最新Common Surgical Presentations：常见的手术演示-药学医学精品资料.ppt

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1、最新CommonSurgicalPresentations：常见的手术演示-药学医学精品资料IntroductionAbdominalPainAbdominalPainAbdominalPainAbdominalPainBleedingLegPainLegPainGeneralSurgeryUrologyVascularTraumaT&OTheAbdomenAcuteCholecystitisInvestigationsBloodseCXRUSSMRCPManagementAnalgesiaIVfluidsAntibioticsERCP+/-sphincterotomyCholecystec

2、tomyCholangitisFeatures:Charcot’sTriad(60%)1)Feverandrigors2)RUQpain3)JaundiceShockAlteredconsciousnessCholangitisInvestigationsBloodsUSSManagementResuscitationAntibioticsHDU/ITUERCP/PercutaneousdrainageERCPEpigastricPainAllRUQpainPerforatedulcerPancreatitisAcuteChronicDyspepsiaPerforatedgastro-duo

3、denalulcerCauses:H.pyloriDrugsAlcoholPhysiologicalstressMalignancyPresentation:Sudden,severepainShoulderpainReboundtendernessRigidityShock/SepsisPerforatedUlcerInvestigations:eCXRBloodsCTManagement:ResuscitationNGAnalgesiaAntibioticsPPISurgery–uppermidlinelaparotomyAcutePancreatitisMiddle-agedmenCa

4、usesGallstonesAlcoholPresentation:PainNausea/VomitingPeritonismShockInvestigations:AmylasePANCREASpO2(<8kPa)Age(>55)Neutrophils(WCC>15)Calcium(<2)uRea(>16)Enzymes–AST/ALT/LDHAlbumin(<32)Sugar(>10)eCXRUSSCTAcutePancreatitisManagementResuscitateFluid+++AnalgesiaLUQpainGastriculcerSplenicinjuryPneumon

5、iaPericarditisRIFpainAppendicitisInflammatoryboweldiseaseTesticulartorsionRenalcolicPerforationHerniaPsoasabscessGynaecologicalAcuteAppendicitis2nd/3rddecadesPresentationCentralRIFpainOfffood,N&VLowgradefeverPeritonismDiarrhoeaUrinaryfrequencyBentoverRIFguardingRovsing’sSignAcuteAppendicitisInvest

6、igationsBloodsUrinedip(USS/CT)ManagementAnalgesiaIVfluidsAntibioticsAppendicectomy(Percutaneousdrainage)TesticularTorsion1in4000males<25yrsold90%ofacutelypainfulscrotums(13-21yrolds)History:Suddenonset,severe,unilateralpainNausea/VomitingScrotalswelling,erythema,warmthHigh,horizontallieTesticularTo

7、rsionManagement:TheatreimmediatelyLIFPainDiverticulitisPerforationInflammatoryboweldiseaseHerniaTesticularTorsionRenalColicPsoasabscessGynaecologicalDiverticulitisDiverticulosis=PoucheswithinbowelwallDivert