THE SURGICAL ABDOMEN MASTERCLASS

COURSES

Topics

• Regions
• Organs
• Diseases
• Diagnosis: Symptoms/Signs/Tests
• Management

Notes

• Practical – not full Theory 
• Write Notes
•  
• Part of body most commonly dealt with by a Surgeon
• 9 Regions
• two vertical midclavicular lines (left and right)
• two horizontal: subcostal (through lower edge of 10th costal cartilage) and transtubercular (through tubercles of iliac crests)
• One disease at least each region
• Organs
•  
• Disease conditions
• Biliary 4 – anatomy – tests
• Biliary Colic
• Cholecystitis Rx ABs, Cholecystostomy
• Choledocholithiasis: gallstones within the common bile duct Rx: ERCP, PTC
• Cholangitis – inflammation of the bile duct system – Charcots Triad (Pain, Pyrexia, Jaundice)
• Blood Tests 2345 125/130 BAGL Amylase ALP 
• USS, MRCP
•  
• GORD – Diagnosis: OGD Rx PPI 
• PUD: Gastric & Duodenal Ulcer. Gastric Exacerbated & Duodenal Relieved by food GERD
• Ulcer perforation 
• Diagnosis: CXR, CTAP – Air under diaphragm in GD Ulcer & Diverticular Perforation
• Rx NG, PPI, ABs
• 
  
• Splenic Injury
• Stable (no Hb drop Not Tachycardic) – Strict bed rest, Regular monitoring Observations & Hb
• Unstable – Tranexamic Acid, Embolisation of Splenic Artery or Splenectomy
• Hb drop: 2o units in 24 hours OR Absolute value of 70 units
•  
• Pancreatitis 
• GS:ETOH 70:30
• Amylase Lipase 125 50 x 3 times ~ 2 days x 2 weeks 
• Modified Glasgow Score PANCREAS
• Rx IVF AB
• IVF 
• Urinary Catheter 0.5ml/kg/hour
• Mild Gallstone Pancreatitis: Early Cholecystectomy 2/52
• Severe Gallstone Pancreatitis: Delayed Cholecystectomy 6/52
•  
• Renal/Ureteric colic: 
• Sym: Flank pain
• Diagnosis: USS/CT KUB
• 4mm or less can pass spontaneously
• Alpha-blockers like tamsulosin) can help stones pass more easily
• Pyelonephritis – Fever >=37.9, Flank pain, nausea & vomiting
•  
• Diverticular Disease – Diverticulosis, Diverticultis, Diverticular Perforation
• Diverticultis
• Diverticular Perforation
• Hinchey: Stage I (pericolic abscess), Stage II (pelvic abscess), Stage III (generalized purulent peritonitis), and Stage IV (generalized fecal peritonitis).
• Flex Sigi/ Colonoscopy in 5-6/52
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• Bladder(Retention)/Gynaecological causes(PID, Endometriosis)
• UTI – Nitrites favour
• Testicular Torsion
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• Appendicitis
• Signs Alvarado score Max 10. RIF tenderness & WCC >10 (each 2)    >/= 5 Appendicitis 
• Migration, Anorexia, Nausea, Fever >= 37.3, Rebound, Neutrophilia
• Appendicular abscess CTAP – Radiological drainage
• Rx: Operation/Antibiotics (Recurrence 25-35% in one year)
• DD: Mittelschmerz, Meckel’s, Testicular Torsion
• (Meckel’s – add Proceed, Bowel resection to consent)
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• Ruptured AAA
• Expansile Pulsatile mass, RadioFemoral Delay, BP drop, 
• Fast scan, CTAP, Straight to theatre
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• Bowel Obstruction
• LBO – Ileocaecal valve competent/not
• SBO – Ryles tube
• Lactate >2, CTAP 
• DRE – do in all obstructions
• Don’t forget Hernial orifices – Inguinal vs Femoral

 

Media

References