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3. E Med & Surgery > 4- General Surgery > Flashcards

4- General Surgery Flashcards

1
Q

When should tobacco be discontinued prior to surgery?

A

8 weeks

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2
Q

What meds should be continued in the perioperative period? (3)

A

Meds w/ significant withdrawal sxs not affecting anesthesia

CV meds

Statins

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3
Q

When should antiplatelet meds be d/c prior to surgery?

A

7-10 days prior

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4
Q

In low and mod risk patients, how does risk for operative mortality change for emergent procedures?

A

Doubles

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5
Q

What is the greatest RF/ predictor of DVT/ PE or bleeding risk?

A

Prior history

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6
Q

What nutrition state results in increased risk for surgical complications?

A

Severe malnutrition

Weight loss > 15% over prior 3-4 months

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7
Q

When is the body using carbohydrate vs fat stores?

A

Carbohydrate stores @ 24-72 hours

Fat stores @ 72hrs- 10 days (adaptive changes)

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8
Q

What is the nutritional status of a surgical pt hours after injury when pt exhibits sxs of shock and NE release?

A

Ebb phase

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9
Q

What is the nutritional status of a surgical pt days after injury when pt exhibits catabolic > anabolic processes (hypermetabolic, hyperglycemic, increased CO)?

A

Flow phase (peaks 3-5 days)

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10
Q

What is the nutritional status of a surgical pt weeks after injury when pt exhibits anabolic processes such as corticoid withdrawal and repletion?

A

Recovery phase

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11
Q

What lab test is used to indicate stress on the body if a pt has been in the hospital for a long time and has a half life of 21 days?

A

Serum albumin

< 3.5 g/dL

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12
Q

What lab test is used to indicate stress on the body, is highly sensitive, has a half life of 2-3 days and is used for trending purposes?

A

Prealbumin

< 5-17 g/dL

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13
Q

What lab test is used to indicate stress on the body by indicating if a pt is protein deficient and has a half life of 8 days?

A

Serum transferrin

< 200 mg/dL

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14
Q

What is the preferred nutrional support used for malnourished pts?

A

Enteral > parenteral

“if the gut works use it”

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15
Q

What is the nutritional caloric need for a “stressed” pt?

A

Stressed: 50 kcal/kgday, 2.5 protein/kg/day

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16
Q

What body temp should be maintained during immediate post op period for prevention of complications?

A

Core temp between 98.6- 100.4

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17
Q

What levels should glucose be maintained at through the surgical procedure?

A

150 mg/dL

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18
Q

When should hair removal be performed (clippers) for surgery?

A

Immediately prior to prep of surgical field

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19
Q

What skin antiseptics are preferred for prevention of surgical complications?

A

Chlorhexidine solutions (applied and air dry)

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20
Q

What oxygenation levels should be maintained intraoperatively?

A

80%

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21
Q

What is the most common method for prevention of VTE?

A

Mechanical (pneumatic compression)

+/- systemic anticoagulant

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22
Q

When should fluids and electrolytes be evaluated for POD 1 vs POD 2/ beyond?

A

POD 1- q 4-6 hrs

POD 2/ beyond- q 24 hrs

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23
Q

What is the preferred replacement IVF?

A

Crystalloids > colloids/ blood products

(colloids/ blood products more likely to stay in vascular compartment, colloids not used for rehydration/ bolus unless large amts of fluid loss)

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24
Q

What is the most common crystalloid used in the peri-operative period?

A

Isotonic > hyper/ hypotonic

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25
Q

What replacement IVF is used when cystalloids fail to sustain plasma volume due to low osmotic pressure (burns, peritonitis)?

A

Colloids

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26
Q

What Hg value is the common trigger for stable pts requiring a blood transfusion (1 unit = 1 g/dL increased in Hg)

A

7 g/dL

(earlier if sxs, underlying disease, transplant)

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27
Q

What type of transfusion therapy is used for active bleeding in thrombocytopenic pts?

A

Platelets (not packed cells)

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28
Q

What type of transfusion therapy is used for pts with deficiencies in clotting factors, active bleeding, or risk of bleeding from emergent procedure?

A

FFP

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29
Q

What is included in post op care of decreased functional residual capacity?

A

Periodic hyperinflation w/ incentive spirometry and early mobilization

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30
Q

When does peristaltic function begin to return post surgery?

A

Gastric- slowly

Small intestine- 24 hrs

R colon- 48 hrs

L colon- 72 hrs

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31
Q

What factors are the greatest contributors to post-op pain and what is the preferred tx?

A

Duration of surgery, degree of trauma

Opioids

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32
Q

Pt presents with fever, wound crepitence, and gray/ dusky coloration of the skin. What post-op complication are you concerned for and what is the tx?

A

Necrotizing fasciitis

Early/ aggressive surgical excision of affected tissue

33
Q

What post-op wound complication is defined as partial/ total disruption of any or all layers of the operative wound and when is it most common?

A

Dehiscence

5-8 days post-op

34
Q

What post-op wound complication is defined as rupture of all layers and extrusion of abdominal viscera?

A

Evisceration

35
Q

Where is the most common location for Meckel’s diverticulum?

A

Antimesenteric border of the ileum

36
Q

What is the rule of 2’s a/w Meckel’s diverticulum? (6)

A

2% of population

2:1 male: female

2 yo

2 ft from ileocecal valve

2 inches long

2 types of mucosa

37
Q

Pt presents w/ abdominal pain, bleeding, intestinal obstruction, (or asx). What post- op complication are you concerned for and what can be used for dx?

A

Meckel’s diverticulum

Dx w/ Meckel’s scan, mesenteric arteriography, abd exploration

38
Q

What is the tx for Meckel’s diverticulum?

A

Resection

39
Q

What post-op complication is more common in older pts w/ disease causing embolic formation or cardiac disease and presents w/ post-prandial/ intestinal angina with POOP on PE?

A

Mesenteric ischemia

40
Q

What is included in the management for mesenteric ischemia aside from aggressive fluid resuscitation and NG tube? (3)

A

Surgery- abd exploration (embolectomy, colon resection)

Abx

Systemic anticoagulation

41
Q

What is considered a high-output enteric fistula?

A

> 500 mL/day

42
Q

What is the most common cause of enterocutaneous fistulas?

A

Post-op complication

43
Q

What is used for dx of enteric fistulas?

A

Imaging- CT

+/- endoscopy

44
Q

What is the treatment for enteric fistula? (2)

A

Spontaneous closure vs operative tx

Control of drainage and skin protection

45
Q

When is bariatric surgery indicated? (4)

A

BMI > 40

BMI > 35 w/ comorbidity

Failure of non-surgical weight loss efforts

Well-informed, compliant, motivated

46
Q

What is the most common bariatric surgery performed in the US and what type is it (restrictive vs malabsorptive)?

A

Roux-en-y gastric bypass

Restrictive and malapsorptive

47
Q

What bariatric surgery is a band connected to a subcutaneous reservoir and what type is it (restrictive vs malabsorptive)?

A

Gastric banding

Restrictive

48
Q

Is a vertical banded gastroplasty a restrictive or malabsorptive bariatric surgery?

(rarely performed)

A

Restrictive

49
Q

Is a sleeve gastrectomy bariatric surgery restrictive or malabsorptive?

A

Restrictive

50
Q

What will a CT scan show for a pt with appendicitis?

A

Enlargement w/ wall thickening, fat stranding +/- fecalith

51
Q

What is included in the management for appendicitis?

A

Perioperative abx (3-5 days if perforated)

Appendectomy

52
Q

Pt who presents with diffiuse pain after localized tenderness and pain relief followed by peritonitis is concerning for what appendicitis complication?

A

Perforation

53
Q

Pt who presents with high fever post appendicitis w/ perforation is concerning for what?

A

Peritonitis

54
Q

Pt who presents with RLQ mass on PE with CT showing percutaneous drainage is concerning for what appendicitis complication and what is the tx?

A

Abscess

Tx w/ abx and appendectomy (if not already performed) +/- drain placement

55
Q

Where is diverticulitis most common and what can result from an acute attack?

A

Sigmoid

Obstruction

56
Q

What is included in the nonoperative management for diverticulitis?

A

Oral abx

Clear liquids

Low res diet (after sxs improve)

High fiber diet (once normal po intake)

57
Q

When is surgical management of diverticulitis indicated? (3)

A

2+ attacks

Complications

Failure to improve w/ 3-4 days of conservative management

58
Q

What surgical procedure involves the colon being divided with the proximal end being brought through the abdominal wall?

A

Colostomy

59
Q

What type of colostomy involves the distal end of the colon oversewn and placed in the peritoneal cavity as a blind limb?

A

Hartmann’s procedure

60
Q

What are the 2 types of colostomy?

A

Loop and ileostomy

61
Q

What type of colon resection involves removal of the entire colon and rectum?

A

Proctocolectomy

62
Q

What type of colon resection is performed for very low rectal cancers and involves removal of the lower sigmoid colon, entire rectum, and anus?

A

Abdominoperineal resection (APR)

63
Q

What type of colon resection is performed for cancers of the middle and upper sections of the rectum and involves removal of the distal sigmoid colon and 1/2 of rectum with proximal sigmoid-distal rectum anastomosis?

A

Low anterior resection (LAR)

64
Q

What is defined as a connection between 2 tubular organs?

A

Colonic anastomosis

65
Q

How can you differentiate between an internal vs external hemorrhoid?

A

Internal- above dentate line, may bleed/ prolapse, non-painful

External- below dentate line, do not bleed, pain/itching/scarring

66
Q

What is the most common cause of rectal bleeding?

A

Internal hemorrhoids

67
Q

How are hemorrhoids classified and when is hemorrhoidectomy considered?

A

Grades I-IV

Consider hemorrhoidectomy for grades III-IV
(mixed internal/ external, extensive thrombosis/ pain, persistent bleeding)

68
Q

What is the office tx for grade II and III internal hemorrhoid?

A

Rubber band ligation

69
Q

Pt presents with severe, sharp anal pain and PE shows a palpable, tender, fluctuant mass. What are you concerned for?

A

Anorectal abscess

70
Q

What is included in the tx for anorectal abscess aside from wound care?

A

Surgical drainage + abx

71
Q

What is defined as an abnormal communication between the anal canal and perianal skin?

A

Fistula in ano

(50% chance after abscess)

72
Q

How is fistula in ano diagnosed?

A

Cord like tract on DRE

Goodsall’s rule

73
Q

What is the tx for fistula in ano?

A

Drainage/ curretage of fistula tract

Placement of Seton (loop of drainage tube)

74
Q

Pt presents w/ palpable, soft abd mass +/- pain/ enlargement with straining. Pt examined upright/ supine confirms sxs. What are you concerned for?

A

Abd wall hernia

75
Q

What is the management for an abd hernia?

A

Surgical repair

(can use laparoscopic if bilateral inguinal, recurrent, ventral/ epigastic)

76
Q

Where will a direct inguinal hernia occur?

A

Through Hesselbach’s triangle

(inguinal ligament inferiorly, inferior epigastric vessels laterally, rectus muscle medially)

77
Q

What kind of repair is used for an inguinal hernia?

A

Lichtenstein hernia repair

(uses mesh)

78
Q

What post-op complications are a/w inguinal hernias?

A

Scrotal hematoma

Hemorrhage

Difficulty voiding

Pain

Neuroma/ neuritis

79
Q

When is there a low vs high risk for hernia recurrence?

A

Low risk for indirect inguinal hernias/ Shouldice and Lichtenstein procedure

High risk for direct (if underlying process not corrected)

3. E Med & Surgery (19 decks)

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