T tube - Drains bile from CBD to bag

APACHE II Score (On admission)
- Age
- Temperature (rectal)
- Mean arterial pressure
- pH arterial
- Heart rate
- Respiratory rate
- Sodium (serum)
- Potassium (serum)
- Creatinine
- Hematocrit
- White blood cell count
- Glasgow Coma Scale
Ranson criteria for pancratitis- At admission:
- Age in years > 55 years
- White blood cell count > 16000 cells/mm3
- Blood glucose > 10 mmol/L (> 200 mg/dL)
- Serum AST > 250 IU/L
- Serum LDH > 350 IU/L
- Within 48 hours:
- Serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
- Hematocrit fall > 10%
- Oxygen (hypoxemia PO2 < 60 mmHg)
- BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
- Base deficit (negative base excess) > 4 mEq/L
- Sequestration of fluids > 6 L
- Cutoffs are slightly different for gallstone pancreatitis
Faecal elastase - Pancreatic elastase 1 (E1) remains undegraded during intestinal transit => Faecal concentration reflects exocrine pancreatic function
- Inflammation => E1 release into bloodstream => Serum pancreatic elastase 1 allows diagnosis or exclusion of acute pancreatitis
Fitz-Hugh-Curtis
- RUQ pain from perihepatitis following the transabdominal spread of infection from PID
- "Violin string" adhesions form between the anterior liver capsule and the anterior abdominal wall or diaphragm
- Immature anatomy of adolescents makes them more susceptible
Notes - More than two diverticulitis flares within a year => Admission
- Gastrograffin
- = Sodium Amidotrizoate 100 mg/mL + Meglumine Amidotrizoate 660 mg/mL
- Can be used orally or as enema
- Not good for visualisation of mucosal diseases as does not coat well
- Good (compared with barium) when concerned about perforation
- Section 5(2)
- Doctor’s holding power
- For patients who consent to admission but then wish to leave
- Lasts up to 72 hours
- SHOULD NOT simply allow to lapse - Actively decide on next step
- Rectus sheath catheter
- Alternative to epidural analgesia or opioid based IV-PCA
- Targets the anterior branches of the intercostal, segmental nerves which supply the abdomen
- Provides intraoperative and postoperative analgesia for mid-line abdominal incisions
- Cystogastrostomy
- Surgical anastomosis of a cyst to the stomach for drainage
- e.g. For pancreatic pseudocyst
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