Surgery Presentation
Transcript: Surgery: ET's presentation to hopsital Renee Duvenage 25/06/2013 Past Medical History: * 4 months Post partum- vaginal birth * L Carpal tunnel release Family history: * Father: AMI (3rd decade) Medications: * nil * NKDA Social History: * Non Smoker * Non Drinker * Lives at home with husband and child Differentials Provisional Diagnosis: GORD Peptic Ulcer Differential Diagnosis: Pancreatitis Cholecystitis AAA Investigations Management Biliary Colic Acute Cholangitis Chronic Cholangitis Anatomy: Can you name all the structures Management: Categories: 1: Incidental : requires no managment 2: Biliary symptoms, Gallstones (U/S), no complications 3: Atypical Symptoms, Gallstones (U/S) 4: Biliary symptoms without Gallstones (U/S) Complications Outcome Definitions and Classification Examination Further History Findings Thank you Imaging U/S: multiple small mobile calculi, mildly distended, positive sonographraphic Murphy's sign. CBD was not dilated (4.6 mm). Fatty liver changes identified. http://www.sonoguide.com/GB_Video13.html Presentation FBC: Leukocytosis LFT: All mildly elevated Abdominal pain S: Epigastric O: 2/7 C: Crescendo-descrendo, Never fully remitting R: Radiating to back and up to jaw. A: Alleviated by vomiting, associated with nausea, anorexia, T: At night, after dinner E: Exacerbated by food S: ranging from 3-8/10 Observation: appears comfortable at rest, bandages over laprascopic incisions present, IV cannula in situ, and is obese. Palpation: demonstrated a tender RUQ, and Positive Murphy's sign, AA difficult to palpate Auscultation: Bowel sounds present, no respiratory findings, HSDNM Percussion: Liver 14cm, no acites Blood Work Vital Signs: * Heart Rate: 74 bpm * Blood Pressure: 131/88 mmHg * Respiratory Rate: 22 bpm * Temperature: 37.7 C PC