Module: Abdomen / Gastrointestinal Tract

Problem: 2.04 - Session Four

Study Guide 6

An overview of the pharmacological management of pain

Waisea, the 31-year-old man with a groin mass, and vomiting

Resource Person:
Physiology
Mr Sreejesh Govindankutty
Physiology 1. Describe the physiological processes of the generation,
Mr. Napolioni Vulakouvaki transmission, conduction, and modulation of nociceptive pain.
Pharmacology
Pharmacology

Keywords: 2. Describe the WHO pain management ladder and explain the
 analgesics pharmacological approach to the management of
 opioids breakthrough pain.
 morphine 3. Discuss the pharmacology and clinical uses of:
 opioid antagonists a. NSAIDs
 naloxone b. Opioid analgesics – agonist and antagonists
 mediators of pain
 analgesic ladder
 premedication

Resources:
Bryant & Knights,
Pharmacology for Health
professionals, chapters 15 &
16.

March 2024

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Module: Gastrointestinal Tract
Problem: 2.04 – Session Four

Study Guide 7

How do we obtain consent for surgery?

Waisea, the 31-year-old man with a groin mass, and vomiting

Resource Person:
Personal and Professional Development.

1. Discuss the basic principles of ethics in medical care

2. List the principles of an informed consent
3. List the conditions for a consent to be legally and ethically valid
4. Provide examples for the conditions that allow a consent to be legally valid.
5. Give examples of when a consent is not absolutely necessary
6. Discuss situations where consent can be given by a third party.

Recommended Reading
Kerridge I, Lowe M, McPhee J. Ethics and Law for the Health Professions. Chapter 9 Consent.

March 2024

Scenarios and questions for discussion, for study guide 7: Patient consent

1. Elenoa, a 39 year old woman, is admitted to hospital to undergo a cholecystectomy. The consultant surgeon has
explained the procedure to the patient and her family, and has obtained a signed consent form. The new registrar is
assigned to perform the operation under the surgeon's supervision. The consultant surgeon is called away for an
emergency in the adjacent theatre in the middle of the operation, and the registrar completes the operation.
Several days after the operation, it is noted that Elenoa is becoming more and more jaundiced, and it seems
possible that a mistake may have been made during the operation.
In light of your knowledge of the anatomy of the biliary system, what might have happened during the operation
to result in jaundice following the operation? What would have constituted full disclosure in obtaining consent in
this case?

2. A doctor explains the reasons for an operation to Sarah, a woman with advanced cervical cancer. Her questions about
her long-term prognosis are answered honestly by the doctor, who admits that the outlook is pessimistic whether she
has the operation or not. After thinking about it for a day, she tells the doctor she thinks she would rather not have
the operation. Her husband and children have taken the doctor aside, however, and told him he must perform the
operation. She eventually gives her consent.
Should the doctor perform the operation? Assess the voluntariness of her consent.

3. Brigette, a 7 year old child, is brought to A&E after being struck in the crosswalk by an automobile. Her head
injuries necessitate immediate operation, which is done in lieu of parental consent, as attempts to locate the parents
immediately are unsuccessful. Several hours later, the parents arrive, and are told that Brigette has died in the
operating theatre. They are angry, and question how an operation could be done on their daughter without their
consent. They say they plan to sue the hospital.
Should the doctors have awaited the parents’ arrival to obtain consent before performing the
operation? Assess the need for consent in this instance.

4. Xing Do is a deck-hand from a fishing vessel docked in Suva Harbour. He is admitted to hospital one evening after
midnight for severe abdominal pain, which is diagnosed as most likely due to appendicitis. The doctor decides an
operation is needed immediately, but Xing Do does not speak English nor do any of his colleagues, no interpreters
are available, and so it is difficult to obtain informed consent for the procedure.
What are the options in this case?

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