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Chloe's > 1: GENERAL ENDOSCOPIC PRINCIPLES > Flashcards

1: GENERAL ENDOSCOPIC PRINCIPLES Flashcards

1
Q

Hypovolemic shock: Etiology

A

Decreased fluids

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2
Q

Hypovolemic shock: PE

A

GFlat neck veins, pallor, tachycardia

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3
Q

Distributive shock: Etiology

A

Increased ‘pipe’/vessel size

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4
Q

Distributive shock: Examples

A

Drug induced, sepsis, anaphylaxis

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5
Q

Distributive shock: PE

A

Flat neck veins, pallor, tachycardia

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6
Q

Obstructive shock: Etiology

A

‘Pipe’/Vessel obstruction

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7
Q

Obstructive shock: Examples

A

PE, tension pneumothorax, cardiac tamponade

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8
Q

Obstructive shock: PE

A

Variable, although often JVD but apparently euvolemic

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9
Q

Cardiogenic shock: Etiology

A

Pump problem

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10
Q

Cardiogenic shock: Examples

A

MI, arrythmia, cardiomyopathy

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11
Q

Cardiogenic shock: PE

A

JVD, tachycardia, cyanosis

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12
Q

Benefits LSC over laparotomy

A

Less EBL
Improved post-op pain
Decreased LOS
Faster return to activities
Fewer wound infections

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13
Q

Disadvantages of LSC compared to laparotomy

A

Longer operative time
Higher risk of urinary tract injuries
Higher risk of cuff dehiscence

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14
Q

Indications for laparotomy over LSC

A

Suspected extra-uterine pathology (ex: stage 3 ovarian cancer)
Adnexal masses concerning for cancer
Known or suspected malignancy

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15
Q

Patient considerations for laparotomy over LSC

A

Can patient tolerate increased intraabdominal pressure?
Adhesive disease?
Is patient hemodynamically stable? (THOUGH HEMODYNAMIC INSTABILITY SHOULD NOT BE CONTRAINDICATION TO LSC!!!)

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16
Q

Is hemodynamic instability a contraindication to LSC?

A

NO!!!!

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17
Q

Contraindications to HSC

A

Viable IUP
Pelvic infection
KNOWN cervical or uterine cancer
Inadequate experience or equipment

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18
Q

Support for OR HSC over office procedure

A

Patient intolerance
Severe cervical stenosis
Altered anatomy

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19
Q

Pregnancy test prior to HSC?

A

Delay for 2w after unprotected intercourse

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20
Q

Most important independent RF for malignancy?

A

Age (dramatic increase in malignancy risk after menopause)

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21
Q

RFs for ovarian cancer

A

AGE (most important)
White race
Nulliparity
Early menarche
Late menopause
Endometriosis

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22
Q

Radiologic factors concerning for ovarian malignancy

A

Cyst >10cm
Irregular borders
Papillary/solid components
Associated with ascites

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23
Q

Radiologic findings supportive of benign cyst

A

Thin, smooth walls
Absence of internal blood flow

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24
Q

Incidence of mass in post-menopausal time frame being benign

A

68%

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25
Percent resolution of simple cyst in post-menopausal women
70%
26
Ddx for benign adnexal masses
Simple cyst Cystadenoma Fibroma Paraovarian/paratubal cyst Hydrosalpinx
27
Most common ovarian cancer
Epithelial
28
Discuss the management of post-menopausal adnexal masses
<3cm: No f/u 3cm-5cm: Surveillance, repeat US in 3mo 5-10cm: Surveillance or surgical exploration >10cm: Surgery **CAVIAT - IF PT HAVING SYMPTOMS OR ELEVATED CA-125: SURGERY REGARDLESS OF SIZE**
29
Risk assessment scoring systems for ovarian cancer
US-Based Scoring Systems Risk of Malignancy Index Risk of Malignancy Algorithm
30
Examples of low-risk surgery and peri-operative risk:
<1% Superficial surgery (ex: Bartholin's) Minor GYN Cosmetic/Reconstructive Breast Endoscopic Minor urologic Dental
31
Examples of intermediate-risk surgery and peri-operative risk:
1-5% Intraperitoneal Major GYN (ex: hysterectomy, sacrocolpopexy) Major urologic Head and neck Major ortho Renal transplant Minor intrathoracic
32
Examples of high-risk surgery and peri-operative risk:
>5% Major abdominal (anything with risks of major fluid loss)
33
Is there a strict cutt-off of glycemic # to which procedure should be held?
No
34
When to hold Metformin
48hr prior to procedure (d/t risk of lactic acidosis)
35
When to hold PO glycemic meds other than Metformin prior to surgery
Day of
36
When to hold short-acting insulin prior to surgery
Day of
37
When to hold long-acting insulin prior to surgery
Halve it day of
38
Goal of glycemic control for surgery
<180
39
When to hold immunosuppressant meds prior to surgery
Consider 1w prior and one week after surgery (after discussing with rheumatologist d/t increased risk of infection)
40
Why do we use stress dose steroids with surgery?
To prevent adrenal insufficiency
41
Who needs stress-dose steroids?
Patients on Prednisone 5mg QD x3w (or more) within last 6 mo (or equivalent)
42
Equivalent of Prednisone 5mg
43
Recommendation for stopping maintenance steroid prior to minor surgery
CONTINUE
44
Recommendation for stopping maintenance steroid prior to moderate surgery
CONTINUE
45
Recommendation for stopping maintenance steroid prior to major surgery
CONTINUE
46
Recommendation for preoperative hydrocortisone prior to minor surgery
None
47
Recommendation for preoperative hydrocortisone prior to moderate surgery
50mg IV
48
Recommendation for preoperative hydrocortisone prior to major surgery
100mg IV
49
Recommendation for preoperative hydrocortisone after minor surgery
None- resume maintenance steroid
50
Recommendation for postoperative hydrocortisone after to moderate surgery
25mg PO q8hr x24hr, then resume maintenance
51
Recommendation for postoperative hydrocortisone after to major surgery
50mg IV q8hr x24hr, then TAPER to maintenance steroid
52
Definition of low risk of symptomatic VTE
Minor surgery (<30min) or non-complex LSC surgery in patients with NO additional RFs
53
Definition of moderate risk of symptomatic VTE
Minor or LSC surgery in patients WITH additional RFs; Major GYN surgery for benign disease in patients with no additional RFs
54
Definition of high risk of symptomatic VTE
Major surgery in patients WITH additional RFs; Major surgery in patients with malignancy
55
Definition of highest risk of symptomatic VTE
Major surgery in patients >60yo with cancer, a prior VTE, or both
56
% Definition of very low risk of VTE per Caprini
<0.5%
57
% Definition of low risk of VTE per Caprini
~1.5%
58
% Definition of moderate risk of VTE per Caprini
~3%
59
% Definition of high risk of VTE per Caprini
~6%
60
Recommended ppx for ~1% major bleeding complication risk in very low patient risk population
No specific ppx
61
Recommended ppx for ~2% major bleeding complication risk in very low patient risk population
No specific ppx
62
Recommended ppx for ~1% major bleeding complication risk in low patient risk population
Mechanical ppx
63
Recommended ppx for ~2% major bleeding complication risk in low patient risk population
Mechanical ppx
64
Recommended ppx for ~1% major bleeding complication risk in moderate patient risk population
LDUH, LMWH, OR mechanical ppx
65
Recommended ppx for ~2% major bleeding complication risk in moderate patient risk population
Mechanical ppx
66
Recommended ppx for ~1% major bleeding complication risk in high patient risk population
LDUH OR LMWH PLUS mechanical ppx
67
Recommended ppx for ~2% major bleeding complication risk in high patient risk population
Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added
68
Recommended ppx for ~1% major bleeding complication risk in high risk cancer surgery population
LDUH OR LMWH PLUS mechanical ppx AND extended-duration ppx with LMWH
69
Recommended ppx for ~2% major bleeding complication risk in high risk cancer surgery population
Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added
70
Recommended ppx for ~1% major bleeding complication risk in high risk patients with LDUH and LMWH are contraindicated or unavailable
Fondaparinux or Low-Dose Aspirin PLUS mechanical ppx
71
Recommended ppx for ~2% major bleeding complication risk in high risk patients with LDUH and LMWH are contraindicated or unavailable
Mechanical ppx until risk of bleeding diminishes and pharm ppx can be added
72
PALM-COEIN DEFINITION
Polyps Adenomyosis Leiomyoma Malignancy Coagulopathy Ovulatory Endometrial Iatrogenic Not yet classified
73
RFs for endometrial malignancy
Nulliparity Increasing age Late menopause Unopposed estrogen (HRT, obesity, chronic anovulation) Tamoxifen Lynch Syndrome Cowden Syndrome

Chloe's (16 decks)

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