Overview Examination Common presentations RUQ pain RIF pain Epigastriccentral pain Scars Presenting cases Surgical instruments EXAMINATION Bedside inspection fluids blood transfusion vomit pots distended abdomen Uncomfortable ID: 926581
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Slide1
The Surgical Abdomen
Dr Anita Ghosh
Slide2Overview
Examination
Common presentations
RUQ pain
RIF pain
Epigastric/central pain
Scars
Presenting cases
Surgical instruments
Slide3EXAMINATION
Bedside inspection – fluids, blood transfusion, vomit pots, distended abdomen, ? Uncomfortable
Hands – appearance, pulse, flap
Face – jaundice,
lipidaemia
,
anaemia
, ulcers
Neck - JVP
Closer inspection – abdomen size, striae, gynecomastia, spider
naevi
, distended veins
Palpation – liver, spleen, kidneys, abdominal aorta
Percussion – liver, spleen
Auscultation – renal bruits, abdominal bruit, ?renal transplant, ?fistula
Slide4RUQ
cholecystitis
biliary colic
cholangitis
liver abscess
hepatitis
RLL pneumonia
MSK
duodenal perforation
Slide5RIF
appendicitis
ectopic pregnancy/PID
ureteric colic
ovarian cyst (torsion/
haemorrhage
/rupture)
testicular torsion
diverticulitis
TB
MSK
Slide6Epigastric
pancreatitis
gastric perforation
gastric ulcer
GORD
MI
pneumonia
costochondritis
Slide7sCARS
Laparoscopy scars
Small 5mm straight lines
Location dependent on surgery taking place and other patient dependent factors
RUQ
cholecystectomy
other biliary surgery
RIF
appendicectomy
hernia repairs
Midline
Laparotomy – anything bowel related
Conversions
AAA
Stoma
Location
Type
?Functioning
Bag contents
Slide8Presenting cases
Be prepared, concise, confident and methodical
Top 3 differentials
Management plan to narrow down differentials
Bedside investigations
Imaging
How to treat
Senior review
Conservative, medical, surgical
Slide9Volunteers please!
Slide10Case 1 – 47yo gentleman
Clinical signs
sick pot at the bedside
IV fluids attached
HR 102
On examination
Upper abdominal tenderness
No other positive features
Slide11Differentials?
Cholecystitis
Pancreatitis
Hepatitis
Chronic alcoholic liver disease
Gastric ulcer
Perforated gallbladder
Slide12Investigations
Bedside observations
?ABG/VBG
FBC, U+E’s, CRP, clotting, LFT, ?G&S
?ECG
Urine dip
Stool sample
PR exam?
Slide13Results
98% on RA, RR 16, temp 37.1C, BP 134/76, HR 102
VBG - pH 7.36, pO2 4.7, pCO2 6.0, lactate 3
Hb 110, WCC 16.3,
Plts
243, Na 132, K 3.5, CRP 210
ECG – sinus tachycardia
Slide14Imaging
US Abdomen
CBD dilated measuring 8mm, pancreas could not be visualised due to overlying bowel gas
Slide15Management plan
Lipase
Any other additional bloods and why?
IV fluids
Abx?
MRCP/ERCP
Slide16Case 2 – 55yo female
Clinical signs
nil
On examination
Scar seen across the top of the knicker line
Small mass felt a third of the way along the scar from the right hand side
Slide17Differentials?
Hernia
Lipoma
Mass
Slide18Investigations
Bedside observations
FBC, U+E’s, CRP, clotting, G&S
VBG
Stool sample
Urine dip
Slide19Results
99% on RA, RR 12, temp 36.9C, BP 118/72, HR 80
VBG - pH 7.41, pO2 5.2, pCO2 6.0, lactate 0.8
Hb
109, WCC 6.3,
Plts
304, Na 135, K 4, CRP 2
Slide20Imaging
US Groin
incisional hernia consisting of fatty contents
Slide21Management plan
Conservative – watch and wait, reassure, diet
Medical – analgesia, ?fluids
Surgical – when to operate?
Slide22Surgical iTEMs
Name the item
When is it used?
How it works
Slide23Slide24Thank you
Any questions?