Acute Appendicitis: Diagnosis and Management

Acute Cholecystitis: Diagnosis and Management

Suspect acute cholecystitis with prolonged right upper quadrant or epigastric pain, fever, and a positive Murphy sign, typically after fatty meals in a patient with gallstone risk factors. Confirm with right upper quadrant ultrasound showing gallstones, wall thickening, pericholecystic fluid, or a sonographic Murphy sign. Initial management is nil by mouth, intravenous fluids, analgesia, and antibiotics covering enteric organisms, such as ceftriaxone plus metronidazole. Early laparoscopic cholecystectomy within the index admission is the definitive treatment for fit patients. High-risk surgical candidates may need percutaneous cholecystostomy for drainage. Distinguish complications: empyema, gangrene, perforation, and ascending cholangitis with Charcot triad.

Small Bowel Obstruction: Diagnosis and Management

Suspect mechanical obstruction with colicky central abdominal pain, distension, vomiting, and absolute constipation, especially with previous abdominal surgery. Examine for distension, high-pitched or absent bowel sounds, hernias, and signs of strangulation such as peritonism or shock. Erect abdominal X-ray shows dilated small bowel loops with air-fluid levels, while CT with contrast defines the level, cause, and complications. Initial management is nil by mouth, nasogastric decompression, intravenous fluids, electrolyte correction, and catheterization with monitoring. Adhesive partial obstruction without danger signs may settle conservatively with a defined trial period, but complete obstruction, strangulation, closed-loop obstruction, or failure to improve requires urgent laparotomy.

Acute Pancreatitis: Diagnosis and Management

Diagnose acute pancreatitis with two of three criteria: typical epigastric pain radiating to the back, lipase or amylase at least three times the upper limit of normal, and characteristic imaging. Assess severity and hydration, then begin early, goal-directed isotonic crystalloid therapy with frequent reassessment, with adequate analgesia and antiemetics. Start enteral feeding as soon as tolerated, favouring oral or nasojejunal routes over parenteral nutrition. Identify the cause: gallstones and alcohol dominate, so obtain liver tests and a right upper quadrant ultrasound. Urgent ERCP is indicated only for cholangitis or progressive biliary obstruction. Monitor for necrosis, fluid collections, respiratory failure, and organ dysfunction, escalating to high-dependency care when severe.