NGT - The classical Borchardts triad, which comprises severe epigastric pain, unproductive

retching, and inability to pass a nasogastric tube, represent total gastric obstruction
Nasogastric tube
Decompression of the upper gastrointestinal tract is initiated early in the management to avoid vomiting, and to
reduce gastric and small bowel distension.

What are the NPO guidelines?

Aspiration is a serious complication that can occur on induction of anesthesia. Even
when regional or "MAC" anesthesia is planned, there is always the possibility that
general anesthesia will be required. When a surgical procedure is emergent and cannot
be delayed to allow gastric emptying, this must be documented in the chart. In these
cases the risk of aspiration is outweighed by the risk of delaying surgery.
For all other cases the guidelines are as follows:

Solid foods > 8 hours

Clear liquids > 2 hours

Diabetics may use apple juice or ginger ale to treat hypoglycemia.

FOLEY CATHETER
An 83-year-old gentleman presented to the emergency department complaining of lower
abdominal pain extending into his back since the previous day. The attending clinician was
concerned that the gentleman was in acute urinary retention, with a palpable bladder and
inserted a 16Ch Foley urinary catheter. Clear urine was obtained.
The patient was referred surgically for investigation and admission. The patient had a past
medical history of ischaemic heart disease, with a previous myocardial infarction, and a
degree of congestive cardiac failure as well as being in atrial fibrillation. He also suffered
from Pagets disease. His previous surgical history included bilateral inguinal hernia repairs
and a transurethral resection (TUR) of the prostate for benign hyperplasia.

LOW HEMO
Sliding hiatal hernias may not cause any symptoms, or they may cause heartburn that is worse when
you lean forward, strain or lie down. There may be chronic belching and, sometimes, regurgitation
(backflow of stomach contents into the throat).
In some cases, a paraesophageal hernia may slide into the chest and become trapped
(incarcerated) and unable to slide back into the abdomen. If this happens, there is a danger that the
trapped hernia may die because its blood supply is cut off (strangulated). Symptoms of a

strangulated hiatal hernia include sudden severe chest pain and difficulty swallowing. This situation
requires immediate medical treatment.
Occasionally a hiatal hernia can cause anemia from bleeding. This can occur if the wall of the
stomach becomes raw from rubbing against the edges of the diaphragm hiatus.

HIGH NEUTRO
Neutrophilia refers to a higher than normal number of neutrophils. Neutrophilia may result from a shift of cells
from the marginal to the circulating pool (shift neutrophilia) without an increase in the total blood granulocyte
pool (TBGP) or from a true increase in TBGP size (true neutrophilia).
During established infection, the neutrophil count remains elevated, with equal numbers in the marginal and the
circulating pool. During the recovery phase, the flow of cells from the marrow decreases, with a resultant
decrease in the number of neutrophils.
The adequate production and distribution of normally functioning neutrophils is vital to host defense. During an
infection, chemotactic agents are generated that attract neutrophils to the site of infection, which in turn play a
critical role in phagocytosing and killing microorganisms.

Shift neutrophilia
Shift neutrophilia is usually transient and may occur in association with vigorous exercise or an epinephrine
injection and usually lasts 20-30 minutes.[1] Shift neutrophilia is also seen in cases of seizures and paroxysmal
tachycardia. No increase in nonsegmented neutrophilic forms occurs, because no change occurs in the inflow
of neutrophils from the marrow.

True neutrophilia
True neutrophilia occurs in most cases of neutrophilia that are related to infections. The TBGP may be
increased 5-6 times normal. During early infection, the neutrophil count may actually decrease briefly because
of margination of cells from the blood. This is followed rapidly by egress of cells from the marrow, resulting in
an increase in the TBGP and blood neutrophilia. If the demand of cells is high, a shift to the left in the
differential count may occur. A left shift is characterized by the appearance of more immature neutrophil forms
in the blood.
EXPLO LAP
By definition, an exploratory laparotomy is a laparotomy performed with the objective of obtaining information
that is not available via clinical diagnostic methods. It is usually performed in patients with acute or unexplained
abdominal pain, in patients who have sustained abdominal trauma, and occasionally for staging in patients with
a malignancy.
Intestinal obstruction
Patients with vomiting, obstipation, and abdominal distention are likely to have intestinal obstruction. Abdominal
radiographs in these patients may reveal dilated intestinal loops and air-fluid levels. Hernia, especially an
incarcerated inguinal hernia, should be ruled out as a possible cause of the obstruction.