Surgery+gyne Flashcards
A 37 yr old woman comes with vomiting n severe sudden onset rt lower quadrant pain since this morning. She has been undergoing clomiphene ovulation induction and her LMP was 5wks ago. Tenderness over the RLQ with guarding n rebound tenderness. On biannual examination there is rt adnexal tenderness but no mass or cervical motion tenderness. Normal intrauterine px on transvaginal u/s, normal bilateral adnexa, normal Doppler
Dx?
Acute appendicitis
What happens to UC during pregnancy?
Worsening of US with increased severity of sxs. Fetal risks include preterm delivery n small for gestational age
A woman in her third trimester pregnancy comes with nausea vomiting n severe epigastric n RUQ pain which started after breakfast. T-37.2, pr- 106, FHR-170, no contractions. Tender RUQ n epigastric areas with no rebound or guarding
Hb 10mg/dL, platelets 80,000 leukocyte-18000
Glucose 40mg/dL, total bilirubin 4, AST 130, ALT 96
Most likely Dx?
Suggestive features?
Mx?
Acute fatty liver of pregnancy
-RUQ pain, elevated transaminases, leukocytosis ( which can also b seen in acute cholecystitis) plus acute liver failure ( profound hypoglycemia, thrombocytopenia, hyperbilirubinemia) DIC is also possible.
Mx- immediate delivery
A 37 yr old pregnant comes due to decreased fetal movement. A few days ago she has developed generalized itching that is worse in her hands n feet. No sclera icterus, RUQ is tender. Total bilirubin- 2.4, total bile acid- 110(4-6 normal), ALP-200, AST-516, ALT-884. No fetal cardiac activity on u/s
Dx?
Intrahepatic cholestasis of pregnancy- elevated estrogen n progesterone cause hepatobiliary tract stasis decreased bile excretion
- pruritus worse in the hands n feet, elevated bile acid, fetal complications like IUFD
A 66yr old man comes with back pain, fatigue. Spine imaging shows osteoblastic n lytic lesions on multiple vertebral bodies. Alpha fetoprotein and alkaline phosphatase r markedly elevated
Most likely Dx?
HCC!
ALP is elevated due to bone metastasis, not because of biliary obstruction in this case so don’t confuse with cholangiocarcinoma( CA 19-9 n CEA elevations r expected here)
A 4cm defect in an abdominal incision site( postop pt), draining serosanguineous fluid, no areas of necrosis or crepitus, no erythema or induration, INTACT RECTUS FASCIA. Best next step in the mx?
Regular dressing changes only as this is a superficial wound dehiscence
- deep/fascial dehiscence on the other hand is a surgical emergency
Acute Appendicitis in px
Mx?
Immediate surgery is the mx ( same as the rest of the population)
- presentation could b atypical though- eg, rt mid to upper quadrant or flank pain due to displacement of the appendix by the uterus
