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Surgery > Essentials > Flashcards

Essentials Flashcards

0
Q

Prevents air from entering and fluid from siphoning back

A

Underwater seal drainage (i.e. Chest tube)

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1
Q

Drains through a tube to a reservoir at a lower level

A

Gravity drainage (i.e. Foley)

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2
Q

Drains large volumes of fluids (GI) and promotes closure of dead space.

A

Suction drainage (i.e. Jackson-Pratt drain)

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3
Q

One lumen for suction, one for irrigation allows drainage of particulate matter, abscess debris or as continuous irrigation catheter

A

Sump drain (i.e. NG tube)

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4
Q

Unsealed on both ends, used for contaminated cases

A

Penrose drain

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5
Q

Used for pneumothorax, hemothorax

A

Chest tube

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6
Q

Used for non functional GI tract > 1-2 days, decompresses, determines fluid loss

A

Sump tube/NG tube

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7
Q

Used for large raw surfaces to be kept opposed i.e. mastectomies, skin flaps

A

Suction drainage

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8
Q

What can isolate a drain from tissues

A

Foreign body reaction

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9
Q

Used for feeding purposes between skin and stomach

A

Gastrostomy tube/PEG

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10
Q

Used for compression of esophageal varices

A

Gastroesophageal balloon tamponade tube

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11
Q

Tx for SBO
First time
Recurrent

A

First: laparotomy, lysis of adhesions
Recurrent: long intestinal tube

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12
Q

Used for feeding from skin to jejunum

A

Jejunostomy tube

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13
Q

Tx for colonic ileus (cecum d>12cm)

For colonic obstruction

A

Ileus: cecostomy tube
Obstruction: proximal diverting colostomy

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14
Q

Tx for sigmoid volvulus

Or for colonic ileus

A

Rectal tube (transanally) under sigmoidoscopic visualization

Leave for several days or pressure necrosis

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15
Q

Placed in int jugular, svc or femoral vein

Complication - bacteremia

A

Central venous catheter

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16
Q

Placed in intrathoracic vein from antecubital vein

A

Peripherally inserted central catheter

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17
Q

Prolonged venous access, provokes ingrowth of surrounding tissue

For chemotherapy, hemodialysis, hyperalimentation

A

Cuffed central venous catheter

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18
Q

For long term dialysis or management of ascites in pt with malignancy

A

Peritoneal dialysis catheter

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19
Q

How to stage Hodgkin’s disease

A

Staging laparotomy

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20
Q

How to stage upper abdominal tumors

A

Laparoscopy

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21
Q

Therapy for local tumor, lymph nodes

A

Surgery and radiation

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22
Q

Therapy for metastatic tumor, system wide

A

Chemotherapy, immunotherapy

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23
Q

Multimodal therapy for breast ca

A

Surgery and radiation for local control and staging

Chemotherapy for positive nodes

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24
Q

Multimodal therapy for pancoast tumor

A

Preop radiation for spread into brachial plexus

Surgical resection

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25
Q

Multimodal therapy for extremity sarcoma

A 
Incisional biopsy for diagnosis
Preop radiation
Radical local resection
Postop radiation
Chemotherapy
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26
Q

Tx for low grade neoplasm

I.e. Basal cell, mixed tumor of parotid

A

Wide local resection

27
Q

Tx for deeply invading neoplasms

I.e. Sarcoma

A

Radical local resection

28
Q

Tx for tumors that met to regional lymph nodes

I.e. Colon cancer

A

Radical resection with en bloc excision of lymphatic drainage

29
Q

Tx for locally extensive disease with low likelihood of metastatic spread
I.e. Advanced rectal, cervical, bladder, uterine cancers

A

Super radical resection

Removal of all local tissue and lymphatics

30
Q

Tx for advanced ovarian cancer

A

Debulking resection

Made more susceptible to chemo and radiation

31
Q

General principles of postop management

6 things

A
  1. Daily examination, incl wound
  2. Remove tubes asap
  3. Early ambulation
  4. Monitor fluid balance, electrolytes
  5. Adequate but not excessive pain meds
  6. Good nursing care
32
Q

Causes of post op fever

A 
Day 1-3: atelectasis, pneumonia, pulmonary problems
Day 3-5: UTI
Day 5-8: wound infection
DVT, PE, thrombophlebitis
Drug fever (esp abx)
33
Q

Tx for atelectasis

A

Incentive spirometry, coughing, deep breathing and ambulation

Collapse of lobes- NT suction, bronchoscopy to remove secretions

No abx unless infection present

34
Q

What causes wound infections before days 5-8

A

Streptococci, clostridium

35
Q

Pattern of volume flux post op

A

Post op hypovolemia from third spacing

Day 4-5 hypervolemia

36
Q

Tx for surgical infection

A

Drainage, debridement, antibiotics

37
Q

Most common organism infecting prosthesis

A

Staphylococci

38
Q

Timing of prophylactic abx

A

1-2 hrs preop to 6-24 hrs postop

39
Q

Most common sites of intraabdominal abscess

A
  1. Subphrenic
  2. Subhepatic
  3. Lateral gutters posteriorly
  4. Pelvis
  5. Periappendiceal, pericolonic
  6. Multiple sites in 15%
40
Q

Signs of abdominal abscess

A

Spiking fevers, pain, leukocytosis in 2nd week postop

Can result in sepsis

41
Q

Approach to drain pelvic abscess

A

Transrectally or through superior vagina

42
Q

Approach to draining subphrenic abscess

A

Posteriorly through 12th rib

43
Q

Most common organism in cellulitis

A

Streptococci

44
Q

Tetanus prophylaxis after penetrating injury

A

If immune: booster if > 5 years
If not immune: 3 doses, dose 1 and 6 months
If not immune and dirty wound: tetanus Ig and 3 doses at separate site

45
Q

Tx for suspected C. tetani infection

A

Prophylactic PCN in high doses

46
Q

Hemorrhagic bullae, progressive toxicity, foul-smelling serous discharge, air in soft tissues

A

Necrotizing fasciitis

47
Q

Organisms causing nec fasc

A

Microaerophilic streptococci
Staphylococci
Gram-neg aerobes and anaerobes

48
Q

Upper GI surgery abx prophylaxis

A

Obstruction, blood, achlorhydria or malignancy

Cephalosporins or fluoroquinolones

49
Q

Biliary tract surgery abx prophylaxis

A

Elective chole - cephalosporin

Common duct stones, cholangitis, empyema or gangrene of GB - cephalosporin or penicillin combination

E. coli, S. faecalis, salmonella, c. perfringens

50
Q

Colon and rectal surgery abx prophylaxis

A

Mechanical removal preop - mannitol, polyethylene glycol
Oral abx 10-22 hrs preop - neomycin, erythromycin
Emergencies - IV abx, no primary closure

51
Q

Urologic surgery abx prophylaxis when

A

Given perioperatively

52
Q

Vascular surgery abx prophylaxis

A

Perioperative cephalosporin

For s. aureus, s. epidermidis

Amoxicillin if pt undergoes later procedure with bacteremia (i.e. Dental extraction)

53
Q

Complications of cardiac surgery

A

Sternal osteomyelitis and dehiscence
Prosthetic valve endocarditis

Same prophylaxis as vascular surgery

54
Q

Prophylaxis for pulmonary resections

A

Abx against gram-pos cocci

55
Q

Infection complication in orthopedic surgery

A

Slime-forming staphylococci

56
Q

Abx tx for deep burns

A

Assure tetanus prophylaxis

Penicillin G if group A strep infection (first 5 days)

Topical abx on uninjured tissue

57
Q

Tx for suppurative thrombophlebitis

A

Vein excision

58
Q

Tx for bites

A

Penicillin

59
Q

Esophageal atresia fistula

A

Tracheoesophageal

60
Q

Anastomotic leak fistula

A

Colocutaneous fistula

61
Q

Splenectomy fistula complication

A

Pancreaticocutaneous fistula

62
Q

Crohn’s disease fistulas

A

Enterovesical, ileosigmoid fistula

63
Q

Sigmoid colon cancer fistula

A

Colovesical fistula

64
Q

Pelvic irradiation (cervical ca) fistula

A

Enterovaginal fistula

65
Q

Pancreatic fistula leak causes what

A

Metabolic acidosis

Surgery (17 decks)

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