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4q Emergency Med Surg Test 3 > Common Gen Surgery Issues > Flashcards

Common Gen Surgery Issues Flashcards

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Royal College: Emergency Medicine flashcards
1
Q

What do general surgeons do? (13 organs)

A 
stomach
pancreas
gallbladder
intestine
appendix
adrenals
spleen
adipose
thyroid
breast
lymphatics
soft tissue
carcinoma
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2
Q

Serum proteins & nutritional profile indicates_____

A

degree of illness & perioperative morbidity

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3
Q 
Half life of:
Albumin
Pre-albumin
Transferrin
Retinol Binding Protein
A

Albumin: 21 days

Pre-Albumin: 2-3 days

Transferrin: 8 days

Retinol Binding Protein: 12 hours

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4
Q

Ebb Phase: when does it occur, what is it, energy supply/demand, metabolism, hormones

A

first 24-72 hours

non-stressed starvation

basal energy requirements are decreased
& supplied by LIVER & MUSCLE GLYCOGEN STORES
then switch to fatty acids and ketones for energy & stop burning muscle protein as much

↓metabolism

  • catecholamine release
  • norepinephrine release
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5
Q

Flow phase: when does it occur, characteristics

A

Catabolic & Anabolic-peaks 3-5 dyas
HYPERMETABOLIC, HYPERGLYCEMIC
subsides 7-10 days & merges with anabolic phase
high cardiac output, restoration of oxygen delivery & metabolic sustrate

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6
Q

Blood glucose level post surgery

A

it is common for people to have hyperglycemia post-surgery

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7
Q 
Hypermetabolic phase:
net result (3)
control what to what range, why?
A

net result: negative nitrogen balance, ↓adipose stores, hyperglycemia

control of hyperglycemia [at least below 150 (80-150mg/dl)] is important to limit complication & ↓morbidity and mortality

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8
Q

Normal caloric needs, protein needs

‘stressed’ patient needs

Kcal/gram in: protein, carbs, fat

A

normal:
25-30 kcal/kg/day
0.8-1g protein/kg/day

‘stressed’:
50 kcal/kg/day
2.5 protein/kg/day

Protein: 4 Kcal/gm
Carbs: 3.4 Kcal/gm
Fat: 9 Kcal/gm

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9
Q

Enteral nutrition is done via

A 
"if the gut works, use it"
feeding tubes (NG, nasojejunal, duotube, gastrostomy, jejunostomy)
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10
Q

Parenteral Nutrition: 2 types

A

Peripheral Parenteral Nutrition

Total Parenteral Nutrition (TPN)

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11
Q

Enteral nutrition advantages (7)

A
  • ↓ gut hyperpermability/ translocation
  • ↑ gut blood flow
  • gut immunity
  • ↓ infectious complications
  • ↓ mortality
  • GB emptying/avoid hepatic chloestasis
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12
Q

Enteral Nutrition Sites

A

Oral
NGT-nasogastric
G-tube: gastrostomy tube, PEG
J-tube: feeding jejunsotomy

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13
Q

Enteral Nutrition contraindications (5)

& relative contraindications (3)

A
  • bowel obstruction
  • peritonitis
  • ileus
  • massive GI hemorrhage
  • ischemic gut

relative contraindications

  • pancreatitis
  • IBD
  • high output fistula
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14
Q

Enteral nutrition complications (4)

A
  • perforation
  • aspiration
  • dislodgement
  • diarrhea
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15
Q

TPN advantages (4)

A
  • ability to provide ‘full’ nutrition without gut
  • can tailor the formulation as needed
  • inability to use the gut
  • inability to get full nutritional needs via enteral feeds
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16
Q

TPN disadvantages (7)

A
  • cholestasis & hepatic dysfunction
  • need for vascular access
  • INFECTION-line & other
  • electrolyte abnormalities
  • hyperglycemia
  • hyper-triglyceridemia
  • costly
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17
Q

Anti-reflux procedure

A

Nissen fundoplication (laprascopic or open)

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18
Q

Peptic Ulcer Surgery: elective 3 types

A

Vagotomy & Antrectomy-Bilroth 1
Vagotomy & Pyloroplasty
Highly Selective Vagotomy

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19
Q

Bariatric Surgery Patient Selection

A

BMI>40
BMI>35 with comorbidity
failure of nonsurgical weight loss efforts
well-informed, compliant, motivated patients

20
Q

Restrictive types of bariatric procedures (3)

A

vertical banded gastroplasty
laparoscopic adjustable gastric band
sleeve gastrectomy

21
Q

Malabsorptive types of bariatric procedures (3)

A

jejunoileal bypass
biliopancreatic diversion
biliopancreatic diversion with duodenal switch

22
Q

Combination of restrictive & malabsorptive bariactric procedure

A

Roux-en-Y gastric bypass

23
Q

What is the most common bariatric surgery performed in the US currently?

A

Route-En-Y Gastric Bypass

  • restrictive & malabsorptive
  • procedure 30mL gastric pouch
24
Q

Gastric banding

A
  • silicone band lined with inflatable balloon
  • Band connected to subcutaneous reservoir
  • Restrictive
25
Q

Vertical Banded Gatroplasty

A

Restrictive
Stapled 30mL pouch off the lesser curvature
RARELY performed now

26
Q

Sleeve Gastrectomy

A

Restrictive majority of greater curvature of stomach (w/small capacity) is created
problem: stomach tends to dilate over years

27
Q

Gastric CA: 4 points to remember

A
  1. lots of structures nearby: pancreas, liver, omentum, duodenum
  2. lymph node staging, levels & Tiers
  3. Neoadjuvant Therapy: chemo preop and/or post-op
  4. Resectability & morbidity associated with it
28
Q

Nutritional Effects of Total Gastrectomy (3)

A

1) Macrocytic Anemia (b/c of B12 deficiency, loss of intrinsic factor, folate deficiency)
2) Microcytic Anemia (b/c of decreased iron absorption)
3) Calcium & Vitamin D deficiency (achlorhydria)

29
Q

Small intestine: beginning, end, 3 functions

A

pylorus to the ileocecal valve

  • Absorption
  • Secretion
  • Digestion
30
Q

Meckel’s Diverticulum: describe

A 
True Diverticulum
ANTIMESENTERIC border of ileum
"Rule of 2s":
2%
2:1 (male:female)
2 years
2 feet from ileocecal valve
2 inches
2 types of mucosa: GASTRIC or small intestine
31
Q

Meckel’s Diverticulum presentation

A 
can be asymptomatic
abdominal pain
bleeding
intestinal obstruction
Meckel Diverticulitis
32
Q

Meckel’s Diverticulum dx & tx

A

dx:
Meckel’s Scan
Mesenteric Arteriograph
Abdominal Exploration

tx: resection

33
Q

Colon and Rectum dz (8)

A

terminal portion alimentary tract-dz is common

  • diverticulosis
  • polyps
  • adenocarcinoma
  • ulcerative colitis
  • hemorrhoids
  • fissures
  • volvulus
  • Crohn’s
34
Q

Colonic Anastomosis

A

connection between two tubular organs (ie. colonic: end to side, side to side, end to end)

35
Q

Colostomy

A

colon divided, proximal end brought through abdominal wall

36
Q

Hartmann’s procedure

A

Colostomy with distal end oversewn and placed in peritoneal cavity as blind limb

37
Q

Loop colostomy

A

loop of Colon up to abdominal wall

[might be used to study distal area in emergency situation, when you want to divert feces from moving into it]

38
Q

Ileostomy

A

end

loop of ileum up to abdominal wall

39
Q

Stoma

A

temporary or permanent
divert stool
the stoma is the part outside: imp to look at stoma after the operation to determine the health of the intestine

40
Q

Proctocolectomy

A

removal of entire colon and rectum

41
Q

Abdominoperineal Resection (APR)

A

VERY LOW RECTAL CANCERS

removal of lower sigmoid colon, entire rectum and anus

42
Q

Low Anterior Resection (LAR)

A

Cancers of MIDDLE & UPPER SECTIONS OF RECTUM

removal of distal sigmoid colon and 1/2 of rectum

proximal sigmoid-distal rectum anastamosis

43
Q

Pectinate (dentate) line importance

A

below is sensate

above is insensate

44
Q

Internal Hemorrhoid

A

above dentate line
may bleed & prolapse
non-painful

45
Q

External Hemorrhoid

A

below dentate line
do not bleed, may thrombose
Pain, itching, scarring (tag)

46
Q

Most common cause of rectal bleeding?

A

Internal hemorrhoids

47
Q

Hemorrhoid Diagnosis procedures

A 
physical examination
visual inspection
DRE
Anoscopy
other endoscopic procedures

4q Emergency Med Surg Test 3 (1 decks)

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