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Chapter 1: Principles of Surgery - Coggle Diagram
Chapter 1: Principles of Surgery
Haematemesis
Coffee-ground: old/low vol gastric bleeding
Dark/bright red: arterial/variceal
Blood streaked vomit: gastritis or oeso trauma
Haematuria
Start of urination: bladder cause
End of urination: penile/prostate cause
Pancreatitis pain
Epigastric
radiates through to back
relieved by sitting forward
Biliary colic vs cholecystitis/cholangiitis
Colic waxes + wanes, not constant
Colic < 6hrs duration
Both can be preceded by ingesting a fatty meal
Bowel Obstruction
3-6-9 rule
bilious (green) vomit: SBO
faeculent (brown) vomit: LBO
high pitched bowel sounds
distension
risk of perforation
Appendicitis
migratory umbilical to RIF pain
McBurney's point: 1/3 of distance from ASIS to umbilicus
Rosving's sign: palpate LIF
Rebound tenderness
Retrocaecal appendix
psoas sign: extend knee and hip
obturator sign: flex knee and hip to 90, internally rotate hip
McBurney vs Lanz incision
NGTs
wide bore: to relieve vomiting/obstruction
fine bore: to feed
Management considerations
Feeding
Fluids
Analgesia
Abx
Anti-emetics
VTE prophylaxis
TEDS
LMWH (e.g. enoxaparin 20-40mg SC OD)
PPI
When can you remove a drain?
when contents fall <30-50ml in 24hrs
Effects of poor nutrition
impaired wound healing
impaired immune activity
impaired albumin production
myopathy + weakness
Types of nutritional support
oral
PEG/jejunostomy
NGT/NJT
TPN
CVC (Hickmann) vs PICC
risks of CVC: bleeding, infection, carotid art damage, air embolism, pneumothorax, arrhythmias
TPN comps: poor glyc control, derranged LFTs, cholestasis, hyperosmolarity, nutrient deficiencies, pancreas atrophy
Monitoring required: LFTs, glucose, U+Es
Pre-Op drug alterations
CCBs + B-blockers must be ctd
COCP+HRT stop 4wks before
stop K-sparing diuretics + ACEis day before
stop Li day of
stop warfarin 5 days before, start LMWH 24 hrs later, start warfarin 12-24hrs post procedure
Guidelines for warfarin admin
INR <6 - reduce dose
INR 6-8: omit
INR >8: omit + give PO vit K
minor bleeding + INR>5: IV vit K
severe bleed: PCC + IV vit K
Fluids
Colloids
Blood
FFP
Albumin
Crystalloids
normal saline
Hartmanns
5% dex
Resus: 500ml of bolus crystalloids over 10-15mins, 250ml if in HF
Parkland Formula in burns: 4 x kg x TBSA%
Transfusion times shouldn't exceed >4hrs for 1 unit of RBCs
qSOFA for sepsis
RR 22+
Altered mental status
Sys BP<100