00 Surgical F1 Flashcards by spencer shaw

Estrogen OCP and HRT

Stop x weeks pre op

4 weeks preop

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Contraindications gentamicin

Allergy
Myasthenia gravis
Renal impairment:
- caution eGFR

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Before giving Tazocin

Ask

Penicillin allergy

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Gentamicin dose

And max dose

5mg/ kg OD

Max 520mg

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Dosing gentamicin

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

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Gentamicin dose level
Toxicity
V
Therapeutic

Toxic > 1mg/L

Therapeutic

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Oramorph dose

10-20mg every 4h PO

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Prescribing b blocker ask

Asthma?
PVD?
Low BP

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Drinks that effect warfarin

Increase INR

cranberry, grapefruit juice
binge drinking EtOH

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NBM rules

Elective surgery

No food from midnight
No food 2h
NBM

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1 stone = x kg

6.35kg

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RIFLE classification

Risk: creatinine x1.5
Injury: creatinine x2
Failure: x3
Loss: RF> 4w
ESRF

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Excessive N saline causes

Hyperchloraemic metabolic acidosis

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Sentinel loop

Localised loop of bowel ileus

Associated abdo inflx: eg pancreatitis

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Chemo for Colon Ca

Oxaliplatin

- SE neuropathy

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Tx external rectal prolapse

Abdominal procedure
- rectopexy

Perineal procedure
- delormes

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Ileus
V
Pseudo Ob

Ileus: SB
V
Pseudo Ob: large bowel

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Intra abdominal air dissipates x time post op

48-72h post op

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Proximal stomach Ca tx

Oesphagogastrectomy:
- Ca involving OGJ
Total gastrectomy

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Colonic bleeding

Acute: endoscopy rarely helpful
Proctosigmoidoscopy ? Haemorrhoids

Unstable Pt
- angiogram CT: angio dysplasia bleeding point

Stable - elective colonoscopy

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UC pt flair failed medical management

Subtotal colectomy

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Groin lump Qs

Cough impulse
Pulsation and Expansile: true aneurysm
Both testes in scrotum?
Distal infx

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Post op ? Bile duct injury

ERCP + stent

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X% diverticulitis bleeds settle with conservative management in what time

70% in 24-48h

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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

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