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Presentations
Phil Polson
Urology Registrar
Clinical Teaching Fellow
Introduction
Abdominal Pain
Abdominal Pain
Abdominal Pain
Abdominal Pain
Bleeding
Leg Pain
Leg Pain
General Surgery
Urology
Vascular
Trauma
T&O
The Abdomen
The Abdomen
RUQ pain
Biliary colic
Acute cholecystitis
Cholangitis
Acute Hepatitis
Hepatomegaly
Pneumonia
Acute Cholecystitis
Murphys Sign
Acute Cholecystitis
Investigations
Bloods
eCXR
USS
MRCP
Management
Analgesia
IV fluids
Antibiotics
ERCP +/sphincterotomy
Cholecystectomy
Cholangitis
Features:
Charcots Triad (60%)
1) Fever and rigors
2) RUQ pain
3) Jaundice
Shock
Altered consciousness
Cholangitis
Investigations
Bloods
USS
Management
Resuscitation
Antibiotics
HDU/ITU
ERCP / Percutaneous drainage
ERCP
Epigastric Pain
Dyspepsia
Causes:
H. pylori
Drugs
Alcohol
Physiological stress
Malignancy
Presentation:
Sudden, severe
pain
Shoulder pain
Rebound
tenderness
Rigidity
Shock / Sepsis
Perforated Ulcer
Investigations:
eCXR
Bloods
CT
Management:
Resuscitation
NG
Analgesia
Antibiotics
PPI
Surgery upper
midline laparotomy
Acute Pancreatitis
Middle-aged men
Causes
Gallstones
Alcohol
Presentation:
Pain
Nausea/Vomiting
Peritonism
Shock
Investigations:
Amylase
PANCREAS
pO2 (<8kPa)
Age (>55)
Neutrophils (WCC >
15)
Calcium (<2)
uRea (>16)
Enzymes
AST/ALT/LDH
Albumin (<32)
Sugar (>10)
eCXR
USS
CT
Acute Pancreatitis
Management
Resuscitate
Fluid +++
Analgesia
LUQ pain
Gastric ulcer
Splenic injury
Pneumonia
Pericarditis
RIF pain
Appendicitis
Inflammatory bowel disease
Testicular torsion
Renal colic
Perforation
Hernia
Psoas abscess
Gynaecological
Acute Appendicitis
2nd/3rd decades
Presentation
Acute Appendicitis
Investigations
Bloods
Urine dip
(USS / CT)
Management
Analgesia
IV fluids
Antibiotics
Appendicectomy
(Percutaneous drainage)
Testicular Torsion
History:
Testicular Torsion
Management:
Theatre immediately
LIF Pain
Diverticulitis
Perforation
Inflammatory bowel disease
Hernia
Testicular Torsion
Renal Colic
Psoas abscess
Gynaecological
Diverticulitis
Diverticulitis
Investigations:
Bloods
CT
Colonoscopy?
Management:
Low fibre diet
Antibiotics
Surgery for
complications
Complications:
Bowel obstruction
Peritonitis
Abscess
Fistula
Strictures
Bleeding
Renal Colic
Renal Colic
Investigations:
Management:
NSAID
IVI / IV antibiotics
? Stent
? Nephrostomy
Other treatment
options:
ESWL
PCNL
Ureteroscopy +/LASER +/- basket
Size matters!
<4mm 90% pass
4-5.9mm 50% pass
>6mm 20% pass
Diffuse Pain
Acute Pancreatitis
Bowel obstruction
AAA
Appendicitis
Gastroenteritis
Inflammatory Bowel Disease
IBS
Mesenteric ischaemia
Peritonitis
Sickle-cell crisis
Bowel Obstruction
Causes
Carcinoma
Volvulus
Diverticular disease
Pseudo-obstruction
Causes
Adhesions
Hernia
Malignancy
Colicky pain
Absolute constipation
Vomit faeculent
Abdo distension
Tender
Resonance
Reduced bowel sounds
Empty rectum
Colicky pain
Absolute constipation
Vomit food, bile
Abdo distension
Visible peristalsis
Tender
Resonance
High-pitch bowel
sounds
Normal PR
AXR
Bloods
CT
AXR
Bloods
Contrast study
(gastrograffin)
CT
Resuscitation
Treat cause:
Malignancy
Surgery
Volvulus
decompress
Nutritional support
Mesenteric Ischaemia
Risk factors:
AF
>50yrs
PVD
Presentation:
Pain out of
proportion
Distension, nausea,
vomiting
PR bleed
Investigations:
Bloods
ABG
eCXR
ECG
CT with IV contrast
CT angiography
Mesenteric Ischaemia
Management:
Oxygen
Analgesia
Fluids
Laparotomy
Mortality = 45-80%
Other
AAA
Urinary retention
Leaking AAA
Investigations:
Bloods (X-match)
?CT
Management:
Resuscitation
Surgery open vs. EVAR
Prognosis:
Urinary Retention
Acute vs Chronic
Causes:
BPH
Prostate cancer
Urethral strictures
Post-op
Clots
Drugs
Stones
Phimosis
Urinary Retention
Presentation
Suprapubic pain
Cant wee!
LUTS
Suprapubic mass
Dull to percuss
DRE
Neuro assessment
Investigations
Bloods
USS
CSU
? PSA
Urinary retention
Management:
Catheter (Residual volume)
Observe for diuresis
? Tamsulosin
TWOC vs LTC vs TURP
Bleeding
GI Bleeding
Upper GI = Medical
Lower GI = Surgical
Presentation:
Bright red blood
Dark clotted blood
? Pain
? Change in bowel habit
PR EXAM ESSENTIAL
Lower GI Bleeding
Causes:
Diverticular disease
60%
Inflammatory bowel
disease 13%
Colorectal cancer
Infective colitis
Post-op
Management:
Resuscitation
Bloods
Rigid sigmoidoscopy
Colonoscopy
Angiography
Lower GI Bleeding
Surgery:
Persistent bleeding / shock
>6 units transfused
Mortality = 2-4%
Rebleeding = 14-38%
Haematuria
Haematuria
Management:
3-way catheter
Bladder washouts +/- irrigation
GA cystoscopy
Abscesses
Perianal
Ischio-rectal
Pilonidal
Analgesia
Surgical Drainage
Pack wound
Others
Trauma
#s, abdominal
Orthopaedics
Septic arthritis, back pain
Urology
Priapism, Paraphimosis, Epididymo-orchitis
ENT
Epistaxis, foreign bodies
Vascular
Acute limb ischaemia
Summary
Plus plenty of
others!
Any questions?