General Surgery
Achalasia
loss of ability for oesophagus to move food down
treatment : myectomy / inject botox
Ivor lewis oesophagectomy - indications : mid or lower third oesophageal lesions / end stage achalasia
minimal invasive 3 hole oesophagectomy
Post op complications:
anastomotic leak : CT oral contrast
stricture : balloon dilatation
perforation
Parathyroidectomy/ thyroidectomy
Post op complications:
injury to recurrent laryngeal nerve
hypocalcemia
start patient on thyroxine 100mcg OD
IV calcium gluconate 2g if calcium less than 2
calcium carbonate tabs TDS
calcitriol
Gall bladder pathology
anatomy : cystic duct + bile duct ---> common bile duct
acute cholecystitis - inflammation of the gall bladder ( murphy sign positive ) - put hand at RUQ - ask patient to take deep breath, tender when inflammed gall bladder touches the doctor's hand
cholelithiasis - stones in gall bladder
choledocholithaisis - stones in common bile duct
treatment : acute cholecystectomy ( removal of gall bladder )
triad / pentad ascendong cholangitis : fever, RUQ pain, jaundice, hypotension and confusion
defitinitive treatment that instantly relieve symptoms of ascending cholangis : ERCP
but look out for post ERCP pancreatitis ( check lipase if in doubt )
gallstone ileus - stones passed into the small bowel through a fistula - causing small bowel obstruction
Colorectal pathology
hemicolectomy
Hartman procedure
proctacolectomy
right hemicolectomy
loop ileostomy - can be temporary / permanent -
transverse colon cancer
Small bowel obstruction pathology
drip and suck - monitor daily NG tube output - initially on free drainge, then spigot with 4 hour aspirate / aspirate when patient feel nausea
PICC line for TPN
slowly wean off TPN when able to escalate diet
Psuedobstruction
treatment : neostigmine or decompression
causes : opiates, recent surgery, background parkinson
