Final B Flashcards
Induction plan for hiatal hernia surgery
RSI
Common side effect after gallbladder removal
Diarrhea
GI organs in right upper quadrant
- Liver
- Gallbladder
- Duodenum
- Right kidney
GI organs in left upper quadrant
- Spleen
- Pancreas
GI organ in right lower quadrant
Appendix
The “upper GU tract” consists of which organ
Kidneys
What anatomical features make up the “lower GU tract”
- Ureters
- Urethra
- Bladder
Important history in patients with kidney disease
- History of kidney dysfunction
- History of dialysis
- Location/function of AV fistula
- Current medications
- Daily urine production
What does CHLORIDE stand for when trying to characterize a symptom
- CHaracter of pain
- Location
- Onset
- Radiation
- Intensity of pain
- Duration
- Exacerbating/alleviating factors
What is dysphagia
Difficulty swallowing
What is odynophagia
Pain with swallowing
What electrolyte abnormalities can be caused by excessive diarrhea? (4)
1) Hyponatremia (can’t excrete water due to ADH release)
2) Hypernatremia (if free water loss is not replaced)
3) Hypokalemia (loss of K+)
4) Metabolic acidosis (loss of bicarb)
What is melena? What does it signify?
Black tarry stool that signifies upper GI bleed
What is hematochezia? What does it signify?
Bright red blood that signifies lower GI bleed
What is jaundice?
Yellowish discoloration of skin from increased levels of bilirubin
What is dysuria
Pain with urination/difficulty voiding
What is polyuria
Increase in 24 hour urine volume
What is nocturia
Urinary frequency at night
What are the 4 main types of incontinence
1) Urge (overactive bladder)
2) Stress (poor closure of bladder)
3) Overflow (poor contraction/blockage)
4) Functional (medications or health problems)
What is borborygmi
Stomach growling
Where should bruits be auscultated for a basic abdominal exam
- Aorta
- Renal artery
- Iliac artery
- Femoral artery
When are bruits normal?
When they are confined to systole
How do we assess for peritoneal inflammation
Ask patient to cough and determine where the cough produces pain
Pain associated with costovertebral angle tenderness (CVA tenderness) is associated with what
Pyelonephritis (kidney infection)
A normal aorta is not more than __ cm wide
3
Risk factors for AAA
- Over 65 y/o
- Smoker
- Male
- Family history
What do we assume about a patient coming in for a bowel obstruction who has a history of N/V and feculent emesis
Full stomach
Normal albumin levels
3.5-5.5g/dL
Albumin levels are a measure of…
Hepatic function and nutritional status
Normal AST and ALT levels
7-40 U/L
Which aminotransferase is found predominately in the liver
ALT
Normal alkaline phosphatase levels
25-85 IU/L
When are alkaline phosphatase levels increased?
- Obstructive biliary disease
- Cirrhosis
What test is useful in confirming that elevated ALP is due to liver pathology?
5’-Nucleotidase
When is 5’NT test not useful?
Later in pregnancy
What are amylase and lipase labs used for?
To detect and monitor pancreatic disease
Normal bilirubin levels
Less than 1.5mg/dL
What is the most sensitive liver enzyme for detecting biliary obstruction, cholangitis, and cholecystitis?
GGTP (gamma-glutamyl transpeptidase)
Normal PT value
11-14 seconds
What does PT tests assess for
Extrinsic pathway of clot formation
Normal PTT
25-38 seconds
What does PTT assess for
Intrinsic pathway of clot formation
Coagulation test used in coumadin therapy
PT
Coagulation test used in heparin therapy
PTT
How does hepatocellular disease affect PT
Prolongs PT because the production of coagulation factors by the liver is altered
Why does hepatocellular disease prolong PTT
Decreased factor VII
Normal BUN levels
10-20mg/dL
BUN levels are an indication of…
Renal health
Main causes of an increase in BUN
- High protein diet
- Decreased GFR
- Hypovolemia
- CHF
- GI hemorrhage
- Fever
Main causes of a decrease in BUN
- Liver disease
- Inappropriate ADH
Normal creatinine levels in men
0.8-1.3mg/dL
normal creatinine levels in women
0.6-1mg/dL
A doubling of creatinine levels suggests a __% reduction in GFR
50
What does creatinine clearance measure?
Glomerular filtration rate
Na+ levels are considered critically low if they are under
131mEq/L
Na+ levels are considered critically high if they are over
150mEq/L
K+ levels are considered critically low if they are under
2.5
K+ levels are considered critically high if they are over
5.9
A patient’s stress response to surgery is proportional to what factors? (4)
1) Magnitude of injury
2) Total operating time
3) Amount of intraop blood loss
4) Degree of postop pain
What is the most important component of the pre-op evaluation?
The patient’s history
How soon before surgery should monoamine oxidase inhibitors be discontinued?
2-3 weeks
How soon before surgery should oral contraceptive pills be discontinued? Why?
6 weeks due to increased risk of venous thrombosis
How soon before surgery should herbal supplements be discontinued
2 weeks
How soon before surgery should aspirin be discontinued
7-10 days
How soon before surgery should Thienopyridines (such as clopidogrel) be discontinued
2 weeks
How soon before surgery should oral anticoagulants be discontinued
4-5 days
Oral anticoagulants are discontinued before surgery to allow INR to reach what level
1.5
Major patient risk factors for periop cardiac complications
- MI within 30 days
- Unstable/severe angina
- CHF
- Significant arrhythmias
- Severe valvular disease
Procedures that are high risk factors for periop cardiac complications
- Emergency surgeries
- Aortic/major vascular surgeries
- Prolonged surgeries with large fluid shifts or blood loss
- Unstable hemodynamic situations
What are METs
Metabolic Equivalents of oxygen consumption
Procedure related risk factors of post-op pulmonary complications
- How close the surgery is to the diaphragm
- Length of surgery (more than 3 hours)
- General anesthesia
- Emergency surgery
Patient risk factors for post-op pulmonary complications
- COPD
- Smoker
- Over 60 y/o
- Obese
- OSA
- Poor exercise tolerance
Intra-op blood glucose should be kept under
180mg/dL
Complications of periop hyperglycemia
- Dehydration
- Impaired wound healing
- Inhibition of WBC function
In which procedures do patients not need to alter their anticoagulant regimen
- Dental extractions
- Arthrocentesis
- Biopsies
- Ophthalmic operations
- Diagnostic endoscopies
Invasive surgery is generally safe from major hemorrhagic complication when the INR is…
Below 1.5
How long does it take for the INR to reach 1.5 once oral anticoagulants are discontinued
4 days
How long does it take for the INR to reach 2.0 once the oral anticoagulant is re-started postoperatively
3 days
How soon before a spinal procedure should Warfarin be discontinued
4-5 days
How soon before a neuraxial procedure should a thromboprophylaxis dose of LMWH be stopped
12 hours
How soon before a neuraxial procedure should a treatment dose of LMWH be stopped
24 hours
SubQ heparin is not a contraindication to a neuraxial procedure if the dose is under…
10,000 units
How long should neuraxial needle/catheter insertion be delayed after a dose of IV heparin
2-4 hours
What lab test is used to monitor heparin effects
PTT
EKG changes associated with hyperkalemia
- Peaked T waves
- Loss of P wave
- Sine wave
3 EKG changes associated with hypokalemia
- ST depression
- Flattened T wave
- U wave
What part of the EKG is affected with alterations in serum calcium
QT interval
How does hypocalcemia affect EKG
Prolongs QT interval
How does hypercalcemia affect EKG
Shortens QT interval
Arrhythmia associated with prolonged QT
Torsades de Pointes
When are Osborn waves seen
Hypothermia
How does Digitalis affect the EKG
Downsloping ST segment depression
Stages of EKG changes in pericarditis
1) ST elevation
2) ST back to baseline
3) T wave inversion
What is hypertrophic obstructive cardiomyopathy?
Primary disease of the myocardium where a portion of the myocardium gets thick without any obvious cause
Common EKG changes seen in patients with hypertrophic obstructive cardiomyopathy
- Left axis deviation (due to LVH)
- Q waves in lateral leads
Most common conduction blocks associated with myocarditis
- Bundle branch blocks
- Hemiblocks