General surgery notes detailing pathologies and conditions for medical school examinations. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines.
Look at specialty section and content list for the summary contents of this file.
Clinical Syndromes that usually require Laparotomy
Peritonitis Rupture of an Organ
- Perforation - Organ Rupture
o Ulcer: Peptic; Duodenal (commoner in H. pylori) o OBGYN: Ectopic pregnant
o Intestinal: Diverticulum; Appendix o GI: Spleen
o Organ: Gall bladder (advanced cholecystitis) o Vascular: Aorta
- Exam and Investigations - Signs of Rupture
o Pain: Tenderness ± rebound pain (Blumberg sign) o Shock: See table below
o Palpation: Abdominal rigidity ± Guarding o Swelling: Abdominal swelling
o Auscultation: Absence of bowel sounds o NB: Spleen rupture may take wks to present
o XR: Erect AP CXR may show gas under diaphragm
o Special: Pain on cough test
Estimating Blood Loss from Patient's Initial Presentation
Parameter Class I Class II Class III Class IV
Blood Loss <750 mL (<15 %) 750-1500 mL (15-30 %) 1500-2000 mL (30-40 %) >2000 mL (>40 %)
Pulse <100 BPM >100 BPM >120 BPM >140 BPM
BP ↔ ↔ ↓ ↓
Pulse Pressures ↔/↑ ↓ ↓ ↓
Respirations 14-20/min 20-30/min 30-40/min >35/min
Urine Output >20 mL/hr 20-30 mL/hr 5-15 mL/hr Negligible
Mental State Slightly anxious Anxious Confused Lethargic
Fluid to give Crystalloid crystalloid Crystalloid + Blood Crystalloid + Blood
Clinical Syndromes that may not require a Laparotomy
Local Peritonitis Colic
- Inflammation - Nature of Presentation
o Intestinal: Diverticulitis; Appendicitis o Muscles: Spasms leads to intermittent pain
o Organ: Cholecystitis; Salpingitis o Restless: Pain may also be full and constant
- Indications of Investigations - Locations affected
o USS/CT: Swelling; Swinging fever; ↑ WCC o GI: Gut; Bile Duct; Gallbladder
- Investigations Options o Urinary: Ureter
o XR: Peritonitis can induce localised ileus o OBGYN: Salpinx; Uterus
- Management Options
o Drainage: Cutaneous; Laparotomy
Upper GIT Problems
Peptic Ulcer Diseases GI Haemorrhage
- Location: Epigastrium - Location: Epigastrium
- Sx: UGI Haemorrhage may be seen - Sx: Haematemesis
- Cx: LT NSAID use; Alcohol Excess; H. pylori - Cx: PUD; Typically gastric ulcer
- NB Duodenal: Relieved by eating - NB: Severe bleeds usually involves Left Gastric a.
- NB Gastric: Exacerbated by eating
Lower GIT Problems Hepatobiliary Problems
Appendicitis Biliary Colic
- Location: Umbilical (initial) ➔ RIF - Location: RUQ
- Sx: Rosving’s sign positive; Anorexia; ↑ HR - Sx: Provocation with fatty meal
- Cx: Infection can block appendix - Cx: Gallstone lodges in bile duct
- NB: Rupture leads to peritonitis - NB: No fever or inflammatory markers
Acute Diverticulitis Acute Cholecystitis
- Location: LLQ - Location: RUQ
- Sx: Colicky pain; Fever; Diarrhoea ± Blood - Sx: Murphy’s sign +ve (inspiration tender); Fever
- Cx: Diverticula form in weakened parts of colon - Cx: Inflammation/Infx of gallbladder 2o to stones
- NB: Raised inflammatory markers and WCC - NB: Raised inflammatory markers
Intestinal Obstruction Acute Pancreatitis
- Location: Umbilical - Location: Epigastrium; Radiates to back
- Sx: Vomiting; Constipation - Sx: Pain is often severe ; Low-grade fever; Ileus
- Cx: Malignancy; Adhesions - Cx: Alcohol; Gallstones migrating to pancreas
- NB: Tinkling bowel sounds - NB: Tenderness on exam
Urological Problems
Renal Colic Urinary Retention
- Location: Loin pain radiating to groin - Location: Suprapubic
- Sx: Severe but intermittent pain; Restlessness Acute Pyelonephritis
- CX: Renal stones trapped in GUT - Location: Loin pain
- NB: Visible or non-visible haematuria - Sx: Fever; Rigors; Vomiting
Gynaecological Problems
Ectopic Pregnancy Urinary Retention
- Location: RIF or LIF - Location: Suprapubic
- Sx: Pain; Amenorrhoea; Vaginal bleeding - Sx: Urinary retention; Hesitancy
- Cx: Incorrectly implanted embryo; Usually fallopian - Cx: BPH
- NB: Amenorrhoea typically started 6-9 wks ago
Vascular Problems
Ruptured AAA Mesenteric Ischaemia
- Location: Umbilical radiating towards back - Location: Umbilical
- Sx: Shock; Hypotension; Tachycardia - Sx: Diarrhoea; Rectal bleeding; Ab pain
- NB: May have a hx of CVD - NB: Hx of AF; Metabolic acidosis
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