Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Surgery > Common Abdominal and Chest Surgeries > Flashcards

Common Abdominal and Chest Surgeries Flashcards

1
Q

What is the main difference between open surgery (laparotomy) and laparoscopy?

A

Size of incision
Laparotomy: single incision multiple inches long
Laparoscopy: minimally invasive with several incisions one-quarter or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the difference between laparoscopy and laparotomy as far as recovery?

A

Laparotomy: longer recovery, hospital admission
Laparoscopy: less blood loss, less trauma, faster recovery, many can go home that day or after 23 hr OBS, can be more $

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

how is a patient selected for laparotomy vs laparoscopy?

A

Overall health
BMI
Prior surgeries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is used for scoring of appendicitis and what score has a high index of suspicion?

A

Alvarado score
7-10

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Common cause of appendicitis

A

Fecalith/appendiceal obstruction
Can be cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Work up of appendicitis

A

Labs: leukocytosis + left shift
U/S: initial imaging modality in children when body habitus permits
+/- abdominopelvic CT scan with oral contrast if concerned for perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Indications for appendectomy

A

Standard of care for acute appendicitis
Som may elect for conservative non op management if uncomplicated non perforated appendicitis, but 30% have recurrent appendicitis within 1 year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What abx would be given if a patient opts for non op management of appendicitis

A

IV abx for 1-3 days followed by oral
Ceftriaxone + metronidazole IV
followed by fluoroquinolone + metronidazole, 3rd gen cephalosporin + metronidazole or augmentin oral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the psoas sign?

A

Extend hip and see if pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

A patient should do what prior to appendectomy?

A

Void bladder to prevent bladder injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Procedure of laparoscopic appendectomy

A

Pneumoperitoneum via Veress needle or open Hassan
Laparoscope inserted into abdomen and 2 additional ports placed: one in LLQ, one in suprapubic region
Patient positioned in trendelenburg with left side of table down to pull small bowel away from cecum
Abdomen inspected and cecum ID
Cecum grasped and appendix IDd
Mesoappendix grasped and divided with endoscopic stapler
Endoscopic stapler used to remove appendix from cecum
Abdomen irrigated and inspected for bleeding
If hemostasis satisfactors, ports removed under direct visualization, fascia and skin closed, dressings applied

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Laparotomy appendectomy procedure

A

Dissection through Camper and Scarpa fascia
External abdominal aponeurosis exposed and incised
External oblique split
Internal oblique muscle and transversus abdominis split to expose transversalis fascia and peritoneum
Transversalis fascia and peritoneum grasped with 2 straight clamps
Incision with Metzenbaum scissors and peritoneal cavity entered
Appendix mesoappendix complex freed and mesoappendix ligated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Post appendectomy care

A

Can d/c home same day with nonperforated/uncomplicated lap appy
Admit for perforation or open technique
Abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What abx are used for non-perforated/uncomplicated lap appy? What about perf-postop?

A

Lap-appy: single preop dose
perf-postop: ceftriaxone and metronidazole x5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indications for cholecystectomy

A

Symptomatic cholelithiasis, may also require intraoperative cholangiogram
Asymptomatic cholelithiasis if increased risk of GB carcinoma or gallstone complications
Acalculous cholecystitis
Gallbladder polyps >.5 cm
Porcelain gallbladder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Contraindications for cholecystectomy

A

Diffuse peritonitis
Hemodynamic compromise
Uncontrolled bleeding disorders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Most common indication for open chole vs lap chole

A

Inability to safely perform a lap chole or highly suspect cancer
have hemodynamic conpromise and will not tolerate introp pneumoperitoneum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

work up of cholecystectomy

A

RUQ US
+/- abdominal CT scan
Labs
+/- MRCP
+/- ERCP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Complications of cholecystectomy

A

Common bile duct injury/CBD leaks/obstruction
Bowel injury
Liver injury
Intra-abdominal abscess
Bleeding
dyspepsia and diarrhea

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When should you suspect common bile duct injury/CBD leaks/obstruction

A

fever
abdominal pain
2-10 days postop

may lead to peritonitis/infection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

how would you confirm common bile duct injury/CBD leaks/obstruction

A

U/S or CT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

how is common bile duct injury/leak/obstruction treated?

A

U/S guided percutaneous drainage with ERCP to stent or repair OR re-operation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

post-op care if uncomplicated lap chole

A

d/c home same day
give po pain meds no abx needed
f/u in office in 5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

post-op care if open or complicated lap chole

A

admit for 1-3 days
pain meds
typically no abx needed unless surgery contraindicated
monitor for complications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
common colon surgeries
right colectomy: cecum, ascending colon, hepatic flexure, first portion transverse colon left colectomy: second portion transverse colon, splenic flexure, descending colon, sigmoid colon total colectomy sigmoid colectomy proctocolectomy: includes the anus colostomy
26
indications for colon surgery
tumors/masses ulcerative colitis diverticulitis/perforation ischemic colitis: vasculopath, intestinal volvulus/obstruction
27
work-up for colon surgery
PE- palpable mass? Labs: tumor markers (CEA/CA 19-9) Colonoscopy CT abdomen and pelvis w/IV and oral contrast
28
What are reasons for benign disease colectomy?
IBD Diverticular disease Rectal prolapse Colonic dysmotility
29
What are neoplasia reasons for colectomy?
Polyps not amenable to resection via colonoscopy Colorectal cancers Hereditary colon cancer syndromes: familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer
30
Compared with open colectomy, laparoscopic surgery has been shown to be associated with decreased ....
post op pain and analgesia requirement, faster return of bowel function, earlier resumption of PO intake, shorter hospital stay, and better cosmesis
31
What are the drawbacks of laparoscopic colectomy?
Time consuming --> greater expense and require specialized training
32
Complications of colectomy
Anastomotic leak Intra-abdominal abscess Bleeding Bowel obstruction
33
What is a colostomy?
Piece of colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon
34
Inidications for colostomy
Gangrenous/perforated bowel Colorectal cancer INflammatory bowel disease Trauma: GSW/penetrating wounds Fecal diversion: common in quad/para pts who have decubitus ulcers, prevent fecal contamination/infection
35
Post-op care for colostomy
Admit for anywhere from 6-12 days for open procedure; 4-6 days for laparoscopic procedure typically NPO first 24 hours, then clear liquids --> full liquids next 24, then regular diet if tolerated Postop abx if indicated Pain management Ambulation - up ith assistance POD 2, walking with assistance POD 3 Incentive spirometer use F/U in office 10 days PO (5-7 days after discharge)
36
Risk factors for developing hernias
Straining Fascial weakness or defect from previous incision or injury Obesity, more common in males
37
Diagnosis of hernia
Pain with movement Bulge or mass that worsens with straining Palpable mass/defect on PE Confirm with CT
38
What is an indirect hernia
Passes through inguinal canal and into scrotum
39
What is a direct hernia
Originates above Hesselbach's triangle - bulge above inguinal ligament
40
what is a femoral hernia
bulge below inguinal ligament in area of the femoral canal
41
Nerve supply to hernia
ilioinguinal genito-femoral genital femoral lateral cutaneous branch of femoral
42
Surgery is indicated for all ..... hernias
inguinal and femoral If strangulated/incarcerated- urgent/emergent surgery
43
Watchful waiting can be considered with hernia for ....
men without symptoms; all women should have surgery due to higher risk for complications and strangulation/incarceration Femoral hernias are more common in elderly women
44
Post-op complications of herniorrhaphy
Hematoma/seroma MC Chronic pain: post-hernia repair neuralgia (m/c with open) with pain lasting >3 months postop Infection Hernia recurrence Mesh erosion/infection
45
Most common chest surgeries
Lumpectomy Mastectomy Video-assisted thoracoscopic surgery: diagnostic or therapeutic Open thoracotomy: lobectomy or CABG
46
Indications for lumpectomy
Lump: fibroadenoma Ductal carcinoma in situ Invasive breast cancer
47
Indications for mastectomy
Prior radiation to breast/chest wall Radiation therapy contraindicated 2/2 pregnancy Inflammatory breast cancer Diffuse suspicious or malignant appearing microcalcifications Widespread disease in multiple quadrants Positive pathologic margin after repeat excision
48
Work up for breast surgeries
Palpable mass on PE Mammogram U/S Biopsy Tumor markers: CA 15-3, CEA, CA 27/29
49
Postop care for breast surgery
Admitted and monitored for a day or two Pain control Wound/drain care F/U within week for drain removal
50
Complications of breast surgery
Infection DVT Hematoma/Seroma Delayed healing Abnormal scar formation Winged scapula - complication due to exposing long thoracic nerve during axillary lymphadenectomy
51
Complications with flap/implant
Flap ischemia Fat necrosis Capsular contracture Implant failure
52
Indications for lung surgery
Empyema (MC due to underlying pneumonia) Lung cancer small cell vs non small cell Bullous lung: air space within the lung measuring >1 cm in diameter Lung reduction surgery: COPD/emphysemia pts
53
Work up for lung surgery
CXR/CT Labs: inflammatory markers Tumor markers: CEA, SCC, NSE Blood gas SPO2 levels
54
Post op care for lung surgery
Admitted to ICU with close cardiopulmonary monitoring, likely to remain intubated post operatively wean as able Chest tube management Pain control Wound care
55
Complications of lung surgery
Pneumothorax: chest tubes left in place post op Infection Bleeding Afib Dyspnea
56
Indications for thoracotomy for open heart surgery- CABG
congenital defect repair 3 vessel blockage or left main stem artery stenosis Heart valve dysfunction Infection: constrictive pericarditis Pericardial tamponade/ventricular rupture
57
WOrk up for CABG
Echo Stress test: chemical vs bruce protocol EKG LAbs
58
Post-op care for CABG
admitted to ICU and intubated with close cardiopulmonary monitoring chest tube management pain control wound care
59
post-op complications for cabg
death bleeding infection afib bradycardia dvt pleural effusion/pna
60
indications for peripheral venous lines
short term access for medication administration, hydration, or blood product transfusions suitable for patients who require frequent blood draws or intermittent intravenous therapy
61
contraindications for peripheral venous lines
severe peripheral vascular disease or damage presence of thrombosis in the vein intended for cannulation cellulitis or infection at the intended insertion site inadequate peripheral venous access due to collapsed or sclerosed veins
62
procedure for peripheral venous lines
clean site, insert catheter into peripheral vein using aseptic technique and secure it in place. confirm placement and initiate therapy remove dressing, gently withdraw catheter, apply pressure to site, and assess for complciations
63
Potential complications of peripheral venous lines
Phlebitis (inflammation of the vein) Infiltration/extravasation (leakage of fluid into surrounding tissues) Thrombophlebitis (blood clot formation within the vein) Infection at the insertion site
64
Indications for central venous lines
Long-term access for chemotherapy, prolonged antibiotic therapy, parenteral nutrition, hemodynamic monitoring Administration of irritant medications that may cause peripheral vein damage
65
Contraindications for central venous lines
Coagulopathy or bleeding disorders Infection at the insertion site Presence of severe hypotension or shock Severe thrombocytopenia
66
3 possible site for CVL placement in adult patients
Internal jugular Femoral Subclavian
67
What placement of central venous line is the most direct path to the right atrium?
right internal jugular and subclavian valves
68
what central venous line site may be better for patients who are at high risk for bleeding?
Femoral
69
Complications of central venous lines
Infection Thrombosis --> embolism --> tissue damage or blockage Pneumothorax (d/t incorrect insertion or movement) --> respiratory distress and emergency Hemorrhage, especially in coag disorder or anticoagulant therapy Catheter malposition --> ineffective delivery of medication or fluids and trauma to surrounding structures Air embolism --> stroke or MI Nerve injury --> pain, numbness, or weakness Skin irritation and breakdown at insertion site
70
Equipment needed for central lines
Sterile gloves Sterile gowns and drapes Central line kit Ultrasound machine Flushing solutions: heparin or NaCl
71
Indications for cut down venous access
Emergency situations when rapid venous access necessary Inability to access veins using traditional methods Pediatric patients with small veins
72
Contraindications to cut down venous access
Presence of infection at site of incision Thrombosis or vascular compromise in area of planned incision Patient refusal or inability to tolerate the procedure under local anesthesia or sedation
73
What is the most common vein used for cut-down venous access?
Saphenous vein
74
Definition of intraosseous line
needle directly into bone marrow cavity to access systemic circulation
75
indications for intraosseous line
emergency situations where vascular access cannot be achieved by traditional methods patients in cardiac arrest or shock pediatric patients with difficult peripheral venous access
76
complications of intraosseous lines
infection at the insertion site extravasation of fluids or medications dislodgement of needle bone fractures in fragile bones
77
common sites for IO line
proximal tibia (in adults and children) distal femur (less commonly used)
78
what is vNOTES
new procedure where laparoscopic and vaginal approaches are combined
79
indications for vNOTES
ovarian cysts fibroids tubal sterilization abnormal uterine bleeding adenomyosis hysterectomy salpingectomy oophorectomy removal of ovarian cysts
80
benefits of vNOTES
shorter hospital stay less postoperative pain less pain medication no visible scarring

Surgery (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions