Ward Round Notes

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]

1. Kocher’s incision/ Right subcostal -  Cholecystectomy 2. Transverse 3. Lanz (at McBurney’s point) 4. Mcburney’s incision - appendicectomy 5. Full midline laparotomy - most major abdominal surgery, trauma, aortic surgery. 5a. Upper midline – gastric surgery, duodenal surgery, cholecystectomy. 5b. Lower midline – colon surgery, gynaecological surgery. 6. Paramedian 7. Pfannensteil/suprapubic – gynaecological surgery, Caesarean sections 8. Loin/oblique – nephrectomy 9. Laparoscopic ports – laparoscopic procedures eg. Cholecystectomy, appendectomy, gynaecological surgery and urological surgery. 10. Inguinal/hockey stick – Inguinal hernia, renal transplant. (not shown, usually on RIF) References:  http://chestofbooks.com/health/anatomy/Human-Body-Construction/Abdominal-Incisions.html#.UtV5xGRdWyU http://www.surgical-tutor.org.uk/default-home.htm?system/abdomen/incisions.htm~right http://www.fastbleep.com/me...

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...

The vocal cords are innervated by the superior laryngeal nerve and the recurrent laryngeal nerves which are branches of the vagus nerve (cranial nerve X). The superior laryngeal nerve splits into the external and internal branches. The internal branch contains sensory nerves from the larynx whereas the external branch supplies the cricothyroid muscle which tenses the vocal cords. Damage to the superior laryngeal nerves can be caused by thyroid surgery. Unilateral damage to the superior laryngeal nerve causes slight voice changes, usually affecting pitch. Bilateral damage to the superior laryngeal nerves reduces the ability for the vocal cords to close increasing the risk of aspiration. The recurrent laryngeal nerves supply the other muscles of the vocal cords, including the posterior cricoarytenoid muscle which is the only muscle which opens the vocal cords. The recurrent laryngeal nerves have a different course on the left and the right. The left is longer and descends down to...