May 28, 2022

Answers for the previous essays for surgery questions.

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Bleeding peptic ulcer disease. Explain how you would manage the condition.

During resuscitation;

  • Insert iv line for possible fluid resuscitation and blood transfusion.
  • Take blood samples for grouping and cross-matching.
  • Start the patient on iv fluids according to your hospital’s policies.
  • If the hemoglobin levels are low, start blood transfusion according to hospital policies.
  • If the patient is in respiratory distress, administer high flow oxygen 2 – 3 litres per minute.
  • Monitor patients vitals closely.

For supportive treatment;

  • Ensure the patient doesn’t take anything by mouth( Nil Per Oral)
  • Do endoscopy to confirm where the bleeding is coming from and the nature and severity of the ulcer
  • You can also insert a nasogastric tube.
  • If the patient is on NSAIDs, then stop them from taking them.
  • Diet advice, they should avoid spicy foods.

For the specific management;

  • If there is perforation, the patient should be put on IV antibiotics as plans for surgery are underway.
  • Injection of sclerosant to try and stop the bleeding.
  • Continue in H2 antagonist, or better yet, Proton Pump Inhibitors(PPIs).

Give four clinical features of peritonitis.

  • Abdominal pain is usually the presenting complaint.
  • There may be abdominal tenderness. It may also not be there.
  • Patients will present with pain.
  • Because of the pain, there is guarding when the physician tries to examine the abdomen.
  • When you request a full blood count, you will see leukocytosis
  • When you take the peritoneal aspirate, you will notice that it is tabid, showing there is infection.

What do you understand by the term Acute abdomen?1mk)

The term acute abdomen is a term we use for conditions that are either surgical, medical and gynecological where the primary symptoms the patient complains of is pain. This pain is usually located in the abdomen. Further investigations will help the physician pinpoint the exact problem. Clinical features of peritonitis include;

List any 5 gynecological causes of Acute abdomen. (5 mks)

  • It can be due to an ectopic pregnancy. An ectopic pregnancy is when the fetus implants in other parts other than the uterus. For example the fallopian tubes. They will eventually bleed leading to pain and bleeding, making it a fatal condition.
  • Presence of pelvic inflammatory disease(PID). An article will be soon updated on this important gynaecological condition.
  • If the patient is suffering from endometriosis, which is, in simple terms inflammation of the endometrium.
  • If the is fibroid degeneration.
  • Salpingitis.
  • In situations where there is a ruptured ovarian cyst

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