Chapter 1: Pre-op Flashcards
During Surgical Examination, you look out for
Jaundice Anaemia Cyanosis Clubbing Oedema Lymphadenopathy
During Medical Examination, you look out for
Dressed In a Surgeon’s Gown A Physician Should Succeed In Treatment
Definition Incidence Sex Geography Aetiology Pathogenesis Signs Symptoms Investigation Treatment
During a Pathological Examination, you look out for
Dressed in a Sugeon’s Gown A Physician Might Make Progress
Definition Incidence Sex Geography Aetiology Pathogenesis Macroscopic Pathogenesis Microscopic Pathogenesis Prognosis
What are the different kinds/categories of Surgical Complications?
CIMETIDINE Congenital Inflammation Metabolic Endocrine Trauma Ischaemia Drug induced Iatrogenic Neoplasm Everything else
Name 11 different kinds of incisions/scars
Kocher Ramstedts Pyloromyotomy scar McBurneys Periumbilical Lateral thoracolumbar scar Upper Midline incision Inguinal incision Renal transplant scar Point incision scar Periumbilical scar
Define Abscess
A cavity containing pus
Define Cyst
A fluid filled cavity surrounded by epi/endometrium
Define Fistula
A connection made between two epithelial surfaces
Define Hernia
A weakness in the abdominal wall that ruptures and allows a viscus or part of a viscus through the defect
Define Ileus
Adynamic Bowel
Define Colic
Intermittent Pain caused by an obstruction of a hollow viscus
Define Sinus
A blind-ending tract, lined with epithelium or granulation tissue, which opens up to an epithelial surface.
Define Stent
An artificial tube placed inside a biological one to keep it open
Define Stoma
An artificial union between two conduits (or a conduit and the outside).
Define Ulcer
An interruption in the continuity of an epi/endothelial surface
Define Volvulus
Twisting of a structure around itself
Define Pre-Op Care
Provides diagnositc and prognostic information, to understand the nature, aims and outcome of surgery
Name the 4 aims of Pre-Op Care
Ensure pt gets the right surgery
Get informed consent
Assess/balance risks of anaesthesia while maximising fitness
Check Anaesthesia type with Anaesthetist
Note: optimise O2 to improve outcome of surgery
How would you assess a pt for Pre-Op Checks
1: asses cardiovascular risk, exercise tolerance, check illnesses, drugs taken, allergies
2: Take pt history: MI, Diabetes, HT, Asthma, Rhematic fever, Epilepsy
3: Assess risks: pregnancy, complications DVT, previous anaesthesia, Neck stability
When taking Family History in Surgery, you must take note of
Malignant Hyperpyrexia Dystrophy myotonica Porphyria Cholinesterase problems Sickle-cell disease
What should you look out for in drug history and allergies for: ABx Anticoagulants Anticonvulsants B-blockers Contraceptive Steroids Digoxin Diuretics Levodopa Lithium Tricyclics
plaster/antiseptic/drugs
ABx: Tetracyclin and neomycin = NM blockade
ACoag: do not give it regional, epidural and spinal blocks
AConv: Give as usual pre-op, but give them IV post op
B-block:
Contraceptive Steroids
Digoxin: keep as normal, since it excludes labile cardiovascular response.
Diuretics: check for hypokalaemia and dehydration - do U&E
Levodopa: arrhythmias
Lithium: NM blockade and arrhythmias
Tricyclics: enhance adrenaline and arrhythmias
Which part of the drugs in drug history should you be aware of?
ABx Anticoagulants Anticonvulsants B-blockers Contraceptive Steroids Digoxin Diuretics Levodopa Lithium Tricyclics
As a house officer, how would you prepare a pt for a surgery in the ward (before he goes to theatre)?
- Fast patient
- Bowel/Skin prep and prophylactic ABx
- Start DVT prophylaxis
- Write up pre-meds and book X-rays + Frozen sections
- Book post-op physio
- Catheterise + insert ng tube before induction
Pre-Op Checklist for bloods
U+E
FBC
Blood glucose test
Amylase: if acute abdomen
LFT: if jaundice, liver disease or alcoholic
Drug test: if suspected abuser
Clotting studies: if liver/renal disease, blood losses, high risk patients
