Clinical Protocols
Guideline-based clinical protocols prepared for quick bedside decisions present first-line treatment, doses, red flags and referral criteria on a single card; pages also work offline once opened.
Genel Cerrahi
Red zone
Acalculous Cholecystitis (Gallstone-Free Cholecystitis) — Emergency Management
Acalculous cholecystitis should be considered in a critical patient in the intensive care unit with a history of sepsis, major surgery/trauma, or prolonged TPN/fasting, presenting with unexplained fever, sepsis, and right upper quadrant tenderness.
Yellow zone
Acute Abdominal Pain / Appendicitis Triage
In a patient presenting with acute abdominal pain, especially localized to the right lower quadrant, appendicitis should be considered; first exclude peritonitis/instability and stratify risk with Alvarado/Pediatric Appendicitis Score.
Yellow zone
Acute Cholecystitis / Cholangitis
In a patient presenting with right upper quadrant pain, fever, and jaundice (Charcot's triad), acute cholecystitis or cholangitis should be considered, and the need for early biliary drainage in cholangitis should be evaluated.
Variable
Acute Mechanical Bowel Obstruction
Acute mechanical bowel obstruction should be considered in patients with cramp-like abdominal pain, distension, vomiting, and cessation of gas and stool.
Red zone
Acute Mesenteric Ischemia
Acute mesenteric ischemia should be considered in patients with disproportionately severe abdominal pain on physical examination until proven otherwise.
Red zone
Ogilvie Syndrome (Acute Colonic Pseudo-obstruction) — Bedside Protocol
Ogilvie syndrome should be considered in patients with massive colon (especially cecum) dilatation without mechanical obstruction on the basis of critical illness, major surgery/postop, trauma, sepsis, or advanced age.
Red zone
Perforated Peptic Ulcer
In a patient with sudden severe epigastric pain, rapidly spreading abdominal pain, and board-like abdomen, perforated peptic ulcer should be considered and evaluated as a surgical emergency.
Yellow zone
Perianal Abscess and Anal Fistula
The treatment for perianal abscess is drainage; antibiotics do not reach the closed cavity and are ineffective, and each passing day increases tissue loss. In deep abscesses, there may be no external swelling, and diagnosis should not be excluded just because examination is normal. Discrepancy between pain and examination findings is an early sign of necrotizing infection. In fistula surgery, the sphincter relationship determines continence.
Variable
Volvulus (Sigmoid / Cecal) — Bedside Protocol
Sigmoid/cecal volvulus should be considered in patients with progressively increasing abdominal distension, colicky pain, and obstipation, especially in elderly, chronically constipated patients, when the 'coffee bean' sign is seen on plain X-ray.