Ward Round Notes

The position of NG tubes are most accurately ascertained by x ray. A chest x ray should be done if there is any doubt about the tubes positioning or if there is suspicion that the tube has moved. To confirm the placement of an NG tube on an x ray the NG should: Be in the midline Bisect the carina go through the diaphragm at the midline The tip should be below the diaphragm

Fresh PR bleed: Diverticulitis Benign and malignant tumour Haemarrhoids anal fissure Ulcerative colitis Angiodysplasia Trauma Coagulopathy massive upper GI bleed Non PR bleeding - mensturation, haematuria.  Malaena: Gastric ulcer Peptic ulcer Mallory weiss tear Gastritis Benign and malignant tumour Oesophageal varicies Merkel's diverticulum Dark stools without blood - iron tablets References: Ellis H, Calne R, Watson C, Lecture notes - General Surgery,  11th Ed., Oxford, Blackwell Publishing, 2006 SurgWiki, Haematemasis and Malaena, [online] available from: http://www.surgwiki.com/wiki/Haematemesis_and_melaena [accessed:20/10/2014]

Ulcerative colitis Definition: Ulcerative colitis (UC) is a relapsing and remitting inflammatory condition of the large bowel, with unknown aeitiology. Ulcerative colitis is moderately common with a prevalence of 100-200 per 100 000. It is 3 times more common than crohns, and is more common amongst Caucasians, and tends to affect women more than men. It has a bimodal distribution, most commonly affecting people between the ages of 15-30 with a smaller peak between 55-65. Risk factors: ·       Ulcerative colitis is thought to be autoimmune ·       Family history of parent, children or sibling with ulcerative colitis increases the risk of an individual developing it. ·       Smoking is protective in ulcerative colitis, and UC is 3 times more common in non smokers.

Demographics:  Colon cancer is a common malignancy, it primarily presents in older patients, however it may occur earlier in two hereditary conditions which leads to colon cancer. Familial adenomatous polyposis (FAP) is a autosomnal dominant condition which causes the formation of multiple polyps in the colon. The condition tends to cause cancer in patients by the age of 40. Hereditary non-polyposis colorectal cancer (HNPCC) also causes colon cancer in younger patients. HNPCC is also associated with endometrial, gastric, renal, uteric and CNS cancers.  Risk factors and causes Crohn's and Ulcerative colitis increases colorectal cancer risk History of small bowel cancer, endometrial cancer, breast cancer or ovarian cancer Family history - family member with cancer before the age of 60 Specific hereditary causes : FAP and HNPCC Low fibre diet and high red meat diet is thought to increase risk Sedentary lifestyle, obesity, smoking, high alcohol intake Diabetes m...

If a patient presents with nausea and vomiting, a clear cause should be established before perscribing antiemetics, as nausea and vomiting may be a sign of serious illness such as diabetic ketoacidosis, and may be reversed by treating the cause, for example in digoxin overdose. The cause of nausea and vomiting may be apparent with history and examination. patients with persistent nausea and vomiting should also be assessed for their fluid status, and for any electrolyte abnormalities caused by the vomiting. Causes of nausea and vomiting Nausea and vomiting may be caused centrally through stimulation of the vomiting center and the chemoreceptor trigger zone in the medulla, or caused afferent signals due to irritation in other areas of the body, usually in the gastrointestinal tract, but also due to disease in the central nervous system or the vestibular system in the ear.