetic measures
Conservative - adequate fluids, adequate analgesia, ensure no obstrc
Pharmaceutical - multimodal therapy
The red flag condition for N+V?
Incarcerated Hernia
The red flag conditions for epigastric pain? (2)
MI + Leaking AAA (also flank pain)
The red flag condition for RUQ pain?
RLL Pneumonia
The red flag condition for groin pain?
Torted Testes
The red flag conditions for RIF pain? (2)
Large bowel obstrc + ruptured ectopic preg (also LIF pain)
What would pain out of proportion to clinical findings suggest?
Ischaemic Bowel
What is the most common acute abdo dx worldwide?
Appendicitis
Antiemetics if impaired gastric emptying
Metoclopramide or Domperidone
Antiemetic if suspected obstrc
Hyoscine
Antiemetic if metabolic
Metoclopramide
Antiemetics if opioid induced
Ondansetron or Cyclizine
What is involved in the pre-op examination?
General - identify any underlying undx pathology
Airway - predict difficulty of intubation
Outline the ASA classification
I - normal healthy pt
II - mild systemic disease: current smoker, preg, BMI 30-40
III - severe systemic disease: BMI >40
IV - above + constant threat to life
V - moribund + won’t survive w/o op
What does the ASA grade correlate with?
Risk of post op comps and absolute mortality
What is included in the airway examination?
Any obv facial abnormalities e.g. retrognathia
Degree of mouth opening, dentition and loose teeth, Mallampati classification
Neck ROM and distance b/w thyroid cartilage and chin <6.5cm difficult intubation
The pre-op drug regime
To stop - OCP/HRT, hypoglycaemics, clopidogrel, warfarin
To alter - S/C insulin + long term steroids
To start - LMWH, TED stockings, abx
CIs for NG Tube
Absolute - mid face trauma + recent nasal surgery
Relative - coag abnormalities, recent alkaline ingestion, oesophageal varices/strictures
How do you measure the length of a NG tube?
Tip of nose, to earlobe, to bottom of xiphoid process