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Review Sheet - General Surgery

This document discusses the role of a general surgeon. It describes a case of an 87-year-old man admitted with abdominal pain, fever, and jaundice. After examination, imaging, and lab work, the patient is diagnosed with ascending cholangitis due to gallstone obstruction in the common bile duct. He will require ERCP to place a stent and drain the bile duct, followed by laparoscopic cholecystectomy to remove the gallbladder and prevent further stones.

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sammy
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49 views2 pages

Review Sheet - General Surgery

This document discusses the role of a general surgeon. It describes a case of an 87-year-old man admitted with abdominal pain, fever, and jaundice. After examination, imaging, and lab work, the patient is diagnosed with ascending cholangitis due to gallstone obstruction in the common bile duct. He will require ERCP to place a stent and drain the bile duct, followed by laparoscopic cholecystectomy to remove the gallbladder and prevent further stones.

Uploaded by

sammy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Doctors in Making-

Introduction:
General Surgery surgery, monitoring the progress of
the patients’ condition until stable
 “A successful surgeon should be a person to return to the ward environment.
who, when asked to name the three best  Suturing:
surgeons in the world, would have
difficulty deciding the other two.”
Dr. Denton Cooley
 Job of a General Surgeon:
o Diagnose and treat problems of the
Digestive tract. Split into 3 groups:
 Upper GI: Focusing on the
esophagus, Stomach and
Duodenum
 Hepatobiliary: Focusing on
the Liver, Pancreas, Spleen
and Gall Bladder
 Colorectal: Focusing on the
Small & Large Intestine,
Appendix, Rectum and
Anus
 Common surgeries shared
among all Sub-specialties Surgical Patient Approach:
of General Surgery: Gall
Bladder removal, Appendix
removal, Hernia repair.
 Surgeon’s Office: The Operating Room
Case Analysis:
 Patient History:
o While you are on call, your doctor
in charge pages you to review the
blood results of an 87-year-old man

 Roles of Theater Staff:


o Scrub Nurses: Qualified nurses
sub-qualified to work in theaters.
Work directly with the surgeon
within the sterile field, handing
equipment when required.
o Anesthetist: Qualified nurses sub-
qualified to work in theaters.
o Work directly with the surgeon
within the sterile field, handing
equipment when required.
o Recovery Nurses: Qualified nurses
who provide critical care after who was admitted that morning
with sharp abdominal pain. He is
confused and unable to give an obstruction is diagnosed based on
accurate history. He had been the common bile duct (CBD)
spiking temperatures during the diameter.
afternoon and had increasing right- o The upper limit of the normal
sided abdominal pain. diameter for the CBD is 5mm.
 Physical Examination: Greater than 7mm indicates
o The observation chart shows he has obstruction, although the bile duct
a temperature of 38°C and a diameter increases in the elderly
tachycardia of 120/min. You notice and after cholecystectomy.
he has a yellow discoloration of the  Next Steps:
skin and sclera, and abdominal o Once the diagnosis is confirmed,
examination reveals that the the patient must undergo a
maximal tenderness is in the right procedure called Endoscopic
upper quadrant. There are no retrograde
palpable masses or abdominal cholangiopancreatography (ERCP).
hernia. Rectal examination This allows the surgeon to place a
demonstrates normal stool with no stent and to remove the gallstones
palpable rectal mass. A plain from the duct.
abdominal radiograph, done that o Surgical removal of the Gall
morning, was normal. Bladder is preferred, as soon as
 3 Main Keywords: possible, to prevent further stones.
o Right-Sided Abdominal pain This procedure can be done
o Fever Laparoscopically, called
o Jaundice Laparoscopic Cholecystectomy.

Diagnosis and Case Report:


 The symptoms of Fever, Right-sided
abdominal pain and jaundice are
collectively known as Charcot’s Biliary
triad and is a diagnostic characteristic of
Ascending Cholangitis.

 Using imaging to find out blocked bile


duct:
o Ultrasonography is the most used
initial imaging modality.
o Gallstones may not be directly
visualized by ultrasound or CT, so

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