Surgical Same Day Emergency Care (SSDEC) draft

• An abscess is a collection of pus that usually forms after a localised bacterial infection. They can develop anywhere in the body and commons sites include the axilla (armpit), around the bottom (peri-anal or pilonidal), the breast, the groin, the neck and the abdominal wall
• They are painful and characterised by a painful, swollen and red area of tissue
• On the Surgical SDEC Unit, the doctors will decide if your abscess needs treatment with antibiotics alone or whether you need it to be drained with an operation called an ‘incision and drainage’
• Surgical drainage is usually carried out under local anaesthetic though sometimes a short general anaesthetic is needed
• Most patients can be discharged on the same day as surgery, if you have someone to take you home and look after you overnight after your operation.
• After surgery, you may be required to have daily packing and dressings. This is typically carried out by GP services; however, some practitioners have opted out of this service.

• Gallstones are small stones that form within the gallbladder. The gallbladder is a small organ in the top right part of your abdomen that sits underneath your liver and helps you digest food.
• Gallstones are very common and affect over 10% of adults in the UK.
• Though they do not usually cause symptoms, gallstones can cause a range of conditions including biliary colic (pain caused by gallstones when you eat), cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas gland) and they are also sometimes the cause of jaundice.
• On the Surgical SDEC Unit, your doctors may request blood tests and scans to help make the diagnosis and determine a treatment plan
• Sometimes, they will recommend keyhole surgery to remove the gallbladder (an operation called a laparoscopic cholecystectomy). This operation is usually performed on a day-case or same-day basis though sometimes requires a brief hospital admission
• Patients with gallstones are often sent home from the Surgical SDEC Unit with a proposal for elective (planned) surgery later. Sometimes, patients are admitted to hospital for emergency surgery
• There are other treatments that might be required for gallstone-related disease; these include antibiotics (often intravenous), endoscopy procedures or further scans.

• Non-specific abdominal pain (NSAP) refers to abdominal pain that has no clear diagnosis. It is usually diagnosed after other common diseases have been excluded
• It is quite common, accounting for a half of emergency surgical admissions for abdominal pain.
• Treatment strategies for NSAP may include further blood tests or scans on an outpatient basis, clinical review in the Surgical SDEC Unit or painkillers
• It usually settles gradually over time, without further investigations being required

• This is an acid-related inflammation of the stomach lining. It has many possible risk factors including alcohol consumption, spicy foods, smoking, or infections. It does not usually require surgery though certain tests are often arranged
• Possible tests include scans and an endoscopy (camera test) of the stomach

• Diverticular disease is a condition characterized by the formation of small bulges or pockets, known as diverticula, in the lining of the large intestine (colon).
• Diverticular disease can cause a range of conditions including diverticulitis (inflammation or infection of the diverticular disease), rectal bleeding (bleeding from the back passage), perforation (a hole in the affected section of bowel), abscess formation (collection of pus around the diverticular disease) or diverticular stricture (a narrowing of the affected section of bowel causing a blockage)
• On the Surgical SDEC Unit, your doctors may request blood tests and scans to help make the diagnosis
• Complications of diverticular disease, such as diverticulitis, can usually be treated with antibiotics alone. If you have a mild attack, you will be treated with oral antibiotics and discharged from the Surgical SDEC Unit. If your doctors feel that you have a more serious attack, they may recommend hospital admission for intravenous antibiotics
• Occasionally, surgery is required for complications of diverticular disease.

• This is bleeding from your back passage, occurring before, during or after you have passed stools
• It can be bright red, dark red or black and can be on the toilet paper alone, in the toilet bowl or mixed with the stools
• Common causes include haemorrhoids (‘piles’), diverticular disease, inflammation of the bowel (colitis or inflammatory bowel disease), anal fissure (small tears in the lining of the anus), polyps in the colon or cancerof the colon
• On the Surgical SDEC Unit, we will often take blood tests and examine your rectum to determine the colour and consistency of the bleeding to help us work out the cause and source of it
• Patients with stable observations and blood levels, and small volume bleeding, are often discharged from the Surgical SDEC unit with plans for further tests

Patients often require an endoscopy of the colon (called a sigmoidoscopy or colonoscopy) and this is usually performed as an outpatient.

• Small bowel obstruction occurs when there is a partial or complete blockage in the small intestine, preventing food, fluids, and gas from moving through. This condition can be life-threatening if not treated promptly.
• Symptoms of small bowel obstruction include vomiting, abdominal distension, abdominal pain and constipation
• If this is suspected on the Surgical SDEC Unit, your doctors may request blood tests and scans to confirm the diagnosis. If confirmed, you will almost always require hospital admission for ongoing treatment (which can include a nasogastric tube, urinary catheter and intravenous fluids)
• Some patients are prescribed a medication called Gastrografin which is a contrast dye dissolved in a liquid. After drinking it, they are then asked to have an abdominal x-ray 4-6 hours later to see where the blockage is, and if it is likely to settle without surgery

• A hernia is a condition that occurs when an organ pushes through a weak spot in the muscle or tissue that holds it in place, often resulting in a bulge.
• Common places to get a hernia include the groin (inguinal or femoral hernia) or the bellybutton (umbilical hernia)
• Hernias that do not cause any symptoms do not require surgery
• However, once they do cause pain or discomfort, surgery is often recommended.
• On the Surgical SDEC Unit, your doctors may request blood tests and scans to help make the diagnosis.
• Patients with uncomplicated hernias are often sent home from the Surgical SDEC Unit with a proposal for elective (planned) surgery later. Sometimes, patients are admitted to hospital for emergency surgery if they have signed of a blocked or strangulated hernia