Basics of surgery

Question 1

Define adhesions

Answer 1

scar-like tissue inside the body that bind surfaces together

Question 2

Define fistula

Answer 2

an abnormal connection between two epithelial surfaces

Question 3

Define tenesmus

Answer 3

the sensation of needing to open bowels without being able to produce stools (often accompanied by pain)

Question 4

Define hemicolectomy

Answer 4

removing a portion of the large intestine (colon)

Question 5

Define Hartmann’s procedure

Answer 5

removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy (proctosigmoidectomy)

Question 6

Define anterior resection

Answer 6

removal of the rectum

Question 7

Define Whipple’s procedure

Answer 7

removal of the head of the pancreas, duodenum, gallbladder and bile duct (pancreaticoduodenectomy)

Question 8

When is kocher incision used?

Answer 8

open cholecystectomy. top right diagonal incision.

Question 9

When is chevron/ rooftop incision used?

Answer 9

liver transplant, Whipple procedure, pancreatic surgery or upper GI surgery

Question 10

When is mercedes benz incision used?

Answer 10

liver transplant

Question 11

When is midline incision used?

Answer 11

for a general laparotomy, allows good access to abdominal organs

Question 12

What are the different incisions used for open appendicectomy

Answer 12

Battle incision, gridiron/ mcburney incision, lanz incision, Rutherford Morrison incision

Question 13

What is diathermy?

Answer 13

Diathermy uses a high-frequency electrical current to cut through tissues or to cauterise small blood vessels to stop bleeding.

Question 14

What is pfannensteil incision?

Answer 14

curved incision two fingers width above the pubic symphysis. Joel-Cohen incision is a straight incision that is slightly higher (this is the recommended incision).

Question 15

Two types of diathermy

Answer 15

monopolar and bipolar diathermy

Question 16

Types of absorbable sutures

Answer 16

Vicryl and Monocryl.

Question 17

Types of non-absorbable sutures

Answer 17

remain in place for a long time and provide support to the tissues. Examples include silk, nylon and polypropylene.

Question 18

What is ASA Grade?

Answer 18

American Society of Anesthesiologists. Patients are given a grade to describe their current fitness prior to undergoing anaesthesia/surgery.

Question 19

What are the different classifications of ASA?

Answer 19

ASA I – normal healthy patient
ASA II – mild systemic disease
ASA III – severe systemic disease
ASA IV – severe systemic disease that constantly threatens life
ASA V – “moribund” and expected to die without the operation
ASA VI – declared brain-dead and undergoing an organ donation operation
E – this is used for emergency operations

Question 20

What are the pre-operative assessments?

Answer 20

group and save, crossmatching for blood transfusiion. ECG or ECHO if cardiac issues. LFTs and ABG for resp problems. HbA1C if patient is diabetic. U&E’s if there is a possibility of developing AKI or electrolyte abnormalities.

Question 21

Fasting before surgery

Answer 21

6 hours of no food or feeds and 2 hours NBM.

Question 22

Fasting before surgery in acutely unwell surgical patient

Answer 22

Acutely unwell surgical patients that potentially require emergency surgery are made nil by mouth and given maintenance IV fluids.

Question 23

What medications needs to be stopped prior surgery?

Answer 23

Anticoagulants need to be stopped before major surgery. The INR can be monitored in patients on warfarin to ensure it returns to normal before the operation.
Oestrogen-containing contraception or HRT need to be stopped 4 weeks before surgery to reduce the risk of VTE

Question 24

How can u reverse warfarin?

Answer 24

Warfarin can be rapidly reversed with vitamin K in acute scenarios

Question 25

What are the implications of a surgical patient using long term corticosteroids (>5mg oral pred)?

Answer 25

Surgery adds additional stress to the body, which normally increases steroid production. In patients on long-term steroids, there is adrenal suppression that prevents them from creating the extra steroids required to deal with this stress. Management involves:

• Additional IV hydrocortisone at induction and for the immediate postoperative period (e.g., first 24 hours)
• Doubling of their normal dose once they are eating and drinking for 24 – 72 hours depending on the operation

Question 26

What are the implications of a surgical patient with diabetes?

Answer 26

The stress of surgery increases blood sugar levels. However, fasting may lead to hypoglycaemia. In general, the risk of hypoglycaemia is greater than hyperglycaemia.

Question 27

What is the management of patients on insulin going for surgery

Answer 27

Continue a lower dose (BNF recommends 80%) of their long-acting insulin
Stop short-acting insulin whilst fasting or not eating, until eating and drinking again
Have a variable rate insulin infusion alongside a glucose, sodium chloride and potassium infusion (“sliding-scale”) to carefully control their insulin, glucose and potassium balance

Question 28

VTE prophylaxis in surgical patients

Answer 28

Low molecular weight heparin (LMWH) such as enoxaparin
DOACs (e.g., apixaban or rivaroxaban) may be used as an alternative to LMWH
Intermittent pneumatic compression (inflating cuffs around the legs)
Anti-embolic compression stockings

Question 29

What are the 4 criteria a patient needs to meet to demonstrate capacity to make a decision?

Answer 29

• Understand the decision
• Retain the information long enough to make the decision
• Weigh up the pros and cons
• Communicate their decision

Question 30

Legal framework around capacity and making decisions for patients that lack capacity

Answer 30

Mental Capacity Act (2005).

Question 31

What are the different types of consent forms?

Answer 31

Content Form 1: Patient consenting to a procedure
Consent Form 2: Parental consent on behalf of a child
Consent Form 3: Where the patient won’t have their consciousness impaired (e.g., a breast biopsy)
Consent Form 4: Where the patient lacks capacity

Question 32

What is used to reverse the effects of opiates in respiratory depression

Answer 32

Naloxone

Question 33

When giving morphine what drugs are prescribed in conjunction?

Answer 33

antiemetics and laxatives to avoid constipation from opiates