ACUTE ABDOMEN MARKING

 

ACUTE ABDOMEN MARKING

George Zulu aged 24 years; a football play of Real Mpezeni Football Club is admitted to your ward with a provisional diagnosis of Acute Abdomen.

a)     Define Acute Abdomen.                                                                                            5%

This is an acute/sudden onset of abdominal pain caused by a condition that may necessitate surgery.

 

b)     State five (10) other causes of Acute Abdomen. (2% for each explained)        20%

I.          Strangulated hernia

II.          Acute intestinal obstruction

III.          Perforated peptic ulcer

IV.          Peritonitis

V.          Intussusception

VI.          Ruptured spleen

VII.          Ruptured ectopic pregnancy

VIII.          Appendicitis

IX.          Volvulus

X.          Ruptured uterus

 

c)     Discuss the pre-operative care of George                                                             50%

Objectives 2%

To resuscitate the patient

To prepare the patient for emergency surgery                                                                             

 

Resuscitation 14%

·       Quick physical assessment of the patient is done

·       Maintain patient airway for effective breathing

·       Commence intravenous fluids as ordered such as normal saline are recommended to correct hypovolaemia due to haemorrhage and you should maintain a strict fluid balance chart.

·       Insert a urinary catheter to empty the bladder in order to prevent accidentally puncturing it during surgery.

·       Insert an N.G tube to use it to aspirate stomach contents to keep the GIT empty in preparation for surgery. This will prevent George from vomiting on the operating table when under the influence of anaesthesia.  

·       Immediately the decision is made to do an emergency surgery, George will be kept nil orally to prevent him vomiting on the operating table during surgery because of the effects of anaesthesia.

·       Blood for Hb, grouping and cross match is taken in readiness for blood transfusion.

·       Pethidine 50 mg IM stat to reduce pain

·       Urinary catheter is inserted to prevent full bladder and injury during operation

·       Blood transfusion should be started as soon as Hb results are out. 

 

Observation 6%

·       ¼ hourly pulse, respiration and BP to monitor any improvement or worsening of the patient’s condition

·       Temperature is also taken and hypothermia may indicate shock.

·       Any cyanosis will necessitate oxygen administration

·       Abdominal distention due to intra-abdominal haemorrhage

 

Psychological care 6%

·       Assess the psychological status of the patient to assist you in planning the interventions.

·       Ask the patient to express her worries and fears so that you can address the specific areas of concern.

·       Explain the condition in simple terms to the patient and relatives to empower them with knowledge.

·       Explain all the procedures to the patient before performing them.

·       Involve the relatives in the care of the patient. 

 

Investigations 3%

·       Blood for Hb, grouping and cross match is collected.

·       Abdominal ultrasound is done to detect the affected organ.

·       Any other necessary investigation is done.

 

Consent form 3%

·       A relative or patient is asked to sign the consent form.

·       This is a legal document that protects the surgeon and the patient.

 

Nil orally 3%

·       The patient is kept nil orally.

·       An NG tube may be inserted and left for continuous drainage to prevent vomiting during surgery.

 

Shaving, gowning 6%

·       The abdomen is shaved from umbilical area to thigh including according to the hospital policy.

·       The patient is dressed in theatre gown and her clothes are put together with personal belonging, labeled and stored in a safe place.

·       Any dentures are removed to prevent choking during anesthesia.

·       Rings are removed to prevent electric shock from diathermy.

·       Nail polish is removed and lip stick for easy monitoring of cyanosis during surgery.

 

Labeling 2%

·       A label with the patient’s name, age, ward, diagnosis and type of procedure, date and type of anesthesia is put on the patient’s forehead or forearm, for identity and to guide on specific procedure to be done on the patient.

 

Pre-medication 2%

·       The anesthetist or surgeon examines the patient and give certain drugs like anti-hypertensive to stabilize the patient and avoid complications during and after the operation.

 

Taking patient to theatre 3%

·       Last vital signs observations are done for baseline data in theatre. The patient’s file, investigation results e.g. ultrasound; and blood if required are taken with the patient to theatre.

 

d)     Explain five (5) complications which George is likely to develop within the first 72 hours.                                                                                                            25%

1.     Shock – from hypovolaemia, pain or sepsis

2.     Paralytic ileus – resulting from general anesthesia, GI manipulation and immobility due to pain manifested by decreased or absent bowel sounds, abdominal pain, abdominal distention and inability to pass flatus or stool.

3.     Infection – unsterile practices by the theatre team and dressing materials following surgery.

4.     Deep Vein Thrombosis – resulting from immobility and/or fat embolism.

5.     Abdominal adhesions – these are fibrous bans of scar tissue that develop following abdominal surgery in the peritoneum. They could cause intestinal obstruction by looping over a portion of the bowel.

6.     Hypostatic pneumonia – related to effects of anesthesia, sedation and immobility due to pain.