Month: January 2018

WHAT IS ACUTE CARE SURGERY?

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Acute care surgery is an evolving specialty with three essential components – trauma, critical care, and emergency surgery.  Acute care surgeons provide multidisciplinary care for patients who require emergency surgery because of an accident or sudden illness. This care continues throughout the patient’s hospitalization and following discharge.

These changes in surgery are in response to a number of forces. General surgeons are becoming increasingly more focused, especially in areas such as advanced laparoscopic surgery, bariatric (obesity) surgery, endovascular surgery, and breast surgery. With these areas of concentration, come less interest in being on call for emergencies (especially during “off” hours), which can interfere with other, non-emergency cases and office practice. In addition, many trauma surgeons wish to increase their operative case load because trauma care itself has become less involved with operative procedures.

As this specialty has grown, acute surgical emergencies often represent the most common reason for hospital admission. These conditions include, but are not limited to: acute appendicitis, cholecystitis or gallbladder disease, diverticulitis, pancreatitis, intestinal obstruction, intestinal ischemia, intra-abdominal sepsis, incarcerated hernias and perforated viscous.

Acute care surgery integrates the long-established field of trauma surgery with the management of general surgical emergencies. Traditionally, management of non-traumatic emergency conditions requiring surgery has been entrusted to both general surgeons and surgical subspecialists, depending on the supply and availability of these surgeons in each hospital, but as stated above, many surgeons are reluctant to take on-call responsibilities.

Dr. Matthew Johnson is board-certified in acute care surgery, general surgery, and critical care, as well as being a board-certified robotic surgeon. After completing his residency in general surgery, he then went on to become one of the early fellows in the country to complete an acute care surgery fellowship at the University of Nevada School of Medicine.

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Appendicitis

appendicitis_s2_inflammation_illustration

Appendicitis begins with pain near the belly button and then moves to the right side. This is often accompanied by nausea, vomiting, poor appetite, fever, and chills.
People may experience:
Pain areas: in the mid-abdomen or right lower abdomen
Pain types: can be dull, sharp, mild, or severe
Whole body: chills, fever, loss of appetite, or malaise
Gastrointestinal: diarrhea, nausea, or vomiting
Also common: abdominal pain migration or abdominal tenderness
Critical: consult a doctor for medical advice

What are the signs and symptoms of a hemorrhoid?

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Hemorrhoids are the most common cause of rectal and anal complaints. The most common complaint symptoms are:

painless bleeding,
anal itching,
pain,
swelling and feeling a lump at the anus are all associated with an inflamed hemorrhoid.
It is important to remember that rectal bleeding or blood in the stool is never normal and while it may come from a relatively benign cause like hemorrhoids, more serious causes can be life threatening. These include bleeding from ulcers, diverticulitis, inflammatory bowel disease, and tumors. If rectal bleeding occurs, it is important to contact your health care professional or seek emergency medical care. This is especially important if the person is taking blood thinning medications.

When an internal hemorrhoid becomes inflamed, it can cause swelling. This in itself does not cause pain because there are no pain fibers attached to the veins above the pectinate line. Passing a hard stool can scrape off the thinned lining of the hemorrhoid causing painless bleeding. However, the swollen hemorrhoid can also cause spasm of the muscles that surround the rectum and anus causing pain, especially if they protrude or prolapse through the anus. A lump can be felt at the anal verge. Internal hemorrhoids can also thrombose (clot) leading to severe pain.