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COMMON CONDITIONS IN GENERAL SURGERY • 22 years old,Male • 24-hour history of generalized abdominal pain,later localized to the right lower quadrant CASE 1 • Associated nausea,anorexia,and mild fever • No urinary or bowel symptoms • No prior similar episodesEXAMINATIONAND INVESTIGATIONS • Low-grade fever (37.8°C) 1. Bloods: ↑WBC,↑ CRP • Tenderness at McBurney’s point 2. Urinalysis:Negative • Positive Rovsing’s sign and psoas sign 3. Imaging: • No guarding or rebound tenderness • Ultrasound:Non-compressible appendix with wall thickening • CT abdomen (if ultrasound inconclusive):Dilated appendix (>6mm) with fat strandingACUTEAPPENDICITIS  Initial: IV fluids,analgesia,NBM,IV antibiotics  Definitive: o Laparoscopic appendectomy o Open appendectomy if perforation/surgical difficulty  Complications: Perforation,abscess,peritonitis • 65 years old,Female • 3-day history of worsening colicky abdominal pain • Abdominal distension,nausea,and vomiting CASE 2 • Absolute constipation (no bowel movement or flatus) • Past medical history:Prior abdominal surgery (hysterectomy 10 years ago)EXAMINATIONAND INVESTIGATIONS •Tympanic and distended abdomen • Bloods: Dehydration (↑ urea/creatinine), •High-pitched bowel sounds electrolyte imbalances • Imaging: •No peritonism ▪ X-ray (AXR): Dilated loops of bowel,air- fluid levels ▪ CT abdomen with contrast (gold standard): Identifies site and cause of obstructionBOWEL OBSTRUCTION  Conservative (for partial obstruction): o NGT (nasogastric tube) decompression o IV fluids,electrolyte correction o Bowel rest (NPO)  Surgical (for complete obstruction,ischemia,perforation): o Laparotomy/laparoscopy for adhesion lysis, tumor resection,or stoma formation if needed  Complications: Perforation,ischemic bowel,sepsis • 45 years old,Female • Right upper quadrant (RUQ) pain,radiating to right shoulder CASE 3 • Onset after a fatty meal,persistent pain for 8 hours • Associated nausea,fever,and mild jaundiceEXAMINATIONAND INVESTIGATIONS •Febrile (38.2°C) 1. Bloods: ↑WBC,↑ CRP ,mild ↑ALP/GGT •Murphy’s sign positive (pain on RUQ palpation with 2. Imaging: inspiration) • Ultrasound (first-line):Thickened •Mild jaundice but no peritonitis gallbladder wall,pericholecystic fluid • CT scan: Used in complications or uncertain casesACUTE CHOLECYSTITIS  Conservative: o IV fluids,NPO,IV antibiotics (ceftriaxone + metronidazole) o Analgesia (avoid morphine due to sphincter of Oddi spasm)  Definitive: o Laparoscopic cholecystectomy (early within 72h preferred) o Open cholecystectomy in complicated cases  Complications: Empyema,perforation,gallbladder gangrene • 60 years old,Male • 4-day history of left lower quadrant (LLQ) pain CASE 4 • Associated low-grade fever,nausea,and loose stools • No urinary symptoms or PR bleeding • Past medical history: Chronic constipationEXAMINATIONAND INVESTIGATIONS •Low-grade fever (37.9°C) 1. Bloods: ↑WBC,↑ CRP •LLQ tenderness without guarding 2. Imaging: •Mild abdominal distension • CT abdomen with contrast (gold standard): Shows bowel wall thickening, fat stranding,possible abscess • Colonoscopy (after acute phase)DIVERTICULITIS  Uncomplicated diverticulitis:  Oral antibiotics (ciprofloxacin + metronidazole or amoxicillin-clavulanate)  Bowel rest,clear liquids,analgesia  Complicated diverticulitis (abscess,perforation,obstruction):  IV antibiotics,NPO  Percutaneous drainage of abscess if >3 cm  Surgery (Hartmann’s procedure or primary anastomosis in selected cases)  Complications:Abscess,perforation,fistula,sepsis SUMMARY Question Answer Acute Appendicitis: RLQ pain, McBurney’s sign, fever. Bowel Obstruction: Colicky pain, distension, vomiting. How can we differentiate these conditions clinically? Acute Cholecystitis: RUQ pain radiating to shoulder, Murphy’s sign. Diverticulitis: LLQ pain, low-grade fever. Appendicitis: Thickened appendix on ultrasound/CT. What are the key imaging findings for each? Bowel Obstruction: AXR - dilated loops, air-fluid levels. Cholecystitis: Thickened gallbladder wall, pericholecystic fluid. Diverticulitis: CT - bowel thickening, fat stranding. Conservative: Mild appendicitis, partial obstruction, uncomplicated When do we opt for conservative vs. surgical diverticulitis, unfit patients. management? Surgical: Appendicitis, complete obstruction, gallbladder infection, severe diverticulitis. Appendicitis: Perforation, abscess. What complications should we monitor for? Bowel Obstruction: Ischemia, perforation. Cholecystitis: Empyema, bile peritonitis. Diverticulitis: Abscess, perforation, obstruction.THANKYOU