University:
The University Of Western Ontario
Course:
Biology 2290F | Scientific Method in Biology
Academic year:

2022
Views:

442

Pages:

3
Author:

Kyuwon J.

Patients basics ● Age, sex , name ○ In case study name will not be given due to privacy issue ● Admission date/ presentations ● PMHx ○ Prior disease, surgery, cancer, disorderness of metabolic ● PSHx ○ Prior laparotomies ○ Resection ○ Cholecystectomy ● Medications ○ NSAIDs: ulcers ○ Anticoagulant: bleeding risk ● Allergies ● Social history ○ Alcohol, tobacco ○ Drug use ○ Travel: pandemic ○ Sexual activity ● Family history ○ IBD ○ Dolorectal cancer ○ Gallstones Chief complaint categories Type Pain Appendicitis, pancreatitis, cholecystitis, perforation, AAA Distension SBO, ascites, ileus Bleeding GI bleeding, ruptured varices, perforated ulcer Altered bowel habits Constipation, obstruction, IBD Systemic signs Fever, sepsis, anemia, weight loss HPI ● OPQRST +GI specific question ○ Onset ■ Sudden vs gradual ○ Provoking ■ Eating, movement , urination n ○ Quality ■ Sharp, crampy, burning ○ Radiation ■ back , shoulder, groin ○ Severity ○ Timing ○ GI-specific ■ Nausea + vomiting ■ Diarrhea ■ Blood in stool Physical exam focus ● Vital sights ○ Fever, tachycardia, hypotension ■ Possible sepsis or peritonitis ● Abdomen ○ Inspection: Distension scars, hernias, peristalsis Difference in diagnosis by regions Region Common Causes RUQ Cholecystitis, hepatitis, cholangitis, liver abscess LUQ Gastritis, splenic infarct, pancreatitis RLQ Appendicitis, Meckel’s, ovarian torsion, Crohn’s LLQ Diverticulitis, sigmoid volvulus, ectopic pregnancy Epigastric Pancreatitis, PUD, MI, perforated ulcer Periumbilical Early appendicitis, mesenteric ischemia, SBO Suprapubic Cystitis, pelvic inflammatory disease, urinary retention Diffuse Peritonitis, gastroenteritis, bowel obstruction, mesenteric ischemia Preliminary Risk Stratification ● Is it emergency? ● Surgery required? ● Is the status of patient stable? ○ Imaging, lab … ● Contraindication on CT ● Medical or surgical? Pre-Operative Workshop ● NPO ● IV bore ● IV fluid ○ Resuscitation or maintenance ● Cross matched blood types ○ If bleeding or unstable patient ● Analgesia + antiemetics