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CP3 SURGERY > GEN SURG part 1 > Flashcards

GEN SURG part 1 Flashcards

1
Q

Def clean operative procedure

A

Procedure doesn’t enter a colonised viscus, or lumen in the body

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2
Q

What is surgical site infection due to in a clean operative procedure?

A

Contaminants from enviro/surgeon

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3
Q

Def potentially-contaminated operative procedure?

A

Operative procedure enters into a colonised viscus or body cavity under elective/controlled circumstances

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4
Q

What is surgical site infection (SSI) due to in a potentially-contaminated procedure?

A

Endogenous bacteria

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5
Q

Def contaminated operative procedure

A

Contamination present at surgical site, without obvious infection

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6
Q

SSI risk contaminated operative procedure

A

From endogenous bacteria

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7
Q

Def dirty operative procedure

A

Surgery performed where active infection is already present

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8
Q

SSI risk dirty operative procedure

A

Established pathogens

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9
Q

What is a rigid proctoscopy

A

Endoscopic examination of the anal canal using a proctoscope (direct vision)

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10
Q

What is a rigid sigmoidoscopy

A

Endoscopic exam of the rectum to recto-sigmoid junction using a rigid sigmoidoscope

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11
Q

Indications rigid scope (5)

A 
Suspicion colon neoplasia 
Ix IBD
Biopsies under direct vision 
Tx haemorrhoids 
Prior to op
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12
Q

What is a flexible sigmoidoscopy

A

Endoscopic exam visualising up to splenic flexure

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13
Q

Indications flexible sigmoidoscopy (5)

A 
CRC screening 
Surveillance prev diagnosed malignancy 
Endoluminal stent insertion - strictures 
Pre-op assessment - ano-rectal surgery 
Haematochezia req haemostasis
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14
Q

Indications tube thoracostomy (chest drain) (3)

A

Pneumothorax
Pleural effusion
Post op

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15
Q

Technique chst drain

A

LA into skin
2cm incision in triangle of safety
Blunt dissect into parietal pleura + palpate lung
Insert drain + attach to underwater seal
Apply airtight dressing + sit pt up to 45’
Chest position w/ CXR

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16
Q

Where is the ‘triangle of safety’ for chest drain

A

Betw lateral border of pec major + lat dorsi, sup to 5th ICS , inf to axillary border

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17
Q

What does an ileostomy look like

A

Spouted
On RHS
Bilious contents

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18
Q

What does 1 visible lumen indicate - ileostomy

A

= end ileostomy

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19
Q

When is an end ileostomy used

A

After removal of distal bowel
(permenant)
UC

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20
Q

What does 2 visible lumens indicate - ileostomy

A

Loop ileostomy

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21
Q

Indications look ileostomy (3)

A

Rest distal bowel (IBD)
Temporarily protect distal anastomoses following surgery
Provide functional relief from severe incontinence
TEMPORARY

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22
Q

Features of colostomy (3)

A

Flush to the skin w/ flat mucosal folds
LHS
> faeculant

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23
Q

What kind of op’s are end colostomies used after (3)

A

Hartmanns
Left hemicolectomy
AP resection

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24
Q

When are urostomies used?

A

After radical urinary tract surgery

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25
Q

DDx urostomy

A

End ileostomy

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26
Q

What is a gastrostomy

A

Connection for ant stomach to ant abdo wall

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27
Q

When are gastrostomies used?

A

For stomach drainage or direct feeding

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28
Q

Features gastrostomy (4)

A

Narrow
Flush to skin
LUQ
Fitted w/ indwelling access devices

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29
Q

What is a Jejunostomy

A

Connection from jejunum to ant abdo wall

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30
Q

When are jejunostomies used

A

Feeding

31
Q

Early complications of stoma (3)

A

Infarction/necrosis
Infection
High output –> severe dehydration

32
Q

Late complications stoma (4)

A

Parastomal hernia - incisional hernia @ stoma site
Stoma prolapse
Stoma retraction
Stenosis

33
Q

Practice examination of a stoma

A

Do it

34
Q

Indications - urethral catheterisation (4)

A

Urinary retention
Output monitoring
Incontinence
Surgery

35
Q

C/I urethral catheter (2)

A

Urethral injury

Acute prostatitis

36
Q

Size of catheter - M

A

14

37
Q

Size of catheter – F

A

12

38
Q

When should the catheter bag be emptied?

A

When 2/3 full

39
Q

Who needs suprapubic catheter (2)

A

Pelvic trauma

Suspected urethral injury

40
Q

Complications - catheteristion (6)

A 
Retrograde infection 
Paraphimosis 
Creation false passages 
Urethral stricutres 
Urethral perforation 
Bleeding
41
Q

How to take specimen from catheter

A

Aseptically from port in tubing

Or aseptic aspiration of tubing

42
Q

Active drains

A

Inv suction forces provided by vacuumed containers + = used to draw out collections

43
Q

Passive drains

A

Function by differential P between body + exterior ie gravity

44
Q

Are open drains passive or active

A

Passive

45
Q

What are closed drains

A

Tube systems that drain directly into a container w/ orw/o suction

46
Q

Indications - drain placement (3)

A

Remove abnorm collections fl/blood/pus/air
Prevent build up of bodily fl/air
Warn of potentially serious complications

47
Q

How long after peri-op bleed do you remove drain

A

48h

48
Q

Complications of drains (4)

A

Damage to structure during insertion
Damage due to P effects on drain
Infection
Failure of drain

49
Q

Indications - central venous catheter (6)

A 
Critically ill pt req continuous CVP monitor 
Infusion of irritant substance 
Precise infusion for v NTW
LT access - nutrition, chemo, ABx
Haemodialysis 
If no other vv access available
50
Q

Types of central vv catheter (3)

A

Hickmann
PICC line
Portacath

51
Q

Hickmann placing

A

beneath skin

At IJV on right

52
Q

PICC line placing

A

Inserted in arm and advanced to SVC

53
Q

COmplications central vv catheter (6)

A 
Haemorrhage 
pneumothorax
Thoracic duct damage
Air embolism 
Thrombosis
Catheter related sepsis
54
Q

Where does Swan Ganz catheter go

A

From femoral vv –> RHS heart into pulm aa

55
Q

Function Swan Ganz catheter

A

measure pulm aa P

56
Q

Indications Swan Ganz catheter (4)

A

Assess haemodynamic response therapies
Monitor complicated MI/post cardiac surg
Diagnosis pulm oedema
Diagnosis PE/idiopathic pulm HTN

57
Q

Complications Swan-Ganz catheter (3)

A

Arrythmias
Valve trauma
Pulm aa rupture

58
Q

Indications arterial catheter (2)

A

Freq ABG

Continuous invasive BP monitoring

59
Q

Allen’s test

A

Elevate hand
Ask pt to make fist + occlude uln + radial aa 30s
Pt open hand - blanched
Release ulnar aa –> colour returns in 7s

60
Q

Complications art line (3)

A

Digital ischaemia
Thrombosis
Haemorrhage

61
Q

What are the 4 stages of wound repair

A

Haemostasis (immediate)
Inflammation (0-3 days)
Proliferation (3days-3w)
Remodelling (3w to 1y)

62
Q

Haemostasis

A

Platelet aggregates at site
Release inflamm markers + activate clotting cascade
Vasospasm + thrombus formation

63
Q

Inflammation

A

VD + incr cap perm –> oedema
Neutrophils debride + kill bacteria
Macrophages phagocytose debril –> fibroblast migration

64
Q

Proliferation

A

Fibroblasts synth collage
myofibroblasts secrete actin cont products –> would contraction
Angiogenesis stim’d –> granulation tissue

65
Q

Remodeeling

A

Re-orientation + maturation collagen fibres inc wound strength

66
Q

When does 1’ intention healing take place?

A

Where there == a lccosed appositon of clean wound endges

67
Q

When does 2’ intention healing take place

A

Where skin edges cannot be clearly opposed

68
Q

Factors affecting wound healing (6)

A 
DM
Nutrition 
Smoking 
HGH levels 
Infection 
RA (inflamm conditions)
69
Q

When can ‘tidy’ wounds be closed?

A

<12hrs

–> minimal skin loss

70
Q

Mx of ‘untidy’ wound closure

A

Wound excision w/ removal of debris/dead tissue

71
Q

When is delayed closure of a wound indicated?

A

If >6hrs old

Or heavily contaminated

72
Q

Mx of delayed wound closure

A

Dress and inspect daily for further necrosis/inflamm

Then will be closed at 48-72h if ok q

73
Q

Inflammatory changes in a wound/around a suture (5)

A 
Calor 
Rubor
TUmour 
Dolor 
Dunction laesa
74
Q

Mx options infected surgical wound

A

IV ABx
Re-intervention either ward, or threatre
Open, drain, debride, rinse, pack wound
CULTURE

CP3 SURGERY (19 decks)

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