GENERAL SURGERY
GENERAL SURGERY
Embedded Files
APPENDICITIS
APPENDICITIS
Introduction
5 minIntroduction
Introduce yourself and the group
Provide rationale for the session and relevance to clinical practice
Outline learning objectives:
- Demonstrate a thorough and structured approach to taking a history for acute abdominal pain
- Suggest key differential diagnoses for acute abdominal pain
- Suggest relevant investigations to assess for appendicitis
- Recognise clinical features suggesting a need for antibiotics and when urgent operative intervention is required
- Appreciate practical aspects of fasting for scans and theatre (most relevant for final years preparing for clinical practice)
Explain structure of session
Total time:
60 minNumber of students:
1-5Grade of students:
3rd to 5th year medical studentsCreated by:
Dr Harriet MitchellUploaded:
19th September 2019Last updated:
19th September 2019Resources needed for this session:
Resources needed for this session:
Access to local microbiology guidelines
Students can scan the QR code opposite to view all investigation results on their phone as you work through the session.
Resources linked to this session:
Resources linked to this session:
Activity 1: History Taking and Examination Skills
30 minActivity 1: History Taking and Examination Skills
Ask the student(s) to take a focused history from a patient with suspected appendicitis to include relevant past medical history, drug history, social history and family history. Following this, students could perform a focused examination. This should take no longer than 30 minutes in total and could be observed if capacity of the tutor allows.
Activity 2: Documentation and Presentation Skills
10 minActivity 2: Documentation and Presentation Skills
Using an acute surgical clerking proforma, ask the student(s) to document their clinical findings.
Ask the student(s) to present their clinical findings and suggest a few key differential diagnoses. Provide feedback on presentation technique (max 1 min).
Discuss with student(s):
- What are the key investigations needed to differentiate between the causes of this patient's symptoms?
- What might these investigations show which would suggest a diagnosis of appendicitis?
- What kind of imaging would be appropriate in this case?
Activity 3: Investigations
5 minActivity 3: Investigations
With the students, review the patient's initial investigation results e.g. blood tests, imaging results. If none are available, use the examples below. Students can scan the QR codes to view information on their phones if required.
Consider:
- What are the key abnormalities found on these investigation results?
- How does this result alter your differential diagnosis?
- Discuss when CT imaging might be indicated in cases of suspected appendicitis.
Urine dipstick
Leucocytes neg
Nitrites neg
Protein neg
Blood neg
Ketones ++
Glucose neg
Blood tests
Na 143
Potassium 3.9
Urea 7.0
Creat 67
CRP 36
WCC 13.1
Neuts 12.4
Hb 135
USS Abdo/Pelvis Report
Ovaries and uterus visualised were normal. No ovarian cysts visualised on this scan. Gallbladder thin walled, no gallstones seen. CBD 4mm. Pancreas obscured by bowel gas. Kidneys and bladder grossly normal. Trace of free fluid seen. Appendix not visualised.
Activity 4: Management
10 minActivity 4: Management
Consider the scenario that the patient students have seen needs to be kept nil-by-mouth for urgent surgery.
Ask the student(s) to find a fluid prescription chart and complete the following tasks.
- Prescribe suitable fluids for a 24 hour period. This should include appropriate resuscitation and maintenance fluid, including electrolyte replacement, where appropriate.
- Prescribe an appropriate antibiotic for the patient, using hospital or local guidelines where possible.
- Prescribe an appropriate antiemetic for the patient.
Discuss any additional considerations for this patient who may need to undergo urgent surgery e.g. diabetes management, withholding medications/anticoagulants etc.
Summary and Feedback
5 minsSummary and Feedback
Questions
Identify and summarise key learning points (key three points if possible)
Feedback to student – highlight further learning needs
Feedback for teacher - ask students to provide feedback using the QR code opposite
Close
References and Further Reading
References and Further Reading
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