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1

General surgical management for diabetics

• First on morning list
• Urinalysis in morning
• Admitted 2 days prior for assessment and prep
• Avoid hartmanns IV
Insulin to be infused throughout the surgery

2

Pre op blood investigations

FBCs - To find undiagnosed anemia and correct pre surgery

U&Es - susceptibility to AKI to control fluids

LFTs - Directs medication choice and dosing if liver cannot correctly metabolise drugs

Clotting - Identify and correct pre surgery

Group and Save - determines pt blood group and screens for atypical antibodies. Done if blood loss not anticipated but MAY be needed. Takes 40 mins

Cross Match - Physically mixes pt blood with donor blood to see if immune reaciton takes place. Takes 40 mins on top of G&S which must be done first. Done if blood likely will be needed.

3

If female what test needs to be done pre op?

PREGNANCY

4

VTE prophylaxis

• LMWH - Dalteparin
TED stockings - if ABPI is >0.9 and no history of arterial disease

5

Causes of hyperkalaemia

• AKI
• Repeated blood transfusions
• K-sparing diuretics, ACEi, spironolactone
Excessive K treatment

6

ECG of hyperkalaemia

• Tall tented T waves
• Flattened P wave
Widening of QRS

7

Tx of hyperkalaemia

• Stabilise myocardium
○ IV calcium gluconate
• Reduce serum K
○ Salbutamol nebs and insulin with dextrose
• Reduce total body K
Oral calcium resonium

8

S&S of hyperK

• Non specific pains
• Parasthesia
• Muscle Weakness
• N&V
Palpitations

9

Investigations of hyperK

• Bloods - FBC, U&E, CRP
• VBG
• ECG
Catheterisation for fluid status

10

Causes of hypoK

• Diuretics esp thiazides
Hyperaldosteronism

11

Symptoms of hypoK

• Muscle weakness
Atrial and ventricular ectopic beats

12

tx of hypoK

• Treat cause
IV K replacement

13

Where is spinal and epidural given?

Epidural - given anywhere
Spinal - given below L2

14

S&S of hiatus hernia?

• Vomiting
• Weight loss
• Bleeding and anemia
• Hiccups and palpitations
Swallowing problems

15

Types of hiatus hernia?

• Rolling
Sliding

16

Surgical indications for hiatus hernia

• Remains symptomatic
• Increased risk of strangulation
Nutritional failure

17

Surgical tx for hiatus hernia

Fundoplicaiton

18

Patho of peptic ulcer disease

• Most commonly on lesser curvature of stomach or first part of duodenum
Caused by H pylori or NSAIDs

19

Red flags for gastric cancer and investigation

Gastric cancer red flags - ALARMS:
A - Anaemia
L - Lost weight
A - Anorexia
R - Recent rapid onset
M - Meleana
S - Swallowing difficulty

Immediate Endoscopy + biopsy

20

S&S of gastric and duodenal ulcer

• Gastric:
○ Epigastric pain - worse after eating
○ Nausea
○ Weight loss
• Duodenal:
Epigastric pain - worse 2 hrs after eating

21

Investigations for peptic ulcer and tx

• H pylori test - Stool antigen
• +ve H pylori test - Tx:
○ PPI + amoxicillin + clarithromycin for 7 days
• -ve H pylori test - Tx:
PPI

22

RFs for gastric cancer

• H Pylori
• Male
• Age
• Smoking
• Japan/Korean
Alcohol

23

S&S for gastric cancer

• Presentation is non specific:
○ Haematemesis
○ Dyspepsia
○ Dysphagia
○ N&V
• Advanced S&S:
○ Anaemia signs
○ Jaudnice and hepatmegaly - Liver mets
Enlarged Vircows node

24

Investigations for gastric cancer

Investigations:
• Routine bloods
• Endoscopy + biopsy
• If biopsy confirms - CT CAP to stage disease

25

commonest causes of SBO

1. Adhesions -50+%
2. Hernias - 25%
Tumours - 15%

26

Causes of adhesion

• Previous surgery
• Idiopathic
• Abdo infection
Trauma

27

Patho of crohns

• Can affect any part of GI but most common in distal ileum or proximal colon
• Trasmural inflammation
• Cobblestoning
• Ulcers and fissures
Skip lesions

Tranny Granny Skips on Cobblestones

28

RFs of crohns

1. FHx
Smoking

29

Tx of crohns

1. Induce remission:
a. Methotrexate + prednisolone
2. Maintain remission:
a. Azathioprine
Surgery if medical tx fails - ileocaecal resection

30

S&S of crohns

• Episodic abdo pain
• Diarrhoea - possible blood
• Malaise, anorexia, low fever
• Oral ulcers
Perianal disease