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Medicine clinical years
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Medicine clinical years finals notes.
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Acute AbdomenPatients presenting with acute abdomen problems will commonly present with pain, vomiting
and obstructions of some sort. Ensure you take a THROUGH history off the patients with the
following guideline:
History
What is the presenting complaint?
Vomiting red (fresh blood), yellow/green (bile), coffee ground (old blood/ SB
obstruction), food coloured
Pain SOCRATES
Bowels
o Frequency changed form normal?
o Colour red (fresh blood), maroon (old blood), brown (normal), yellow (fat),
grey/white (biliary obstruction), black (malina, iron)
o Volume
o Pain when passing local or generalised bowel
DO NOT forget to ask the patient about their general health, medications and ALLERGIES
(PC, PCHx, FHx, DHx, SHx and systems review)
ASK THE RELEVANT Qs to RULE OUT DIFFERENTIALS
Examination
What is the general appearance of the patient? jaundice, body habitus, pallor
LOOK AT THE HYDRATION OF THE PATIENT dehydrated = VERY HARD to preform a surgery
Take the vital signs of the patient temperature (pyrexia?), urine (blood, glucose, ketones,
protein and white cells?)
Inspection = scarring, masses, distension, caput medusa, bruising, stomas, pulsations,
CHECK FOR ABDOMINAL RESPIRATION lack of = PAIN (tense and guarded abdo)
Palpation = upon LIGHT PALPATION check for tenderness within the abdomen, upon
DEEP PALPATION check for any masses within the abdomen
o ALWAYS keep an eye on the patient and feel for any GUARDING (invol or nah
tensing of the abs)
o CHECK FOR PERCUSSION TENDERNESS NOT rebound tenderness because
patient WILL 10/10 punch you in the face IF there is no response to
percussion tenderness test THEN check for rebound tenderness
Percussion = listen for the resonance (high resonance = gas, low = fluid)
o Shifting dullness = general dullness across abdomen in supine position but
lateral position = bowel (containing air) comes up = resonance at the top
Auscultation = listen for up to 3 minutes for bowel sounds
o Increased bowel sound frequency and volume in BOWEL OBSTRUCTION
o Tinkling bowel sounds in DILATED BOWEL (sloshing fluid)
o Absent sounds = strangulation, ischemia, ileus
Investigations
FBC
o Hb = elevated (dehydration, polycythemia) or low (anaemia, trauma)?
o NO = infection risk? Does the patient need AB
Serum amylase = elevated in acute pancreatitis
Pregnancy test = used in women of child breaing age (atopic pregnancy)
U&Es dehydration? Kidney funx (urea and creatinine), eGFR
LFTs jaundice or GB problems
Inflammatory markers infections
X-Ray
o Check the date and name of the patient
o Check the spine and pelvis determines age and gender
Increased bone density = younger patient
o Check the solid organs
o Is psoas muscle visible? if not = likely fluid in the abdo
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