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Common Surgical ProblemsLau Cheong Chi
Common Surgical ProblemsAbdominal pain Foreign bodies ingestion Perineum Lumps & bumps AROU Changed bowel habits Haematemesis, Haematuria, Haematochezia, Haemoptysis VV, PVD, Buerger’s disease Tumors
Abdominal pain HBP – cholecystitis, cholangitis,Upper GI – PPU, gastritis, duodenitis Lower GI – I/O, appendicitis Genital – epididymitis +/- orchitis
Perineal concerns Haemorrhoids Fresh PR bleeding / mass / painActive inflammation? Degree of prolapse Manual reduction Drugs: annusol, faktu; cream vs supp. Banding vs surgery Colonoscopy?
Foreign bodies ingestionMost commonly caused by fish bones, followed by chicken bone Odynophagia Direct largynoscope OGD CXR / XR neck: surgical emphysema or retrophargneal abscess
Lumps & Bumps Site, pain, texture, duration, size changes,Lipoma, sebaceous cyst, neuroma Lymphadenopathy (1ry vs 2ry) Benign vs malignant Referral to surgical – malignant potential: fixation, painless, induration, rapid growing, ulceration, texture changes; cosmetic reasons
AROU Painful retention, palpable bladder Risk of vasovagal syncopeBPH, drug (cough, TCA, antipsychotics, etc), UTI, stone, urethral trauma Catheterization, chart RU, save urine x C/ST, AFB, cytology ? Clamp & declamping of Foley’s Uses of minipress/hytrin/cardura; ditropan, pyridium, antibiotic (quinolones)
Changed bowel habit Definition of constipationwhat is change in bowel habit Blood / mucus / anaemia / evidence of malignancy colonoscopy
Haematemesis, haematuria, haematochezia, haemoptysisHaematemesis vs haemoptysis – amount, taste, cough/vomit, CHF/APO; UGIB – varices, PU, Mallory-Weiss Lungs – tumor, bronchiectasis, TB, etc. Pharynx – tumor Haematuria – early signs, medical vs surgical, macroscopic vs microscopic: TB, UTI, tumor, stone; IgA nephropathy, glomerulonephritis Haematochezia – piles, tumor, infection
Tumors Alert Lumps & bumps; moles; skin (BCC vs SCC)H&N(NPC, Ca pharygolarynx) , GI (stomach, esophageus, colon, sigmoid & rectum), HBP (HCC, CC, Ca GB), Lymphoma, haematological malignancy
VV, PVD, Buerger’s DiseaseVV – when to refer, need surgery? Complications, avoid topical medications PVD – risk factors, limit daily activities? Asso. coronary & cerebral vessels, indications for surgery Buerger’s disease – sympathetic blockage, autoamputation; education
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