Ward Round Flashcards
(37 cards)
What is paralytic ileus and causes for it
Paralytic ileus is temperory dynsfunction in bowl motility without mechanical obstruction
Causes
P - post op
E - hypokalemia
M - opioids , anticholinergic drugs
S - DM
T - trauma
I - abdominal sepsis , peritonitis
What is compartment syndrome
It is increased pressure in osseofacial compartment upto a level that compromises tissue perfusion
Causes for compartment syndrome
Fractures - most common
Soft tissue contusions
Bleeding disorders
Burns - curcumferential third degree burns
Post ischemic - reperfusion injury
Tight casts and dressings
Extravasation of iv fluid - contrats under pressure
Clinical feqtures of compartment syndrome
Pain out of propotion
Increasing pain
Pain on passive stretch
Pralysis - late
Paresthesia - late
Pallor - late
Pulselessness - extremely late
Emergency treatment for compartment syndrome
Remove casts or dressings to the skin
Elevate extremities
Fasciotomy - definite treatment
Does compartment syndrome occurs in open fractures
Yes
In acute limb ischemia what is the time limit for irreversible damages
6 hours
Symptoms of acute limb ischemia
Pain
Pallor
Paresthesia
Paralysis
Loss of pulsations
Limb is cold
Toes cannot move
How to differentiate arterial occlusion and venous occlusion
Muscle functions not affected in venous occlusion
How to differentiate acute limb ischemia and compartment syndrome
Acute limb ischemia
- sudden onset
Severe sudden pain
Pulses absent early
Cold
Early distal sensory loss
Motor loss is late and poor prognosis
Minimal swelling
Compartment syndrome
- gradual onset
Pain out of propotion
Pain in passive extension ( hallmark)
Pulses present initially
Warm (initially)
Sensory loss localized to compartment
Motor loss is a late sign
Tense compartment
- presence of palpable pulse does not rule out compartment syndrome
Treatments for acute limb ishemia
Immediate administration of 5000u of heparin IV - reduce extension and maintain patency
Pain relieve
Embolectomy
- local or general anesthesia
- fogarty balloon catheter
- after procedure angiogram is performed to ensure blood flow has restores
- heparin continued until long term anticoagulation with warfrin is started
Thrombolysis
- done if ischemia is not so severe
- usually via common femoral artery a narrow catheter is passed into occluded vessel
- and left embedded in the clot
- tPA is infused through catheter and regular arteriograms are taken to check extent of lysis
- usually lysis successfully achieved in 24hrs
- should stop the procedure if there is no progression of dissolution of clot
- contraindications - recent stroke , bleedimg diathesis , pregnancy , over 80 yrs ( poor results )
Indications for CT in head injury
CT in 1 hour -
Gcs < 13 at any point
Gcs < 15 at 2 hours
Focal neurological deficit
Suspected open , depressed , or basal skull fracture
More than one episode of vomiting
Post traumatic seizures
CT within 8 hours
Age > 65
Coagulopathy - aspirin , warfrin , rivaroxaban
Dangerous mechanisms of injury ( fall from height , RTA )
Retrogade amnesia > 30mins
What is the classification of head injury
Minor - gcs 15 with no LOC
Mild - gcs 14 or 15 with LOC
Moderate - gcs 9-13
Severe - gcs 3 - 8
What are the discharge criteria in head injury
Gcs 15 with no focal deficits
Normal CT brain
Not under alchohol or drug influence
Accompanied by responsible adult
Verbal and written head injury advices -
Persistent / worsening headache despite analgesia
Persistent vomiting
drowsiness
Visual disturbances
Limb weakness or numbness
What is colles fracture
Extra articulr fracture involvingdistal end of radiuswithin 2.5cm from distal articulr surface with distal segment displaced and angulated posterolaterallydriven procimally and supinated
Causes for carpal tunnel syndrome
Obesity
pregnancy
Hypothyroidism
Rheumatoid arthritis
DM
Sensory areas affected in carpal tunnel syndrome?
Palmar aspect of lateral three and half fingers.
Thenar eminence is spared.
What is tinels test and phalens test?
Tinels test - tap over flexor aspect of the wrist over midline. Patient feels a tingling sensation over distribution od median nerve.
Phalens test - ask patient to flex the wrist maximally and keep for one minute. Patient feels pain in hand
ERCP vs MRCP
ERCP (Endoscopic Retrograde Cholangiopancreatography)
What it is:
A combined endoscopic and fluoroscopic procedure that allows direct visualization and treatment of bile and pancreatic duct problems.
How it works:
A flexible endoscope is inserted through the mouth to the duodenum. A contrast dye is injected into the bile and pancreatic ducts, and X-rays are taken.
Uses:
Remove bile duct stones
Place stents for obstruction
Take biopsies
Diagnose and treat strictures, tumors, or leaks
Advantages:
Therapeutic: Can treat problems (not just diagnose)
Risks:
Invasive
Pancreatitis (most common complication)
Bleeding, infection, or perforation
MRCP (Magnetic Resonance Cholangiopancreatography)
What it is:
A non-invasive MRI scan focused on the liver, gallbladder, bile ducts, and pancreas.
How it works:
Uses strong magnetic fields and radio waves to create detailed images of the biliary and pancreatic ducts, without contrast or endoscopy.
Uses:
Detect bile duct stones or strictures
Evaluate pancreatic or biliary tumors
Assess congenital abnormalities
Advantages:
Non-invasive
No ionizing radiation
No sedation required
Limitations:
Diagnostic only (can’t treat issues like ERCP)
May miss very small stones or lesions
Comparison Table:
Feature ERCP MRCP
Invasiveness Invasive Non-invasive
Imaging Type Endoscopy + X-ray (contrast) MRI
Therapeutic? Yes (can remove stones, place stents) No (diagnostic only)
Risks Pancreatitis, bleeding, infection Minimal (MRI-related contraindications)
Use Case When treatment is needed When only imaging is needed
Does mid shaft fracture of both radius and ulnar need an internal fixation?
Yes. It act as a joint in supination and pronation. So if both bones are fratured it needed internal fixation
Features of femoral neck fracture
Shortening and external rotation of lower limb
Advice for UTI in females after intercourse
Double voiding
Void after intercourse. Stop for 20-30 seconds and start voiding again
What are the types of intestinal obstruction
Mechanical
Intraluminal
Intramural
Extramural
Functional
What are the causes for mechanical intestinal obstruction
Intra luminal - fecal impaction , foreign bodies , bezoars , gallstones
Intramural - stricture , malignancy , intussusception , volvulus
Extramural - bands , adhesions hernia
