The appendix is a short tube-like protuberance attached to the caecum, which is the first section of the small intestine (the duodenum) where it joins the stomach. It is shaped a little like a finger of a glove and can be about the same size or slightly longer. It’s usually positioned on the right side of the body.Appendicitis is characterised by severe abdominal pain and is generally diagnosed via ultrasound or CT scan

Acute appendicitis is where the appendix becomes inflamed or diseased and the normal form of treatment is surgical removal of the appendix in this case. This can be performed using conventional open surgery or via laparoscopic surgery.

Gastrointestinal perforation is where a hole appears either in the stomach, or large or small bowel. It can be caused by conditions such as appendicitis or diverticular disease or by injury. It can lead to peritonitis, which is inflammation of the lining of the abdominal cavity.

• Gastrointestinal perforation has the following symptoms…
• Severe stomach pain
• Fever/chills
• Nausea and vomiting
• Gastrointestinal perforation is generally diagnosed via X-ray or CT scan.

Bowel obstruction can be caused by a range of factors, such as cancerous or non-cancerous tumours, scar tissue (common in the small intestine) or narrowing/twisting of the intestine. It can be brought on by Crohn’s Disease or hernias, although severe constipation can also cause bowel obstruction.

Symptoms may include…Intermittent stomach pain or cramps around or below the navel

• Bloating
• Constipation or diarrhoea (the latter indicates the intestine may be partly blocked)
• Vomiting
• Bowel obstruction is generally diagnosed via X-ray or CT scan.

Peritonitis is the inflammation of the inner lining of the abdominal cavity. It is characterised by general abdominal pain and can be brought on by a number of factors, including ulcers, appendicitis, diverticular disease, bacterial infections and other conditions.

Peritonitis is generally diagnosed via X-ray, ultrasound or CT scan.

Volvulus refers to the twisting of a section of the bowel which may lead to bowel obstruction. In babies and young children it is usually congenital, i.e. hereditary, and in adults it may be caused by adhesions, i.e. scar tissue and occurs most frequently with men after middle age. It can also be linked to problems with constipation.

Volvulus is commonly diagnosed via X ray, a barium enema or a CT scan.

Acute mesenteric ischemia describes where the small bowel is affected by lack of blood supply. The main symptoms are sudden severe abdominal pain, nausea and vomiting.

The condition is generally caused by a blood clot in one of the veins supplying the small bowel, often caused by other conditions such as renal failure or heart failure. Most people affected are over 60 years old.

The condition is generally diagnosed via angiogram.

This is where the walls of the bowel are perforated or ruptured by the contents of the bowel. This can be a foreign object or more frequently severe constipation causing hardened faeces. Stercoral perforation may cause peritonitis if untreated and thus needs emergency surgical attention.

Acute mesenteric ischemia describes where the small bowel is affected by lack of blood supply. The main symptoms are sudden severe abdominal pain, nausea and vomiting.

The condition is generally caused by a blood clot in one of the veins supplying the small bowel, often caused by other conditions such as renal failure or heart failure. Most people affected are over 60 years old.

The condition is generally diagnosed via angiogram.

Assess burn

• Depth
•  % body surface area
• Circumferential burns may require early escharotomy
• Fluid resuscitation
• Warm environment to stop fluid losses
• Wound care, Tetanus
• Pain control
• Chemical burns.
• Irrigate copiously with water or saline
• Acids: extensive superficial burns
• Bases: extensive deep tissue involvement
• Electrical burns
• High voltage may cause limited superficial injury, extensive deep injury
• Exit wound often more severe than entrance wound

Infection can cause scarring of the urethra, stones in the bladder can obstruct the outlet, and an enlarged prostate gland can compress the urethra. In any of these cases, the urethra can be blocked, making urination impossible. Often, an instrument can be passed through the obstruction, followed by a rubber catheter, to relieve the acute problem. However, because the obstruction often recurs, subsequent referral may be needed to remove the prostate or the stone or to more radically dilate the urethra. If the urethra cannot be dilated, a bladder catheter can be inserted above the pubic bone (suprapubic cystostomy) as an emergency procedure. Removal of bladder stones and cystostomy are practical operations at a first-level hospital, and prostatectomy can be performed there, if the skills are available. Stones can also form in the kidney itself. Small ones will pass without surgical treatment; if they do not pass, referral is necessary.

Pneumothorax, hemothorax, and empyema are collections of, respectively, air, blood, or pus in the pleural space that compresses the lungs, leading to respiratory insufficiency; they often produce scarring with permanent disability. Infected fluid is serious and can lead to death. In almost all cases, early drainage with a chest tube, combined with antibiotics as needed, resolves the problem

Acute inflammation of the gall bladder (acute cholecystitis) is very rare in rural parts of LICs but increasingly common in cities and MICs. Most patients treated with antibiotics and prompt removal of the gall bladder, but antibiotics alone will control infection temporarily so that an operation can be done later.Patients with jaundice caused by gallstones passing into and obstructing the common bile duct are referred for surgery.

It develops most often in peripubertal (12-18years old) age group, although it can occur at any age Presents with acute onset of unilateral testicular pain and swelling, commonly associated with nausea and vomiting.Typical history of Strenuous physical activity and blunt trauma. Some patients give a history of a prior episode that spontaneously resolved.Absent urinary symptoms Examination reveals extreme tenderness, swollen firm testicle high in the scrotum with transverse lie . Absent cremasteric reflex.Elevation of scrotum does not relief pain.Difficult to differentiate rom epididymitis.Investigation: Color Doppler ultrasound.Treatment: manual detorsion (“open book” technique), Surgery (orchidopexy) which can salvage rate 80-100% up to 6hrs of ischemia, 20% after 10hours and 0% after 24hours

Inability to pull retracted foreskin back over glans

• It is a surgical emergency
• Vascular compromise
• Treatment:

 Continuous firm pressure to glans for 5-10min

•  Dorsal slit
•  Circumcision