14.03.14 AHO notes

T tube

• Drains bile from CBD to bag

APACHE II Score (On admission)

• 1. Age

  2. Temperature (rectal)

  3. Mean arterial pressure

  4. pH arterial

  5. Heart rate

  6. Respiratory rate

  7. Sodium (serum)

  8. Potassium (serum)

  9. Creatinine

  10. Hematocrit

  11. White blood cell count

  12. 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