14.03.14 AHO notes

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