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ABDOMINAL SURGERY MNENONICS

Abdomen inspection :
"5 Ss"
• Size
• Shape
• Scars
• Skin lesions
• Stoma

Abdominal Aortic Aneurysm (AAA) Genetic component :
AAA.(3 As)is sometimes due to a defect in the
Gene encoding for type III procollagen.

Appendicectomy Complications :
"WRAP IF HOT"
W - Wound infection
R - Respiratory (atelectasis, pneumonia)
A - Abscess (pelvic)
P - Portal pyemia
I - Ileus (paralytic)
F - Fecal fistula
H - Hernia (r. inguinal)
O - Obstruction (intestinal due to adhesions)
T - Thrombus (DVT)

Appendicitis Alvarado's Scoring System for Diagnosis:
"MANTRELS"
M - Migratory pain (1)
A - Anorexia (1)
N - Nausea (1)
T - Tenderness (2)
R - Rebound tenderness (1)
E - Elevated temperature (1)
L - Leucocytosis (2)
S - Shift to left (1)

Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more = appendicitis is confirmed.

Causes of right iliac fossa mass :
"CRAB IT"
C - Cancer, Crohns
R - Reticulo-endothelial (lymphoma)
A - Appendix mass, Aspergillosis, Amoeba B - Brucellosis
IT - Ileal Tuberculosis

Child-Pugh classification :
"Pour Another Beer At Eleven"
PT
Albumin
Bilirubin
Ascites
Encephalopathy

Scoring (each is either 1, 2 or 3 points): PT (greater than 12 sec.): 1-3 or 4-6 or >6 .
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)

Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).

Class B: 7-9 points (consider chemoembolization or RFA).

Class C: 10-15 points (consider options in B or no therapy).

Complications of Herniorrhaphy :
"HERNIO"
H - Haemorrhage, Haematoma, Haemotocele, Hydrocele
E - Edema (penile edema) - rare
R - Recurrence
N - Neuralgia due to injury to ilioinguinal nerve causing hyperaesthesia over medial side of inguinal canal
I - Infection, Injury to urinary bladder/bowel
I - Osteitis pubis

GI Bleeding Causes :
"ABCDEFGHI"
• Angiodysplasia
• Bowel cancer
• Colitis
• Diverticulitis/Duodenal ulcer
• Epitaxis/Esophageal (cancer, esophagitis, varices)
• Fistula (anal, aortaenteric)
• Gastric (cancer, ulcer, gastritis)
• Hemorrhoids
• Infectious diarrhoea/IBD/Ischemic bowel

Gastric Cancer Clinical Features :
"LIONS"
L - Lump
I - Insidious onset features
O - Obstructive features
N - New onset dyspepsia
S - Silent presentation (with no complaints but features of metastatic disease such as left supraclavicular lymph node)

Hernias of Abdominal Wall :
Think of the abdomen as a bucket, or "PAIL" that contains the viscera.
These are the four groups of hernias:
P - Pelvic hernias: obturator, perineal, Sciatic
A - Anterior hernias: epigastric, incisional, Spigelian, supravesical, umbilical
I - Inguinal hernias: indirect, direct, femoral
L - Lumbar hernias: inferior lumbar triangle (Petit), superior lumbar triangle (Grynfelt)

Hernias abdominal wall Pelvic :
The end products of metabolism that are released through the pelvis, are
"Pee Or Stool"
• Perineal Hernia
• Obturator Hernia
• Sciatic Hernia

Hernias : Abdominal wall, Lumbar triangles :
"PIGS"
Petit aka Inferior lumbar triangle
Grynfelt aka Superior lumbar triangle

Inguinal mass, Differential:
"Hernias Very Much Like To Swell"
• Hernias (inguinal, femoral)
• Vascular (femoral aneurysm, sapheno varyx)
• Muscle (psoas abscess)
• Lymph nodes
• Testicle (ectopic, undescended)
• Spermatic cord (lipoma, hydrocoele)

Meckel's Diverticulum :
"Di" means "two" so Diverticulum is a thing with all twos
2 inches long
2 feet from end of ileum
2 times more common in men
2 percent occurance in population
2 types of tissues may be present

Mesenteric Cyst different types :
"CUTE"
C - Chylolymphatic cyst (Commonest)
U - Urogenital remnant cyst
T - Teratomatous/Dermoid cyst
E - Enterogenous Cyst

Oesophageal cancer risk factors :
"PC BASTARDS"
P - Plummer-Vinson syndrome
C - Coeliac disease
B - Barrett oesophagus
A - Alcohol
S - Smoking
T - Tylosis
A - Achalasia
R - Russia (geographical distribution)
D - Diet
S - Stricture

Pancreatitis treatment :
"MACHINES"
M - Monitor vital signs
A - Analgesia/ Antibiotics
C - Calcium gluconate (if deemed necessary)
H - H2 receptor antagonist
I - IV access/IV fluids
N - Nil by mouth
E - Empty gastric contents
S - Surgery if required/ Senior review

Zollinger Ellison Syndrome Clinical Triad :
"PIG"
P - Peptic Ulcer Disease
I - Islet cell tumor of non-beta cells
G - Gastric acid Hypersection

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