Angela's Anatomy/Surgical complications Flashcards
What are the most common infections following splenectomy?
Pneumococcus, meningiococcus
*Strep pneumo is the most common of the 2
Also haemophilus influenza (HiB)
Encapsulated organisms
What is LEAST important in management of pancreatic leak?
A) ngt decompression
B) surgery to repair leak
C) somatostatin
D) tpn
surgery to repair the leak
3x ULN amylase to define via drain
In electrosurgery, which type of voltage causes the least amount of tissue injury?
Lowest voltage. 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. Do you tie off her ureter at the pelvic brim or do a nephrectomy?
Tie off ureter - less morbid
Malignant hyperthermia - how does Dantrolene sodium work?
Binds to RYR1, inhibits sarcoplasmic reticulum calcium release
*requires sufficient Mg++ to work
What is the treatment for malignant hyperthermia?
Duplicate
Dantrolene sodium 2.5 mg/kg, discontinuation of the trigger
internet: dantrolene acts intracellularly in skeletal muscle to lessen the excitation-contraction coupling interaction between actin and myosin within the individual sarcomere.
Which is least likely to trigger malignant hyperthermia?
Halothane, sevoflurane, desflurane, propofol
Propofol
What are symptoms of malignant hyperthermia?
Duplicate
hypercapnia/carbia (most reliable first sign)
tachycardia
masseter muscle rigidity
eventual EKG changes
rhabdomyolysis
First sign is unexplained ETCO2 increase, tachypnea
Due to calcium overload within the skeletal muscle cell that leads to sustained muscular contraction and breakdown -> anaerobic metabolism
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
What do you do if you make a clean transection of the ureter at the level of the uterine artery?
A) ureteroneocystotomy
B) ureteroureterostomy
C) transureteroureterostomy
D) urinary diversion
E) cutaneous ureterostomy
ureteroneocystotomy
What do you do if you clamp the ureter, immediately recognize the mistake, and release the clamp?
stent
What is the next best step to treating a patient with a ureteral leak at the level of a urinary conduit?
IR drainage of a large urinoma/abscess and either delayed removal of stents or reinsertion if already pulled - typically antegrade via PCN by IR
What detrusor issue happens immediately postop in rad hyst?
detrusor hypertonia
UTD:
injury to the sensory and motor nerve supply to detrusor muscle of the bladder during the resection of anterior, lateral, and posterior parametrium and vaginal cuff Denervation results in detrusor hypertonicity.
Urodynamic studies: usually a phase during which the bladder has increased resting tone and small volume, with intermittent uncontrolled contractions. This is usually followed by a period of decreased bladder tone, increased residual volume, and absence of bladder wall contractions. Fortunately, constant drainage over several weeks or months often allows the bladder to resume more normal function.
To what depth should VIN be ablated in non-hair baring areas?
1 mm non hair areas
To what depth should VIN be ablated in hair bearing areas?
3 mm in hair areas
Which is the greatest risk factor predisposing to leak during low anterior colorectal anastomosis?
distance from the anal verge “Low rectal anastomosis”, less 7 cm from anal verge
What is most likely to decrease post op wound drainage after groin node dissection?
sparing the saphenous
In inguinal lymphadenectomy do drains increase or decrease complications?
increase
B&H 2021 p1028
MOA lovenox (enoxaparin)?
Duplicate
binds to and accelerates antithrombin III causing Xa inhibition
Enoxaparin binds to and potentiates antithrombin (a circulating anticoagulant) to form a complex that irreversibly inactivates clotting factor Xa. It has less activity against factor IIa (thrombin) compared to unfractionated heparin (UFH) due to its low molecular weight
What is the advantage of LMWH compared to heparin?
fewer bleeding complications, greater ease of use
What do you when you see HIT with heparin, how does it present?
Thrombosis !!! increasing clot despite heparin and low PLTs
usually 5-14 days after heparin was given though it may be earlier if they are being re-challenged
How do you treat HIT?
Duplicate
argatroban (Parenteral direct thrombin inhibitor) is probably best option
Argatroban: direct thrombin inhibitor, a class of anticoagulant drugs
Others:
Bivalirudin (Parenteral DTI) - if liver failure
Danaparoid (Parenteral inhibitor of thrombin and factor Xa (indirect, heparinoid)
Fondaparinux (parental Xa inhibitor)
Apixaban, Edoxaban, Rivaroxaban (PO Xa inhibitor)
Dabigatran (ODTI)
Warfarin (CANNOT BE USED INITIALLY)
What is the blood supply to the long gracilis flap?
medial femoral circumflex artery
what is the blood supply to the short gracilis flap?
terminal branches of obturator artery
Which 3 vessels are present in the superficial inguinal triangle?
1.superficial external pudenal
2.superficial inferior epigastric
3.superficial circumflex iliacs
? Seem to be vessels that are in the superficial area of hesselbach / inguinal triangle?
Remember borders of Hesselbach / inguinal triangle are (rectus muscle - medial; inferior epigastric - superior; inguinal ligament inferior)
What are the borders of the femoral triangle?
1.sartorious
2.adductor longus
3.inguinal ligament
Most likely artery to be transected in rectal resection for ovarian cancer?
superior rectal
Rectal artery flow
(Origins of rectal arteries)
- Inferior Rectal a from internal pudenal
- Middle rectal a from internal iliac
- superior rectal from IMA
What muscle divides the subclavian artery and vein?
anterior scalene
What is the origin of the middle rectal artery?
The anterior branch of the internal iliac
What are the 4 major branches of the SMA?
1.inferior pancreaticoduodenal
2.middle colic
3.right colic
4. ileocolic
Where does the SMA arise from the aorta? (What spinal level)
L1
What are the arcades that anastomose the SMA and IMA along the bowel called?
Marginal artery of Drummond
Occasionally there is an anastomotic vessel between SMA and IMA, what is it called?
Arc of Riolan
Which artery supplies descending colon from splenic flexure to sigmoid colon?
where does it originate?
left colic, originates IMA
What are the branches of the anterior division of the internal iliac artery?
Umbilical
Superior vesicular
Obturator
Vaginal
Uterine
Middle rectal
Internal pudendal
Inferior gluteal
(Everything serves midline structures except inferior gluteal and obturator)
During a pelvic lymph node dissection, what nerve was injured if the patient experiences numbness of the anterior and medial thigh?
What nerve roots form this nerve?
Genitofemoral nerve
L1-2
Which injury results in difficulty walking and tingling anterior thigh?
Femoral nerve
(lateral cutaneous femoral) <— don’t think this is correct bc femoral supplies anterior thigh sensory
What are the nerve roots that form the lateral cutaneous femoral nerve?
L2-3
Notes say L2-4, but this is incorrect - this is femoral
Injury to which nerve causes numbness of the symphysis pubis and groin?
What are the nerve roots of this nerve?
Ilioinguinal
T12-L1
What is the course of the pudendal vessels and nerve?
Internal Pudendal Artery: originates from anterior division of internal iliac artery; exits the greater sciatic foramen (between the piriformis and coccygeus mm) and enters back in through the lesser sciatic foramen into the pudendal canal of Alcock (with nerve) which terminates 2-3cm proximal to ischial tuberosity
- branches: inferior rectal, perineal (gives off the transverse perineal), continues on as clitoral artery (gives off the deep clitoral)
What are the branches of the pudendal nerve?
Inferior rectal (inferior anal) supplies the anus and perianal skin
Perineal–supplies small muscles of the superficial and deep spaces (motor) and labia minora and majora (sensory)
Dorsal clitoras–sensory
