Anatomy/Surgical Complications Flashcards
What are the most common infections following splenectomy?
Pneumococcus, meningiococcus
What is the most common organism causing infection following splenectomy?
s. Pneumococcus
What is LEAST important in management of pancreatic leak?
Surgery to repair the leak-avoid surgery on these patients
Answer choices include: ngt decompression, somatostatin, TPN
In electrosurgery, which causes the least amount of injury?
The lowest voltage causes the least amount of injury, therefore CUT is less injuring because it has less voltage
A patient with a chronically obstructed ureter has <5% function at the time of en-bloc resection of recurrent cancer. What is the best next step?
Tie off the ureter at the pelvic brim.
Much less morbid than doing a nephrectomy
What is the treatment for malignant hyperthermia?
Dantrolene 2.5 mg/kg IV and discontinuation of the trigger
What is the mechanism of action of Dantrolene?
Binds to RYR 1, inhibits sarcoplasmic reticulum calcium release
What is the dose of Dantrolene?
2.5mg/kg IV
What are the symptoms of malignant hyperthermia?
Hypercapnia, tachycardia, masseter muscle rigidity, eventual EKG changes and rhabdomyolysis
What is the LEAST likely to trigger malignant hyperthermia?
Propofol
Most common are the -anes: halothane, sevoflurane, desflurane
What electrolyte abnormality is common with malignant hyperthermia?
Hyperkalemia
What is the BEST repair for a 1cm laparoscopic trocar injury to the colon that has not been prepped?
Primary closure, avoid narrowing of the lumen
What do you do if you make a clean transection of the ureter at the level of the uterine artery?
Ureteroneocystotomy
What do you do if you clamp the ureter, immediately recognize the mistake, and release the clamp?
Stent the ureter to ensure it is patent, clamp can cause crush/pressure necrosis
What is the next best step to treating a patient with a ureteral leak at the level of a urinary conduit?
IR Drainage of the abscess/urinoma, delayed removal of stent or reinsert if already removed, IR by PCN
What detrusor issue happens immediately postop in a rad hyst?
Detrusor hypertonia
To what depth should VIN be ablated in non hair-bearing areas?
1mm
To what depth should VIN be ablated in hair bearing areas?
3mm
What is the greatest risk factor for predisposing to leak during LAR Colorectal anastomosis?
Distance from the anal verge, <7 cm
Which is most likely to decrease the wound drainage in groin dissection?
Sparing of the saphenous
In Inguinal lymphadenectomy, do drains decrease or increase the complications?
Increase
What is the mechanism of action of lovenox?
Binds to and accelerates antithrombin IIIa causing factor Xa inhibition
What is the advantage of LMWH compared to heparin?
Fewer bleeding complications, greater ease of use
How does HIT present?
Thrombosis, increasing clot despite heparin and low platelets, usually 5-14 days after heparin was administered
How do you treat HIT?
Argatroban
What is the blood supply of the long gracilis flap?
Medial femoral circumflex artery
What is blood supply to the SHORT gracilis flap?
Terminal branches of the obturator artery
Which 3 vessels are present in the superficial inguinal triangle?
Superficial external pudendal
Superficial inferior epigastrics
Superficial circumflex iliacs
What are the borders of the superficial inguinal triangle?
Medial-lateral border of the rectus muscle
Lateral: inferior epigastric vessles
Inferior: inguinal ligament
What are the borders of the femoral triangle?
Sartorius
Adductor longus
Inguinal ligament
What is the most likely artery to be transected in RECTAL resection for ovarian cancer?
Superior rectal
Rectal arterial flow
Inferior rectal from the pudendal
Middle rectal from the internal iliac
Superior rectal from the IMA
What is the origin of the middle rectal artery?
The anterior branch of the internal iliac artery
What are the 4 major branches of the SMA?
Inferior pancreaticoduodenal
Middle colic
Right colic
Ileocolic
What level does the SMA arise from the aorta?
L1
Which half of the colon does the SMA supply?
Right, cecum, ascending and 2/3 of the Transverse colon
Which portions of the small bowel does the SMA supply?
Ileum, jejunum, distal duodenum
At the time of reoperation, you notice the jejunum is necrotic. Which artery is likely compromised?
SMA or jejunal
What are the arcades that anastomose the SMA and IMA along the bowel called?
Marginal artery of Drummond
What is another anastomotic vessel between SMA and IMA?
Arc of riolan
Where does the inferior pancreaticoduodenal artery arise?
SMA
What does the inferior pancreaticoduodenal artery supply?
Pancreas and Duodenum
What is the origin of the middle colic artery?
SMA
What does the middle colic artery supply?
Transverse colon
What portion of the colon does the IMA supply?
Descending, sigmoid, and rectum
What are the major branches of the IMA?
Left colic
Sigmoid
Superior rectal
What is the most likely to collateral to the IMA?
Internal iliac artery
At what level does the IMA branch off of the aorta?
L4
Which artery supplies the descending colon from the splenic flexure to the sigmoid colon?
Left colic
Where does the left colic artery originate from?
IMA
Which major artery supplies the rectum?
Superior rectal
Where does the superior rectal artery originate from?
IMA
What are the vessels of the anterior branch of the internal iliac artery?
Obturator, inferior gluteal, vaginal, inferior vesicle, middle rectal, internal pudendal, uterine
What are the vessels of the posterior branch of the internal iliac artery?
Ileolumbar, lateral sacral, superior gluteal
What supplies the omentum?
Gastroepiploic arteries
Where does the left gastroepiploic artery originate from?
Splenic artery
What does the external jugular drain into?
Subclavian vein
Where does the IMV drain?
Splenic
Where does the SMV drain?
Comes together with the splenic to make the portal
What intraoperative injury causes wrist drop?
Radial nerve injury
While performing a lymph node, dissection, you transect a nerve running over the iliopsoas. What motor deficit would the patient have?
Decreased extension of the knee and hip flexion
What injury and a radical hysterectomy with pelvic nodes would present with numbness of the anterior and medial thigh?
Genitofemoral
What are the nerve roots for the genitofemoral nerve?
L1-2
Which injury results in difficulty walking and a tingling anterior thigh?
Femoral, lateral cutaneous femoral
What are the roots of lateral cutaneous femoral?
L2-4
Which injury would cause numbness of the symphysis pubis and groin?
Ilioinguinal
What are the nerve roots for ilioinguinal nerve?
T12-L1
Femoral nerve: motor innervation
To iliopsoas for hip flexors
To quadriceps for knee extension
Course of the internal pudendal artery
Arises from the anterior division of the internal iliac artery, comes OUT of the greater sciatic foramen and back in through the lesser sciatic foramen into the pudendal canal of Alcock
Branches of the internal pudendal artery
Inferior rectal
Perineal
Continues on as clitoral artery
Pudendal nerve roots
S2-4, motor and sensory
Pudendal Nerve branches
Inferior rectal: supplies anus and perineal skin
Perineal: small muscles of the superficial and deep spaces (motor) and labia minora and majora
Dorsal clitoral (sensory)
