CLINICAL IMAGES CXR NGT y Indications: Evaluation of upper GI bleed (i.e.

presence, volume), feeding (6 weeks, thinner bore), administration of drugs, aspiration of gastric contents from recent ingestion of toxic stuff, gastric decompression, small bowel rest in small bowel obstruction, administration of radiographic contrast. y Tube must be below diaphragm y Complications: oesophageal perforation, placed into trachea/bronchi, brain perforation, collapsed lung, nose bleeds, sore throat and sinusitis. y Contra-indicated in base of skull or facial fractures, obstructed nose, oesophageal varices/stricture. PEG percutaneous endoscopic gastrostomy y Tube into stomach through abdominal wall via endoscopy. y Indications: FEEDING stroke, cerebral palsy (dysphagia) recent upper GI surgery. GUT DECOMPRESSION: abdominal malignancy causing gastric outlet or small bowel obstruction or ileus. y Method: pull method most common o local anaesthesia and moderate sedation o patient should have fasted for 4 hours o IV 1st generation cephalosporin if not already on antibiotics o Esophagogastroduodenoscopy (EGD) with standard endoscope and suction of gastric contents o Insufflate stomach and dim lights, abdominal wall transilluminated o Mark the site of maximal illumination o Puncture abdominal wall through small incision and pass guide wire through it and pulled out of mouth, tube then attached to guide wire and pulled through mouth, oesophagus and into stomach and out of the incision. y Contraindications coagulopathies, ascites, peritonitis, sepsis, intra-abdominal perforation, oropharyngeal malignancy, hepatomegaly, splenomegaly.

PEG-J similar but tube advanced into the jejunum NJ tube for persistent vomiting, delayed gastric emptying. All tubes can remain in situ for a month.

CLO TEST y Rapid urease H.py ri test y Ability of h.pylori to secrete urease e zy e which catalyses conversion of urea to ammonia and bicarbonate y Gastric biopsy form antrum of stomach, placed into a medium containing urea and phenol red (indicator). y Urease produced by h.pylori hydrolyses urea to ammonia which raises the pH of the medium and changes its colour from yellow (negative) to red (positive).

Fle i sigmoidoscopy y View rectum and sigmoid colon, y May allow up to splenic fle ure y Can biopsy and remove polyps etc

Rigid sig (18-20cm) rectum and recto-sigmoid junction, can biopsy suspicious lesions.

Proctoscopy visualisation of anal canal for inflammation, ulceration, haemorrhoid, carcinoma fibrous polyps, fistula, pus etc

Colonoscopy enables visualisation and biopsy of entire bowel from distal rectum to caecum. 1-3 days prior patient on low-fibre clear liquid only diet and has bowel prep with oral laxatives before procedure. Adequate sedation IV benzodiazapines.Complications include perforation, bleeding from a biopsy, infection, abdominal distension and discomfort. Gastroscopy looks the same but shorter.

STOMA Know the difference between ileostomy and colostomy

PILONIDAL ABSCESS Occurs near natal cleft of buttocks (butt crack), caused by an ingrown hair. A plionidal sinus is a tract that may originate from the source of infection and open up into the skin. Treatment with just antibiotics for a small sinus, for abscesses surgical excision and wound packing. GP notebook says the following poop: A hair follicle becomes distended with keratin and then becomes infected. Folliculitis ensues and an abscess extends down into the subcutaneous fat. Tracks form out of the cavity in the direction of neighbouring hair growth - in over 90% of cases towards the patient's head. Hairs are sucked or drilled into the cavity as a result of friction with the movement of the buttocks. The hairs on the barbs act to prevent expulsion. These hair then provoke a foreign body reaction and infection

Haemorrhoid

Perianal skin tag

variceal banding

Ryle s tube don t really know what the fudge it is, search it and holla.

Sengstaken Blakemore tube oro or nasogatsric tube used in management of upper GI bleed for oesophageal varices in emergencies.tube with two balloons on it. Paracentesis Main indications are to relieve pressure from ascites or diagnose spontaneous bacterial peritonitis. Wikipedia: Numb a small area of skin and then insert a fairly large-bore needle (along with a plastic sheath) 2 to 5 cm to reach the peritoneal (ascitic) fluid. The needle is then removed, leaving the plastic sheath behind to allow drainage of the fluid. The fluid can be drained by gravity or by connection to a vacuum bottle. Up to 11 litres of fluid may be drained during the procedure. If fluid drainage is more than 5 litres, patients may receive intravenous serum albumin (25% albumin, 8g/L) to prevent hypotension (low blood pressure).The procedure generally is not painful; patients require no sedation. As long as they are not too di y and maintain their blood pressure after the procedure, they can go home afterwards

Caliper (arm fat ting)- measures skin fold thickness

Above: Ayesha shahid