ASA Grade: Physical Status Classification

• I: Healthy patient
• II: Systemic disease without functional limitation
• III: Severe systemic disease with definite functional limitation
• IV: Patient with severe systemic disease that is a constant threat to life
• V: Moribund patient unlikely to survive 24 hours with or without an operation

Causes of renal failure post-surgery - Crying man

• Reduced perfusion
• Gentamycin
• Cholangitis
• CT contrast
  

Spigelian hernia

• Hernia through the spigelian fascia
• Aponeurotic layer between the rectus abdominis muscle medially, and the semilunar line laterally
• Most occur on the right side
• Generally interparietal hernias
• Do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall
• Therefore there is often no notable swelling.
• Usually small and therefore risk of strangulation is high
• Commonest in 4th–7th decades of life
• Compared to other types of hernias they are rare
• Presentation:
• Either an intermittent mass, localized pain, or signs of bowel obstruction
• Treatment
• These hernias should be repaired because of the high risk of strangulation
• Surgery is straightforward, with only larger defects requiring a mesh prosthesis

Meshes

• Biological
• Don't get infected
• Dissolve
• Synthetic
• Strong
• Cheap

Alvarado score

• Scoring system for appendicitis
• Scored out of 10 (2 points for RIF pain and leukocytosis)
  
• Mnemonic:
  
• M: Migration to the right iliac fossa
• A: Anorexia / Ketonuria
  
• N: Nausea/Vomiting
• T: Tenderness in the right iliac fossa - 2 points
  
• R: Rebound pain
• E: Elevated temperature (fever)
• L: Leukocytosis - 2 points
  
• S: Shift of leukocytes to the left (neutrophilia)
  
• Interpretation:
• 5 or 6 : Compatible with the diagnosis of acute appendicitis
• 7 or 8 : Probable appendicitis
• 9 or 10 : Very probable acute appendicitis

Notes

• Replace magnesium before trying to correct potassium
• Apex beat moves if the mediastinum shifts