nota prof gillen org kata prof gillen drogheda ni suka nak dgr jawapan dia jer.

pernah gi tutorial dia n

mmg budak2 ni mintak soalan2 yang dia akan tanya after present case (regardless apa kes pun) and
apa jawapan yang dia nak. p/s: korang maybe ada nota yang berbeza. harap membantu.

sudden onset abdo pain

-vascular- mesenteric ischemic, ruptured aaa, embolus

-perforation viscous: perforated peptic ulcer, (1/3 of duodenal ulcer present with perforation on first
time)

-gynae: twisted ovary, cyst twist, ruptured ectopic pregnancy

-genital- twisted testis

u/s features for cholecystitis

-stone -thickened gall bladder wall

-fluid collection around the gallbladder. (aka pericholecystic fluid)

common bile duct size -normal: 6mm -dilated> 7mm

-risk conversion to laparotomy in lap chole: 3%

- only 30% stone in CBD will be visible on USS, so next step is

- do MRCP: non invasive, safe no radiation. we look for feeling defect

- dont say ERCP first, because high risk of complication (he once said he will fail people who answer
ERCP first ~~~~)

-bilirubin need to be 3 times from normal range before it appear clinically. >50.

-murphy sign - dont rush. ask permission from patient, ask any pain, then explain first how you would
do the test.

-delayed cholecystectomy -usually after 6 weeks

-definitely cannot at 10 days, peak of inflammatory process, the duct is grossly inflamed and dilated
so risk of leak if we put clamp, once it resolved.

empyema in gall bladder- increase wcc, crp, up down up down temperature, need to have uss
guided drainage and cholecystostomy (stoma)

urology cases patient p/w haematuria then stop urinating

- ddx: clot retention -so put 3 way irrigation catheter

- before you put suprapubic catheter/ before have second trial of urinary catheter, ask opinion from
well trained urology doctor

obstructive biliary features on LFT: u need to say increase alkaline phosphatase disproportionate
to transaminase. dark urine due to urobilinogen. how to know whether it is blood or urobilinogen at the
bedside if we dont have any urine dysptick, we shake the urine bag. For urobilinogen, the bubble
produced will stay there because of detergent effect

if patient p/w with acute cholecyctitis, fit enough for the surgery, then do lap chole on that
admission. because if we delay, risk of getting pancreatitis which could be fatal.

3 reasons for difficult catheterization

-BPH, prostatectomy, stricture

traumatic urethra (careful before insert catheter)

-bruising in perineal

-absent prostate on DRE

-blood at the meatus

posisition for suprapubic catheter -2 finger above the pubic symphasis

iA kita akan okay smua