Surgical emergencies

1. Surgical emergenceies
Dr huzaifa Elguneid
GP- medical
commission

2. Intistinalobstruction

3. 4 cardinal signs
1.abdominal pain. 2. abdominal distenssion3. Vomitting 4.constipation
Causes :
Hernia, surgery , tumor, TB, stone ...etc
The most important is ( valvulus ) .
Investigation :
Abdominal xray ...
Dilated bowl and gas fluid level
ttt
ABCs,IV ( fluid , electolytes , anti biotics ) ,NPO, NG tube , folleys catheter
This urgent management for all cases of intistinal obst.
We need surgery in adhessive intistinal obstruction ( surgical addhession , hernia , malignancy , valvulus

4. So........
Sigmoid valvuls
...is
( strangulation +
ischemia )

5. Wich is the twisting of sigmoid colon
against it is mesentry ,the patient will
suffer of the 4 cardinal sign of intistinal
obstruction and the only confirmative test
is the abdominal xray , showed omega sign
or the v shape. The treament either by
conservative ttt or insertion of rectal tube
for un twesting and fixation of the colon
into the abdominal wall , also we can go for
resection and anastamosis.

6. ACUTE BDOMEN
Acute appendicitis

7. Can be caused by either obstruction by
stone or TB, etc or by inflamation of
lymphatic follicles.., common in young
patients , the clinical picture usualy
patients come with pain arround the
umbilicus
after 6 hours the pain shifted into the
RT. iliac fossa, vomitting , fever ,
diarhoea , on examination we have the
most diagnostic clinical sign called the
rebound tenderness , and the WBC is
very high , also we can do abdominal
U/s. the treament by appendectomy

8. ACUTE
PNCERIATITIS

9. grey turner sign

10. The causes can be alcohol, stone , infection , diabetes , tumor
..etc.. , wich result in decrease panceriatic enzymes and distruction
of panceriatic cells ..the patient suffer of pain in upper abdomen
wich is radiated to the back and usualy can not lie forword , there
might be vommitting , fever and epigastrick tenderness ,, we have
also collens sign wich is black discoulration arround umbilicus and
grey turner sign : grey to black coulour in the back ..for tests we
find very high amylase and lipase and high total WBCs and
increase ESR , you might find gall stones in the gall bladder and
odematous inflamed pancerias,high glucose level because of the
abscent of insulin .. The treatment will be conservative by applying
IV ( fluid, electrolytes and anti biotics if needed ) , keep the
patient NPO, NG tube and analgezics,usualy patient will improve
from 2 to 5 days , surgery rarly needed.

11. Upper GI bleeding
DD:
Bleeding oesphygeal varrices,
CA/oesghagus,CA/stomuch and peptic
ulcer diseases,in the history always look
for the age ( old patients ) , occupation
( farmers : shistosomiasis ),ingestion of
NSAIDS , oral contraceptives ,alcohol
abuse , usualy the patient will have
vomitting ( blood stained ) , loss of
conciousness and look for jaundice and
history of blood tranffussion ( hepatitis
) . ttt started with ABCs and insertion of
2 wide poor canulae for blood T and
fluid then the upper GI endescopy then
the synjestaken blackmore tube .

13. Perforated peptic ulcer

14. It is the breaking down of the mucosa of stomuch and
dudenum,causes can be by smooking , alcohol , NSAIDS and last
study said H.pylori bacteria can be a reason wich the end result
can end into bleeding , cancer , perforation , usualy the patient
complaing of epigastric pain , the pain increased or releaved by
food according to the type of ulcer ( dudenal or gastric ) ..we have
a characteristic sign on abd.xray for diagnosis : the gas under the
left dome is normal but in the case of ulcer we found gas under
the RT. dome , the treatment will start with ABCs then
conservative ttt as NPO,NG tube !IV...etc...if the patint improved ,
no need for surgery then, if no improvement will go for surgical
laprotomy ( closing of perforation ).the patient also will be
advised for the tripple therapy ( omeprazole +metronidazole+
amoxicillin).

15. Lower GI bleeding ..
DD
Colorectal carcinoma,Bleeding
diverticular disease,Bleeding peptic
ulcer
Conginital
angiodysplasia,Haimaroids,Fissure,IB
D.
Management by admission ,
resuscitation , IV , observation and if
the bleeding continues send to theatre.

16. Obstructive jaundice
Acute
cholycistitis

17. Stone in gall bladder ..., patients usualy : female
,fatty , fertile , fat dyepepsia and 40 yrs, having
RT hypochondrial pain radiate to RT shoulder
and back, also vommitting and fever may
presents , in U/S we have dilated gall bladder full
with stones , the management will be by ABCs at
first then , iV, anti biotics , analgezics then
cholysystectomy if it possible.

18. Haemothorax
Tenssion
pneumothorax

19. Haemothorax
Trumatic blood in pleural cavity,the patient then will suffer of sever pain at
site of trauma ,SOB,tachypnia, when examining the patient there could be
dullness in percussion on CXR u find white opacity at lession site .
Tenssion pneumothorax
Air in plural cavity can be caused by different ways eg: smooking,ruptured
bollae and some risk factor like tall and thin people etc.... On examination
: hyper inflated chest with dullness on percussion and blackish lung on
CXR , management according to the condition and amount , emergency
managment by insertion of needle below second intercoastal space then
elective under water seal if it necessary

20. Flail
chest

21. Sever refraction ( 2 points ) air
shift from one point to
another. Management will be
by surgical stabilization and
endotrachial intubation may
be indicated .

22. Ruptured spleen

23. Trauma to left lower chest+upper abdomen
, ab.u/s showed free fluid collection in
peritoneal cavity , we can treat this case by
either conservative treatment or emergency,
if lacerated spleen the patient will improve
by conservative ttt , if deteriorate then you
go for laprotomy( suture or spleenectomy ).

24. Neurosurgical emergency
Extradural ( epidural )
haemorage ( haematoma)
Acute subdural haemorage

25. Extradural ( epidural ) haemorage ( haematoma) ,
following RTA or trauma, the patient will suffer of
loss of conciousness and recover and vise versa, the
bleeding is from the middle manengial artery or
sagital sinus damage , skull xray showed fracture (
convex shape ), treatment by evacuation.
Acute subdural haemorage we have lacerated brain
bleed into subdural , the patient will be in a deep
coma and ttt by evacuation .

26. Scrotal condition
Testicular torssion
Acute epididorchitis

27. Testicular torssion
Caused by non descending testis and invassion of the testis ,
the patient will have sever scrotal pain with swelling and the
ttt by orchidopexy ( untwisting + fixation).
Acute epididorchitis
Inflamation of tests and common with old people secondry
to sexual transmitted disease , the patient will have
pain,urethral discharge elevated testis and fever and the
treament will be either oral or iv A/B

28. Urological emergency
Acute urine retention
Insert follys catheter and urine bag , IV A/B, and
look for the cause eg : BPH

29. Acute limb schemia

30. Sudden pain and swelling of the limb , the
limb could be pale , pulsless,painfull,paralized
and cold , it can be caused by embolus or
thrombus and if left for long time can cause
gangarene, doppler or dopplex U/S for
diagnosis also arteriography can help. ttt by
anti coagulant or sergery ( embelectomy )

31. Burn

32. 2 types ( superficial and deep )
Management at the site of burn first you
should take the patient outside , remove
clothes, cover with blanket and then take to
hospital . Then in the hospital ABCs , fluid ,
analagezics and anti ulcer eg omeprazole
Surgery : skin graft.

33. Orthopedic emergency
Fixation ( external F for open fracure , closed fixation )
Rduction ( open by surgery and closed by manupulation )

37. The end