6. Indications and types of operations

Question 1

Indications

Answer 1

Absolute - Vital, urgent, semi-urgent, elective (planned)

Relative

Question 2

Steps of a surgery

Answer 2

1. Insicion
2. Opening
3. Exploration
4. Substantive operation
5. Anastomosis and wound revision
6. Hemostasis

Question 3

Bleeding risk: physical exam

Answer 3

Look for petechiae, ecchymoses, spleno-, hepatomegaly and haematomas.

Petechiae = platelet disorders
Haematomas = coagulation disorders

Question 4

Bleeding risk: lab tests

Answer 4

Platelet count: 150 - 400 G/l
INR: should be around 1 (08-1,2)
aPTT

Question 5

Bleeding risk: Congenital bleeding disorders

Answer 5

von Willebrands disease

Haemophilia

Question 6

Bleeding risk: Aquired bleeding disorders

Answer 6

Advanced liver disease 
Drugs 
Aquired thrombocytopenia
Uraemia 
DIC
Primary/secondary fibrinolysis

Question 7

Bleeding risk: types of bleeding

Answer 7

venous, arterial, capillary

Question 8

Surgical techniques in haemostasis

Answer 8

Regular business:

Ligation
Suture ligation / stick tie / figure of eight suture
Clips

Sci-fi shit:

Electrocautery
Monopolar diathermy
Bipolar diathermy

Question 9

Types of drainage

Answer 9

• Rubber bands: used in small wounds
• Penrose/capillary drains: used in large wounds and body cavities
• Open drainage: fluid is drained into the dressing
• Semi-closed drainage: colostomy bags
• Closed drainage: Redon drain

Question 10

The most common types of surgeries

Answer 10

Amputation
Anastomosis

Bypass

Enterostomy
Enucleation (removal of capsulated organs)
Excochleation (tissue removal with spoon)
Extirpation (removal of full organ)
Excision