Clinical Talk on General Surgery
17th September 2018
Clinicians talked about surgical issues experienced in their in and out of hours roles.
The latest in a series of Clinician Education events that we co-host with BMI Healthcare featured a symposium type forum on the topic of General Surgery and post-operation complications in the community. This took place on Thursday 13th September with guest speaker Mr Christopher Thorn, Consultant General, Laparoscopic and Colorectal Surgeon MBBS MD FRCS.
Mr Thorn has clinical interests in general and colorectal surgery including gallbladder surgery, hernia repair and all aspects of proctology and laparoscopic resectional colorectal surgery.
Dr Steph Ansell, Medvivo’s Clinical Lead for the Bath and North East Somerset area, welcomed clinicians who work within General Practice both in and out of hours. A lively and informative discussion followed with a wide range of issues being raised. Clinicians were keen to get advice on the types of cases they see and the type of best care advice given which ranged from referral to other healthcare services, hospitalisation or self-care.
Key Points
The following are some of the key points discussed during the event:
- If abdominal pain is acute, check if patient is sick or not, and tachycardic or not
- For perianal problems, if there is deep pain but you can’t find an obvious abscess, run finger down the area over the soft tissue and you should feel it if it’s there
- Haemorrhoids develop over time and emergency treatment is rarely needed – in most cases you can advise ice packs and rest
- For children with abdominal pain, eliminate appendicitis diagnosis by seeing if they can hop or get them to do a stretch test where they hyper extend the leg – this will irritate the appendix – also if the child is hungry, this is unlikely to be appendicitis
- If patient has no peritoneal signs (abdominal pain, fever, nausea/vomiting, diarrhoea…), it’s unlikely to be appendicitis
- In young women, it can be helpful to establish where they are in their menstrual cycle – an ultra sound is not always helpful – again check peritoneal signs
- Younger people seem to be presenting with gallbladder problems, which may be as much down to diet as genetics
- A hernia doesn’t always have to be fixed – refer if size increases or symptoms worsen, but otherwise apply gentle persistent pressure laterally to reduce it
- Anal cancer is rare but always keep in mind
- For anal fissures, glyceryl trinitrate (GTN) ointment can be used for 6 weeks but it should be used around the muscle and not up the canal – headache can be a side effect
The new Integrated Urgent Care contract in the Bath and North East Somerset, Swindon and Wiltshire areas went live in May 2018. The implementation period has not been without its challenges however Dr Ansell reported that “Commissioners have been really pleased and impressed with the service being delivered. Everyone working in this service should be thanked for their hard work, dedication and commitment.”
The next Clinical Education event will take place on the 6th December and the focus will be on Geriatric Medicine. Dr Robin Fackrell, Consultant Physician at BMI Healthcare will talk about nursing homes and the intricacies facing the visiting OOH clinicians.
To reserve a place please email GP@medvivo.com – a light supper will be provided so please let us know if you have any special dietary requirements.
Thank you to everyone who gave up their time to attend this event, especially Mr Thorn. And special thanks to our co-hosts BMI Healthcare and BMI The Ridgeway Hospital for their continued support in arranging these events and providing such high calibre guest speakers.
We look forward to getting together again in December.
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