Ward Round Notes

Acute abdomen is defined as any episode of abdominal symptoms, usually abdominal pain, presenting acutely, potentially as a surgical emergency, with no history of trauma. Acute abdominal pain is a common presentation. There are multiple causes of severe abdominal pain. These may be differentiated by the nature of the pain, and the area the pain typically presents in. It is important to take a clear history and do a thorough examination with patients with acute abdominal pain. Are there signs of shock/organ rupture requiring urgent surgery? A rupture of an organ such as the spleen, aorta or an ectopic pregnancy may cause massive blood loss requiring resuscitation and surgery to repair the ruptured part or to stop the bleeding. In additional to abdominal pain, a patient with shock may have altered vital signs such as tachycardia, tachypnoea, or dropping blood pressure. In addition, they may show signs of reduced end-organ perfusion. The skin, kidneys and the brain are usually t

Type Names Main diseases HHV – 1 Herpes simplex virus 1 Genital herpes Oral herpes Herpes simplex eye infection and enchephalitis Cold sores HHV - 2 Herpes simplex virus 2 Genital herpes Oral herpes Herpes simplex eye infection and enchephalitis Cold sores HHV- 3 Varicella zoster virus Chicken pox Shingles Ramsay hunt syndrome HHV – 4 Epstein Barr virus Infectious mononucleosis (glandular fever) Linked with burkitt’s lymphoma, hodgkin’s disease B lymphoproliferative disease, X- linked lymphoproliferative syndrome, nasopharyngeal carcinoma and oral hairy leukoplakia. HHV – 5 Cytomegalovirus Assymptomatic in immunocompetent people but can affect multiple organs if it manifests. Mononucleosis syndrome (febrile illness, impaired liver function and s

Definition and demographics Acute Kidney Injury (AKI) formerly known as acute renal failure, refers to the deterioration of renal function acutely over hours or days. It is characterised by a rise in plasma urea and creatinine ratios. This may occur without clinical symptoms, however tends to be associated with oliguria (urine output less than 400ml/day or 0.5ml/kg/h). Acute kidney injury is common amongst people admitted to hospital. Causes and risk factors The causes of acute renal failure may be divided into pre-renal, renal and post renal causes.

Demographics: Acute urinary retention is a medical emergency . It is relatively common occurring in 7/1000 men. It is more common in men than women, and incidence is higher in men over 70. Causes: The most common cause of acute urinary retention is benign prostatic hypertrophy. Other causes include: structural changes near the bladder and urethra in men ·       Meatal stenosis ·       Penile constricting bands ·       Phimosis ·       Urethral strictures In women ·       Prolapse ·       Urethral strictures

Erb's palsy refers to a palsy involving C5-6 of the brachial plexus. It often occurs in neonates due to traction injury to the arm usually during birth. Erb's palsy affects the deltoids, the biceps and the brachialis muscles and may also affect sensation in the axillary and musculocutaneous (lateral) distribution. people with Erb's palsy have difficulty supinating the forearm, flexing the arm at the elbow and abbducting the arm, leaving the arm in a 'waiter's tip' position. Klumpke's paralysis refers to the paralysis of the lower brachial plexus (C8-T1). It affects the intrinsic muscles of the hand, the flexors of the fingers and the wrist and the pronators of the forearm resulting in a 'clawed hand' and may also cause constriction of the pupils, ptosis, and anhydrosis (honer's syndrome). http://www.patient.co.uk/doctor/brachial-plexus-assessment-and-common-injuries http://en.wikipedia.org/wiki/Klumpke_paralysis http://birthinjury.o

Definition and demographics:  A subarachnoid haemorrhage refers to the spontaneous arterial bleeding into the subarachnoid space, usually from berry aneurysms in the circle of willis. It is relatively rare, with an average GP seeing one case every 7 years, although it makes up 6% of all strokes. It tends to affect younger patients compared to other types of strokes, with a mean age of 50.  Pathophysiology and aetiology:  Subarachnoid haemorrhages are caused by the rupture of berry aneurysms developing on the circle of willis.  These are most common between the posterior communicating artery and the internal carotid artery, between the anterior communicating artery and the anterior cerebral artery, and at the tri- or bifurcation of the middle cerebral artery. The formation of berry aneurysms is thought to be partly due to genetical pre deposition affecting the tissues of the vessels and additional strains such as hypertension and atherosclerosis. 

Definition and demographics Thyrotoxicosis refers to a clinical hyper metabolic syndrome caused by high thyroid hormone levels. Hyperthyroidism is more common in women than men. Graves disease commonly presents between the 2nd and 4th decade, toxic nodular goitre increase with age and is more common in regions where there are iodine deficiency is common.  Causes Graves disease (most common -76%) multi nodular goitre (14%) Solitary thyroid adenoma Rarer causes Subacute thyroiditis (de Quervain's) Post partum thyroiditis Drugs  Very rare causes Radiographic contrast Iodine prophylaxis programme Factitious thyrtoxicosis (where patient takes too much levothyroxine, characterised by raised T4:T3 ratio)  Struma ovarii TSH secreting pituitary adenoma Choriocarcinoma and hydatidiform mole Folicular ± metastases