TEALE FENNING

Abik · Posted: Thu Apr 26, 2007 12:37 pm Post subject: Preop ward round!

Mrs K - 33 yr old. For laparotomy.
28/40 sized left ovarian cyst found on USS by GP.

Mrs A - 37 year old.
For posterior repair. Chronic constipation and digital evacuation needed.

Miss P - 19 year old.
For emergency laparoscopy for pelvic pain.

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966

Mrs K - 33 yr old. For laparotomy.
28/40 sized left ovarian cyst found on USS by GP.

H/0 -- assoc symp, previous surgery, fertility, family - Ca ov, Br, Colon, Prostate, comorbidities.

Ex -- GC, size, mobility, surface, tenderness, firm/hard, ascites, prolapse

Ix -- Preg test, FBC, USS, CT/MRI, IVP, Tumor markers, MSU, LFT U&E, G&S n X-match

Consent -- confirm understanding of op, laparotomy, vertical incision - may need to extend, oophorectomy, discuss what to do if tumor on other ov too or if site not correct on scan, what if tumor not ovarian?

Mrs A - 37 year old.
For posterior repair. Chronic constipation and digital evacuation needed.

H/O -- severity of symp, diet, medications, bladder c/o, tenesmus, bleed PR, sexual h/o, comorbidities

Ex --- GC, confirm degree of prolapse and other prolapse if any, rectal prolapse, piles,

Ix --- FBC, G&S,

Consent -- offer option of do nothing if can cope, risk of bowel injury, diet advice, need for stool softners, bowel prep in extreme constipation, risk of dysparunia

Miss P - 19 year old.
For emergency laparoscopy for pelvic pain.

H/O -- of pain, mdication, OCP, LMP, previous surgery, r/o PID

Ex -- abdo tender, peritonism, cervical excitation, pelvic masses, discharge PV

Ix -- preg test, swabs, FBC, USS,

Consent -- all risks + diathermy to endo + adhesiolysis, if ovarian cyst -- cystectomy/oophorectomy especially if torsion, proceed laparotomy if required

r
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Abik · Posted: Sun Apr 29, 2007 10:49 am Post subject:

Good, Raj!

But too much detail in some areas and not enough in others.
The forum doesn't work so well for the OSCE's cos no-one can be bothered to write enough!

Wolverine and I were having difficulties with the preop WR yesterday and made a list so we didn't forget anything!!

History-

change in presenting complaint?
Is patient happy? - does she know what she's having and why? does she know about alternatives? With the large cyst - has anyone mentioned cancer to her? is she happy for full TAH/BSO if cancer? is she aware of risk of colostomy (v. small)
are we happy? is she fit for surgery? what incision? prev surgery? does she really need this operation?
consent i like putting this here because it prompts more history sometimes.

examination
pretty straight-forward
investigations
start with preg test - necessary (we kept forgetting and kept seeing little babies down our hysteroscopes!!!!!)

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wolverine · Century Club Joined: 16 Jan 2007 Posts: 394

Post-op plan. What to expect (catheter, drains, wound closure, removal of all these), what to eat, when to go home, what she should avoid, how the results will be conveyed to her, etc

mridulaben · Posted: Mon Apr 30, 2007 9:23 pm Post subject:

If we Start with review of case notes will include history, Examn. & Investigations review