13.01.21 Ward notes

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