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Lecture notes

Medicine clinical years

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Medicine clinical years finals notes.

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  • May 8, 2022
  • 2
  • 2021/2022
  • Lecture notes
  • Dr kumar
  • All classes
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kaijaneekugavarathan1
Acute Abdomen

Patients 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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