00 Surgical F1 Flashcards
Estrogen OCP and HRT
Stop x weeks pre op
4 weeks preop
Contraindications gentamicin
Allergy
Myasthenia gravis
Renal impairment:
- caution eGFR
Before giving Tazocin
Ask
Penicillin allergy
Gentamicin dose
And max dose
5mg/ kg OD
Max 520mg
Dosing gentamicin
60
Blood: eGFR 5mg/kg OD: 1st dose Pre dose level (20-24h) Give 2nd dose w/o result Dose level 1mg/L - withhold next dose - recheck level 12-24h later
Gentamicin dose level
Toxicity
V
Therapeutic
Toxic > 1mg/L
Therapeutic
Oramorph dose
10-20mg every 4h PO
Prescribing b blocker ask
Asthma?
PVD?
Low BP
Drinks that effect warfarin
Increase INR
- cranberry, grapefruit juice
- binge drinking EtOH
NBM rules
Elective surgery
No food from midnight
No food 2h
NBM
1 stone = x kg
6.35kg
RIFLE classification
Risk: creatinine x1.5 Injury: creatinine x2 Failure: x3 Loss: RF> 4w ESRF
Excessive N saline causes
Hyperchloraemic metabolic acidosis
Sentinel loop
Localised loop of bowel ileus
Associated abdo inflx: eg pancreatitis
Chemo for Colon Ca
Oxaliplatin
- SE neuropathy
Tx external rectal prolapse
Abdominal procedure
- rectopexy
Perineal procedure
- delormes
Ileus
V
Pseudo Ob
Ileus: SB
V
Pseudo Ob: large bowel
Intra abdominal air dissipates x time post op
48-72h post op
Proximal stomach Ca tx
Oesphagogastrectomy:
- Ca involving OGJ
Total gastrectomy
Colonic bleeding
Acute: endoscopy rarely helpful
Proctosigmoidoscopy ? Haemorrhoids
Unstable Pt
- angiogram CT: angio dysplasia bleeding point
Stable - elective colonoscopy
UC pt flair failed medical management
Tx
Subtotal colectomy
Groin lump Qs
Cough impulse
Pulsation and Expansile: true aneurysm
Both testes in scrotum?
Distal infx
Post op ? Bile duct injury
Tx
ERCP + stent
X% diverticulitis bleeds settle with conservative management in what time
70% in 24-48h
Diverticula bleeds characteristically…
Large volume dark red blood
Chronic Hep and cirrhosis Pt
Regular Ix
Serum AFP and liver USS
Every 6-12m
Ix nodules via MRI
Psoas abscess types
Primary: immunodepressed
Secondary: abdo ds: eg Crohns
Phelgmon
Walled off inflx mass
Without infx
May be palpable
AXR sign toxic mega colon
LBO and thumb printing
AXR can show
Obstruction
Sentinel loops
Perforation
Signs IBD
EMR
Endoscopic mucosal resection
- for small areas Ca
R hemi colectomy
Anastomsis
Ileocolic anastomoses
Low risk leak
Ivor Lewis owsphagectomy
Anastomoses
Oesphagogastric
- high mortality
Cause mediastinitis
L sided lesion Tx
L subtotal colectomy & anastomoses
L hemi and anastomisis
L hemi and colostomy
Colonic stent
Recto sigmoid lesion
Tx
(Below peritoneal reflection)
Loop colostomy
High anterior resection
Ileal resection
Crohns ds
Comp post op diarrhoea
- tx cholestyramine
Risks of ERCP
Injury to teeth Bleeding Perforation Infx: cholangitis Pancreatitis Failure of procedure
Ix
Rectal anastomotic leak
Gastrograffin enema
Ix
Abscess
CT scan
Ix
Anastomotic leak
Ct scan? Contrast?
Ix
DVT
Doppler USS
High dose analgesia
Morphine
Oxycodone
Fentanyl
Morphine > 40mg IV
Oxycodone > 40mg IV
Fentanyl > 300mcg IV
NSAID contraindications
Asthma Ulcers Renal failure: check U&E Heart failure Over 70 Other anticoagulants
GI surgery rehiring prophylactic Abx
Stomach and esophagus Open biliary surgery Resection: colon rectum Appendicectomy ERCP Percutaneous endoscopic gastrostomy/ jejunostomy
Surgical tx
Acute cholecystitis
Acute laparoscopic cholecystectomy
After 48-72h
- Abx & delayed cholecystectomy
Drainage of pancreatic pseudo cyst
Via
Cystogatrostomy
Low rectal Ca tx
APER
Abdomino perineal excision rectum
Cholecystectomy incision
Kochers: R sub costal margin
Appendix abscess
Sx
High fever
D&V
Pelvic pus is an irritant to rectum causing diarrhoea
Decompress biliary tree via
ERCP
TAP
Transversus abdominal plane block
- bupivicaine via USS
- use in extensive laparoscopic surgery
Drains
Redivac: suction
Latex t tube
Low pressure drain
Corrugated drain
Dysfunction anastomoses for low anterior resection with
Loop ileostomy
Subtotal colectomy
Emergency
V
Elective
Emergency: end ileostomy
V
Elective: iliocolic anastomosis
Mnemonic Rockall score
ABCDE Age Blood pressure drop (shock) Comorbidity Diagnosis Evidence of bleeding
Cause of pseudo ob
Electrolyte imbalance
Tx pseudo ob
Supportive: correct electrolytes
Colonoscopic decompression
Neostigmine
Rarely surgery
Ix pseudo ob
AXR + contrast enema
Gastrograffin
V
Barium
Gastrograffin: leak
V
Barium: risk aspiration
Cause mesenteric vein thrombosis
Thrombophilia ~60%
Transfusion related lung injury
Cause
Plasma concentrates transfusion
- micro vascular damage
- diffuse CXR infiltrates
- mortality is high
Early signs abdo dihiscence
Seepage of serosanguinous fluid
- remove superficial sutures
- explore wound
- theatre for closure
High K
ECG changes
Peaked T waves
Loss p waves
Wide QRS
Timing for burst abdomen
Post op
6d
Bowel prep
Esp L sided surgery
Phosphate enema
Or
Oral laxative eg picolax
Inguinal hernia strangulation risk
3% per year
More common with indirect hernias
Causes post op pyrexia
Anastomotic leak Wind: atelectasis, infx Wound infx Water infx Wonder where: abscess, central line sepsis
Hartmann’s procedure =
Sigmoid resection
&
End colostomy
Diversion proctitis
Rectal bleeding + pus
Post end colostomy
