No Hospital Distancing during Abdominal Emergencies
Mon , Jun 20
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‘The abdomen is a Pandora’s box’ is a well-known phrase described by many surgeons around the world. Abdominal pain has always been a tricky symptom to assess for the general public, in regular times. And now, during this lockdown, we are getting a lot more calls from our patients complaining about abdominal symptoms. These may vary from simple gastritis-like pain to acute/severe abdominal pain. These symptoms need to be evaluated and a detailed history needs to be taken to get the diagnosis and to render appropriate treatment.
Abdominal discomfort, on its own, has also been identified as one of the less common symptoms of the COVID-19 infection. Recent literature has revealed that about 20 per cent of patients present to the hospital with a digestive symptom, such as diarrhoea, vomiting and/or pain, accompanying their respiratory symptoms. And roughly 5 per cent show up with abdominal complaints alone. The study in China found that a third of the people with mild COVID-19 experienced diarrhoea that lasted for an average of 5 days. It also took them longer to clear the virus from their bodies, compared to those without gastrointestinal symptoms.
So, when should a patient with abdominal symptoms visit a hospital? If the pain or associated symptoms like vomiting, diarrhoea, bloating or fever are in an increasing trend over a few hours since the onset, it is better to consult with a specialist at the hospital. Any acute abdominal pain could mean one may have an intestinal obstruction, infection or inflammation of the appendix, gallbladder stones causing infection and pus within the biliary tract, intestinal perforations and more. These signs would be intolerable and will limit regular activity or movement.
How do we diagnose once we see you? It’s a combination of complete history taking and clinical examination with blood tests and radiological tests like USG Abdomen or CT Abdomen. Once diagnosed, depending on the problem, treatment choices are offered which may be medical or surgical in nature. With regards to the conditions mentioned, emergency surgery may be recommended without any delay to avoid further sepsis as this may hamper the overall outcome of the treatment and life of a person.
90% of these procedures can be completed by laparoscopy (keyhole surgery) which is a minimally-invasive method of performing surgeries which helps the patients be pain-free, recover faster and reduce the chances of other associated problems like wound infection. Most of these patients get discharged within two days and are able to do their routine work soon. When there is a significant delay between onset of symptoms and arrival to the hospital, that is where the chances of performing these procedures through the keyhole method decreases and the rate of complication rises.
But during this current situation, I am sure you are probably wondering how safe it is for people to visit the hospital. All hospitals are taking utmost precautions to safeguard the health and safety of their patients and, of course, the healthcare workers. Effective screening of every person, including doctors and staff, is performed as they enter the hospital on a daily basis. All patients are screened too along with their attenders. If anyone has any suspected symptom related to COVID-19, they are isolated and admitted in specialised isolation suites until proven negative by means of the tests done for COVID-19.
All patients undergoing surgery are tested for COVID-19 prior to shifting to the operation theatre and all healthcare staff dealing with the patients wear full personal protective equipment while treating or handling these patients, even if the tests are negative. There is a lot of myth among the general public that patients with acute symptoms should not visit hospitals or that if they visit, they may get exposed to the virus. This is completely false because adequate precautions are being taken. Patients in the postoperative period, who are recuperating from surgery, must take extra precautions as their general immunity will be a bit more compromised compared to another person.
People must stay at home if they are fine and healthy, eat healthy food and indulge in some form of exercising like walking and breathing exercises within the house to keep themselves fit. Social distancing is a very important principle to follow during this period but in the case of an abdominal or a gastrointestinal (GI) emergency, healthcare distancing need not be practised. The best outcomes in all these GI emergencies can be fully achieved if the patient reports early to the hospital.
The author, Dr Deepak Subramanian, is the Clinical Lead of the Department of Minimal Access & Bariatric Surgery at MGM Healthcare
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