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CP3 SURGERY > GEN SURG part 2 > Flashcards

GEN SURG part 2 Flashcards

1
Q

Norm Na levels in serum

A

135-145

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2
Q

Norm K levels in serum

A

3.5-5

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3
Q

Norm Ca levels in serum

A

2.2-2.6

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4
Q

Norm Cl levels in serum

A

94-111

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5
Q

Norm lactate levels in serum

A

1-2

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6
Q

Composition of 0.9% saline

A

OSM: 308
Na+ - 154
Cl- 154

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7
Q

Composition of 4% dextrose 0.18% saline

A

OSM: 283
Na 30
Cl 30
40g dextrose in 1 L h20

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8
Q

Composition of Hartmanns

A 
OSM 278 
Na 131
K 5
Ca 2+ 2
CL 111
Lactate 29
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9
Q

Composition of Gelatine 4%

A

OSM 290
Na 145
Cl 145

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10
Q

Composition of 5% albumin

A

OSM 300
Na 150
Cl- 150

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11
Q

Which solutions are ‘colloids’

A

Gelatin

Albumin

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12
Q

Why do colloids not work like they do in theory

A

ill pt have leaky vessels so are not as effective

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13
Q

Other -ves of colloids (2)

A

Expensive

Cause anaphylaxis/allergies

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14
Q

If you give a 70kg man 1L of pure water, how much ends up in the plasma

A

83ml

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15
Q

If you give isotonic solutions, what % ends up in the ECG

A

100%

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16
Q

If you give a 70kg man 1L of isotonic solution, how much ends up in plasma

A

250ml

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17
Q

E.g.s of ‘sensible’ losses

A

Urinary losses

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18
Q

E.g.s of insensible losses ‘3’

A

Sweat
Lungs
Faeces

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19
Q

E.g.s of ‘additional’ losses (4)

A

NG tubes
Stomas
Drains
3rd space losses

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20
Q

What is the ‘third space’

A

Cavities where fl does not normally collect and is not readily exchangable

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21
Q

Egs of third spaces (3)

A

GIT
Pleura
Peritoneum

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22
Q

How many ml lost via urine a day

A

c.1L

23
Q

How many ml lost by lungs and faeces a day

A

c 500ml

24
Q

How many ml lost by sweating a day

A

500ml

25
Q

how many L of fl does an ill pt in hospital need /day

A

3L

26
Q

1 salty 2 sweet regimen

A

1L norm saline +20mmol KCl over 8h
1L 5% dextrose w/ 20mmol KCl over 8h
1L 5% dextrose w/ 20mmol KCl over 8h

27
Q

What must you ALWAYS do before prescribing fl

A

Chekc U+E

28
Q

If pt has pyrexia, how does fl regime change

A

+ 10% for ever degree of fever

29
Q

What activates the RAAS

A

Decreased effective aa blodo volume –> decreased renal blod flow
Or
By unloading of high pressure baroceptors in the aa system

30
Q

Where are the baroceptors (3)

A

LA
Carotid body
Aortic arch

31
Q

What deactivates the RAAS

A

Increaseed EABV –> stretch atrial myocardium –> release of ANP
ANP vasodilates renal aaa _ decreasees RAAS activity

32
Q

sx of mild dehydration (3)

A

Headache
lack of E
Tired

33
Q

sx of mod dehydration (4)

A

Dry mouth
Decr alertness
Sunken eyes
Mm cramps

34
Q

Sx of severe dehydration (5)

A 
Confusion 
Disorientation 
TachyC
Tachypnoea
Low BP
35
Q

Blood results dehydration

A

Deranged U+E

Markedkly raised urea

36
Q

metabolic change vomiting

A

Hypochloraemic, hypokalaemia metabolic alkalosis

37
Q

Tx vomiting

A

0.9% saline

+ 20mmol KCl

38
Q

What do pancreatic, small bowel, and bile fistulas contain

A

High bicarbonate levels

39
Q

How much K levels seem with these fistulae and why

A

Elevated (due to acidosis desplaces K from cells)

But really total body K is depleted

40
Q

Metabolic changes in acute diarrhoea

A

Hyperchloraemic metabolic acidosis

Hypokalaemia if profuse

41
Q

Tx diarrhoea if oral rehydration not possible

A

0.9% saline

20mmol K

42
Q

Fl Mx stable pt w/ closed head injury

A

⅔ of maintenance isotonic solutions

43
Q

Metabolic changes ATN (6)

A 
Hyperkalaemia 
Hyperphosphataemia 
Hypermagnesia 
Hyponatraemia 
Hypocalcaemia 
Metabolic acidosis
44
Q

Essential Ix for dehydration

A 
FBC
U+E
Lactate 
GLucose 
Urinalysis
45
Q

What is SIADH

A

Non-physiological release of ADH

–> DECREASED water excretion + normal Na excretio –> dilutional hyponatraemai

46
Q

causes if SIADH (broad categories)

6

A 
Malignancy 
CNS disorders 
Chest disease 
Endocrine disease (hypothyroidism)
Drugs 
Other
47
Q

Malignancies –> SIADH (3)

A

Small cell lung
Pancreas
Prostate

48
Q

CNS disorders –> SIADH (3)

A

Meningoencephalitis
Haemorrhage
Head injury

49
Q

Chest conditions –> SIADH (3)

A

TB
Pneumonia
Abscess

50
Q

Drugs –> SIADH (2)

A

Opiates

Psychotropics

51
Q

Ix SIADH

A

Hyponatraemia
Norm Urea/creatinine
Incr urinary sodium hence incr specific gravity urine

52
Q

Def diabetes insipidus

A

Passage of large vol of dilute urine b/c imp water resorption by kidneys collecting ducts

53
Q

What causes diabetes insipidus

A

reduced ADH secretion from post pit
OR
impaired response of kidney

54
Q

Consequence of diabetes insipidus

A

Hypernatraemia

Raised plasma osmolality

CP3 SURGERY (19 decks)

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