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Common Surgical Problems

Common Surgical Problems. Lau Cheong Chi. Common Surgical Problems. Abdominal pain Foreign bodies ingestion Perineum Lumps & bumps AROU Changed bowel habits Haematemesis, Haematuria, Haematochezia, Haemoptysis VV, PVD, Buerger ’ s disease Tumors. Abdominal pain.

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Common Surgical Problems

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  1. Common SurgicalProblems Lau Cheong Chi

  2. Common Surgical Problems • Abdominal pain • Foreign bodies ingestion • Perineum • Lumps & bumps • AROU • Changed bowel habits • Haematemesis, Haematuria, Haematochezia, Haemoptysis • VV, PVD, Buerger’s disease • Tumors

  3. Abdominal pain • HBP – cholecystitis, cholangitis, • Upper GI – PPU, gastritis, duodenitis • Lower GI – I/O, appendicitis • Genital – epididymitis +/- orchitis

  4. Perineal concerns • Haemorrhoids • Fresh PR bleeding / mass / pain • Active inflammation? • Degree of prolapse • Manual reduction • Drugs: annusol, faktu; cream vs supp. • Banding vs surgery • Colonoscopy?

  5. Foreign bodies ingestion • Most commonly caused by fish bones, followed by chicken bone • Odynophagia • Direct largynoscope • OGD • CXR / XR neck: surgical emphysema or retrophargneal abscess

  6. Lumps & Bumps • Site, pain, texture, duration, size changes, • Lipoma, sebaceous cyst, neuroma • Lymphadenopathy (1ry vs 2ry) • Benign vs malignant • Referral to surgical – malignant potential: fixation, painless, induration, rapid growing, ulceration, texture changes; cosmetic reasons

  7. AROU • Painful retention, palpable bladder • Risk of vasovagal syncope • BPH, drug (cough, TCA, antipsychotics, etc), UTI, stone, urethral trauma • Catheterization, chart RU, save urine x C/ST, AFB, cytology • ? Clamp & declamping of Foley’s • Uses of minipress/hytrin/cardura; ditropan, pyridium, antibiotic (quinolones)

  8. Changed bowel habit • Definition of constipation • what is change in bowel habit • Blood / mucus / anaemia / evidence of malignancy • colonoscopy

  9. Haematemesis, haematuria, haematochezia, haemoptysis • Haematemesis vs haemoptysis – amount, taste, cough/vomit, CHF/APO; • UGIB – varices, PU, Mallory-Weiss • Lungs – tumor, bronchiectasis, TB, etc. • Pharynx – tumor • Haematuria – early signs, medical vs surgical, macroscopic vs microscopic: TB, UTI, tumor, stone; IgA nephropathy, glomerulonephritis • Haematochezia – piles, tumor, infection

  10. Tumors • Alert • Lumps & bumps; moles; skin (BCC vs SCC) • H&N(NPC, Ca pharygolarynx) , GI (stomach, esophageus, colon, sigmoid & rectum), HBP (HCC, CC, Ca GB), • Lymphoma, haematological malignancy

  11. VV, PVD, Buerger’s Disease • VV – when to refer, need surgery? Complications, avoid topical medications • PVD – risk factors, limit daily activities? Asso. coronary & cerebral vessels, indications for surgery • Buerger’s disease – sympathetic blockage, autoamputation; education

  12. Thank you

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