Basics of surgery Flashcards
Define adhesions
scar-like tissue inside the body that bind surfaces together
Define fistula
an abnormal connection between two epithelial surfaces
Define tenesmus
the sensation of needing to open bowels without being able to produce stools (often accompanied by pain)
Define hemicolectomy
removing a portion of the large intestine (colon)
Define Hartmann’s procedure
removal of the rectosigmoid colon with closure of the anorectal stump and formation of a colostomy (proctosigmoidectomy)
Define anterior resection
removal of the rectum
Define Whipple’s procedure
removal of the head of the pancreas, duodenum, gallbladder and bile duct (pancreaticoduodenectomy)
When is kocher incision used?
open cholecystectomy. top right diagonal incision.
When is chevron/ rooftop incision used?
liver transplant, Whipple procedure, pancreatic surgery or upper GI surgery
When is mercedes benz incision used?
liver transplant
When is midline incision used?
for a general laparotomy, allows good access to abdominal organs
What are the different incisions used for open appendicectomy
Battle incision, gridiron/ mcburney incision, lanz incision, Rutherford Morrison incision
What is diathermy?
Diathermy uses a high-frequency electrical current to cut through tissues or to cauterise small blood vessels to stop bleeding.
What is pfannensteil incision?
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).
Two types of diathermy
monopolar and bipolar diathermy
Types of absorbable sutures
Vicryl and Monocryl.
Types of non-absorbable sutures
remain in place for a long time and provide support to the tissues. Examples include silk, nylon and polypropylene.
What is ASA Grade?
American Society of Anesthesiologists. Patients are given a grade to describe their current fitness prior to undergoing anaesthesia/surgery.
What are the different classifications of ASA?
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
What are the pre-operative assessments?
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.
Fasting before surgery
6 hours of no food or feeds and 2 hours NBM.
Fasting before surgery in acutely unwell surgical patient
Acutely unwell surgical patients that potentially require emergency surgery are made nil by mouth and given maintenance IV fluids.
What medications needs to be stopped prior surgery?
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
How can u reverse warfarin?
Warfarin can be rapidly reversed with vitamin K in acute scenarios
What are the implications of a surgical patient using long term corticosteroids (>5mg oral pred)?
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
What are the implications of a surgical patient with diabetes?
The stress of surgery increases blood sugar levels. However, fasting may lead to hypoglycaemia. In general, the risk of hypoglycaemia is greater than hyperglycaemia.
What is the management of patients on insulin going for surgery
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
VTE prophylaxis in surgical patients
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
What are the 4 criteria a patient needs to meet to demonstrate capacity to make a decision?
- Understand the decision
- Retain the information long enough to make the decision
- Weigh up the pros and cons
- Communicate their decision
Legal framework around capacity and making decisions for patients that lack capacity
Mental Capacity Act (2005).
What are the different types of consent forms?
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
What is used to reverse the effects of opiates in respiratory depression
Naloxone
When giving morphine what drugs are prescribed in conjunction?
antiemetics and laxatives to avoid constipation from opiates
