~Teachingcenter的醫學筆記~

甲狀腺、肝臟手術、消化性潰瘍穿孔、腹部鈍傷、腹/切口疝氣、腸阻塞手術

術前診斷：Left/Right thyroid neoplasm
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
  CXR：unremarkable
  EKG：normal sinus rhythm
PE：
  Neck：
     Trachea：central in position/deviation to ___ side
     Bruit：(-)  LAP：(-)
  Thyroid：No enlargement
       Node：
        size：* cm at left/right side  
        consistence：elastic
        mobility：fixed
        compressibility：compressible
OP indication：
    Growing or Symptomatic tumor
Laboratory data：
Treatment plan：
  1. Arrange Lobectomy
  2. NPO after midnight prior to the day of surgery
  3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Liver Neoplasm
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
 CXR：unremarkable, no lung nodule 
 EKG：normal sinus rhythm
 CT of Liver：Typical imaging features of HCC
 MRI of Liver：Typical imaging features of HCC

 Liver performance：Liver cirrhosis：( + )
 Child classification：___ , Score：___
 Hepatitis virus status：HBV：( + )   HCV：( - )
     ICG R-15(%)：____
     AFP：

PE：
  HEENT：pink conjunctiva、anicteric sclera
   Abdomen：soft and flat, no tenderness, normoactive bowel sound
   Liver/Spleen：Impalpable  no shifting dullness

OP indication：
  Suspicion of malignant transformation
 Resectable with good general performance and hepatic reserve function

Laboratory data：
Treatment plan：
  1. Arrange segmental hepatectomy (S__) and cholecystectomy
  2. NPO after midnight prior to the day of surgery
  3. Blood products preparation
  4. Postoperative ICU management after hepatic resection, if indicated
  5. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family
(1) Hepatic tumor surgical successful rate：about 95%
(2) Possible Peri-operative Complications：
…a. Hepatic failure：7.1%
…b. Pleural effusion：6.3%
…c. Ascites：4.4%
…d. Intra-abdominal infection：1.0%
…e. Bile leakage：1.2%
…f. others：intra-OP hemorrhage, UGI bleeding, ARF...et al.

術前診斷：Hollow Organ Perforation, suspect Perforated Peptic ulcer
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Boey score：___
Image：
  CXR：subphrenic free air (+/-)
   EKG：normal sinus rhythm
   Abdominal CT：pneumoperitoneum with ascites
PE：
    Abdomen：
      rigid and distended
      diffuse tenderness esp. upper abdomen
      diffuse muscle guarding and rebounding pain
      hypoactive bowel sound
      OP scar：No or Yes：_____ and where ____
OP indication：
   Hollow organ perforation with generalized peritonitis
Laboratory data：
Treatment plan：
  1. Arrange emergent operation：laparotomy to repair the defect of GI tract, drainage of intra-abdominal infection +/- tube jejunostomy
  2. NPO with NG decompression
  3. Empiric IV antibiotics use (3^rd generation or cefuroxime + metronidazole)
  4. Post-operative ICU management after operation, if indicated
  5. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Blunt Abdominal Trauma with Spleen injury and Shock
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
 CXR：unremarkable
 EKG：sinus tachycardia
PE：
   Abdomen：
     distended and tenderness
     muscle guarding and rebounding pain：+
     hypoactive bowel sound
     OP scar：No or Yes：_____ and where ____
OP indication：
     BAT with uncontrolled hemorrhage
Laboratory data：
Treatment plan：
     1. Arrange emergent operation：laparotomy to control hemorrhage
     2. NPO with NG decompression, Urinary catheterization
     3. Aggressive IVF and Blood transfusion resuscitation
     4. Empiric IV antibiotics use
     5. Postoperative ICU management after operation
     6. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Ventral Hernia, incisional
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
Image：
   CXR：unremarkable
   EKG：normal sinus rhythm
PE：
    Abdomen：
      soft and flat
      no tenderness  
       ___ * ___ cm abdominal wall defect nearby OP scar
Impression：
       Ventral hernia, incisional
OP indication：
     Symptomatic patient
Laboratory data：
Treatment plan：
     1. Arrange repair of ventral hernia + mesh prosthesis implant
     2. NPO after midnight prior to the day of surgery
     3. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family

術前診斷：Ileus, suspect small bowel obstruction
Comorbidity：
DM ( - )、HTN ( - )、Liver disease ( - )、Renal disease：( - )、Heart disease：( - )、Lung disease：( - )、Coagulopathy：( - )
Previous OP history：No or Yes：_____ and when ____
ASA：class __
 Image：
   CXR：unremarkable
   EKG：normal sinus rhythm

 PE：
    Abdomen：
         soft and distended
         mild tenderness
         muscle guarding：(+)、 rebounding pain：( - )  
     OP scar：No or Yes：_____ and where ____
 OP indication：
   Failed/Progressed by conservative management
Laboratory data：
Treatment plan：
     1. Arrange enterolysis +/- segmental bowel resection & reconstruction
     2. NPO with NG decompression
     3. Empiric iv antibiotics use
     4. Well explain the disease entity, risk, options and prognosis of operation to patient and patient's family