007 Non Acute Abdominal Conditions - Introduction to Clinical Surgery Lectures

Slide 1: Non-acute Abdominal Conditions Nick Harvey

Slide 2: Non-acute Abdominal Conditions: Dyspepsia Indigestion Gastrodudenal Oesophageal Biliary Acute Gastritis/Gastric Ulcer Gastroesophageal Reflux Gallstones Duodenal Ulcer/Ca Stomach RUQ pain Retrosternal Pain NSAIDS Colicky Burning Haematemesis Radiates to back Increased on lying down Melaena Referred to shoulder Relieved by antacids Weight loss Vomiting Jaundice OGD + Biopsy OGD + Biopsy 24 hours pH monitoring USS CT Manometry

Slide 3: Non-acute Abdominal Conditions: Dyspepsia Indigestion Gastrodudenal Oesophageal Biliary Acute Gastritis/Gastric Ulcer Gastroesophageal Reflux Gallstones Duodenal Ulcer/Ca Stomach RUQ pain Retrosternal Pain NSAIDS Colicky Burning Haematemesis Radiates to back Increased on lying down Melaena Referred to shoulder Relieved by antacids Weight loss Vomiting Jaundice OGD + Biopsy OGD + Biopsy 24 hours pH monitoring USS CT Manometry

Slide 4: Non-acute Abdominal Conditions: Dyspepsia Indigestion Gastrodudenal Oesophageal Biliary Acute Gastritis/Gastric Ulcer Gastroesophageal Reflux Gallstones Duodenal Ulcer/Ca Stomach RUQ pain Retrosternal Pain NSAIDS Colicky Burning Haematemesis Radiates to back Increased on lying down Melaena Referred to shoulder Relieved by antacids Weight loss Vomiting Jaundice OGD + Biopsy OGD + Biopsy 24 hours pH monitoring USS CT Manometry

Slide 5: Non-acute Abdominal Conditions: Jaundice Jaundice Pre-hepatic Post-hepatic Hepatocellular Haemolytic Obstructive Urine & stools ?pale stools Pale stools Normal colour ?dark urine Dark urine

Slide 6: Non-acute Abdominal Conditions: Obstructive Jaundice Causes Benign  • CBD stones • Female • Biliary colic • Fluctuating jaundice • No weight loss • Benign biliary stricture Malignant  • Ca pancreas • Male • Painless • Progressive jaundice • Weight loss • Cholangiocarcinoma

Slide 7: Non-acute Abdominal Conditions: Obstructive Jaundice Investigations History & Examination FBC / U&Es / LFTs / INR USS Dilated Biliary Tree Normal Biliary Tree ERCP CT PTC MRCP

Slide 8: Non-acute Abdominal Conditions: Obstructive Jaundice Investigations History & Examination FBC / U&Es / LFTs / INR USS Dilated Biliary Tree Normal Biliary Tree ERCP CT PTC MRCP

Slide 9: Non-acute Abdominal Conditions: Obstructive Jaundice Investigations History & Examination FBC / U&Es / LFTs / INR USS Dilated Biliary Tree Normal Biliary Tree ERCP CT PTC MRCP

Slide 10: Non-acute Abdominal Conditions: Suspected Bowel Cancer Clinical Presentation Right Colon  • Anaemia • RIF Mass • Acute Appendicitis! Left Colon  • Change in bowel habit • PR bleeding • Mass Rectum  • PR bleeding • Tenesmus • ‘Morning diarrhoea’

Slide 11: Non-acute Abdominal Conditions: Suspected Bowel Cancer Other Features PR Bleeding  Change in Bowel Habit  Mucous  Weight loss  Sense of incomplete evacuation  History of IBD  FH of bowel cancer 

Slide 12: Non-acute Abdominal Conditions: Suspected Bowel Cancer PR Bleeding Colour?  Mixed?  Pan?  Paper?  Mucous? 

Slide 13: Non-acute Abdominal Conditions: Suspected Bowel Cancer Change in Bowel Habit Constipation  Diarrhoea  Morning diarrhoea  6 weeks 

Slide 14: Non-acute Abdominal Conditions: Suspected Bowel Cancer Investigations FBC / U&Es / LFTs ?CEA  Rigid sigmoidoscopy  Flexible sigmoidoscopy  Barium enema  Colonoscopy  CT colonography  Pre-op staging: Bx, CXR, U/S, CT, MRI 