Surgical management Flashcards
How do you manage biliary colic?
analgesia
Prescribe lifestyle changes including low fat diet, weight loss, exercise
Elective cholecystectomy within 6 weeks of clinical presentation.
What is the management of acute cholecystitis?
Antibiotics - Co-amoxiclav +/- Metronidazole
Antiemetics
Analgesia
Perform a laparoscopic cholecystectomy
Percutaneous cholecystomy can be carried out for patients not suitable for surgery
What is the management for acute pancreatitis?
Pain management
Antibiotics
NG tube
Calcium replacement
Catheterisation
Replace fluid and electrolytes
Endocrine and enzymes
Antispasmodic drugs
Steroids - during acute attacks
What are some complications of pancreatitis that you should look out for?
Acute respiratory distress syndrome
Pleural effusion
DIC
Hypocalcaemia
Hyperglycaemia
How would you manage chronic pancreatitis?
Analgesia
Steroids if the cause is autoimmune
Enzyme replacement
Treat any underlying diabetes and give fat soluble vitamin supplements (ADEK)
Statins to stabilise lipid levels
How would you manage a pseudo-obstruction?
“Drip and suck”
IV access and fluid prescribing
NG tube for decompression if the patient is vomiting
Catheterise and monitor fluid balance
Correct any underlying causative factor.
When would you consider inserting a flatus tube in a pseudo obstruction?
If the obstruction doesn’t resolve within 24-48 hours.
What are the main causes of bowel obstruction (large bowel)?
Volvulus
Diverticular disease
Malignancy
How would you investigate a patient for a suspected volvulus?
CT abdomen/pelvis with contrast.
A coffee bean sign on an abdominal x ray indicates a volvulus.
How would you manage a patient with a volvulus?
Sigmoidoscopy with decompression
Insert and leave in a flatus tube for 24 hours.
If repeated attempts at decompression fail or is there is sign of necrosis of the bowel then surgical correction is indicated.
Management of an UGIB?
Full A to E assessment of the patient
IV access and fluid resuscitation as appropriate
Urgent OGD as soon as the patient is stable
If peptic ulcer the cause: injections of adrenaline and cauterisation with a high dose of PPI IV (40mg Omeprazole)
Oesophageal varies the cause: endoscopic banding is indicated with prophylactic antibiotics.
In severe cases of an upper GIB, a Sengstaken-Blakemore tube can be used.
How would you manage a haemodynamically unstable patient suffering with rectal bleeding?
A to E assessment acting appropriately. I would gain IV access and fluid rescuscitate appropriately.
G&S and a crossmatch.
Urgent CT angiogram - identifies the source of bleeding and means you can embolise.
How would you manage a stable patient with rectal bleeding?
A lot of the time they can be investigated as an outpatient.
If stable - flexi sig. If no findings then proceed to a full colonoscopy. if no findings then carry out an OGD to find the underlying cause.
