Gen surg Tooics Flashcards
local anaesthetic toxicity
LA toxicity begins with restlessness and progresses to tinnitus, slurred speech, seizures and coma.
Heparin
Prevents activation factors 2,9,10,11
Warfarin
Affects synthesis of factors 2,7,9,10
DIC
Factors 1,2,5,8,11
Liver disease
Factors 1,2,5,7,9,10
Interpretation blood clotting test results
OGD perforation risk
0.01% (diagnostic)
5% (therapeutic). Lower for therapy to benign lesions.
Colonoscopy perforation risk
Colonoscopy
<1 in 1000 if diagnostic
<1 in 500 if therapeutic (polypectomy)
Amount of inguinal hernias that will present as an emergency
Up to 5% of primary inguinal hernias will present with symptoms such as irreducibility or pain and surgery is indicated either during the index admission or soon afterwards depending on the exact situation.
Most radiodense renal stone
Calcium phosphate stones are the most radiodense stones, calcium oxalate stones slightly less so. Uric acid stones are radiolucent (unless they have calcium contained within them).
OGD and anticoagulation
Low risk of bleeding during endoscopy (which include biopsies)=Continue warfarin
Hydro else in clindren
n children a hydrocele is most commonly due to a persistent processus vaginalis. The swelling is intermittent and in most cases that are diagnosed in infancy the hydrocele resolves. Cases that persist beyond two years of age are best managed surgically and the surgical approach is usually made via the inguinal canal where the patent processus is identified and ligated.
Adult hydrogels
Adult hydroceles are less commonly due to the persistence of embryonic remnants and therefore can be managed via a scrotal approach. Both the Lords and Jaboulay procedures are reasonable options.
Submandibular gland surgery
everal nerves are at risk in sub mandibular gland excision. The marginal mandibular and cervical branch of the facial are at risk superficially. During deep dissection the lingual nerve is at risk of injury.
Nerve at risk in parotid surgery
The facial nerve is usually sacrificed in this procedure which is almost exclusively reserved for malignant lesions.
Nerves encountered during surgical procedures
Thyroidectomy - Recurrent and superior laryngeal nerves
Carotid artery surgery -Vagus and hypoglossal nerves
Posterior triangle of neck -Accessory nerve
Submandibular gland surgery Superficial: Marginal mandibular nerve and cervical branch of the facial nerve
Deep: Lingual nerve
Varicose vein surgery- Sural nerve in short saphenous surgery and saphenous nerve in long vein surgery
Thoracic surgery Recurrent laryngeal nerve (particularly left sided)
Approach to brachial artery- Median
Posterior approach to elbow- Ulnar
Anterior approach to hip joint -Femoral
Posterior approach to the hip -Sciatic (and both inferior and superior gluteal nerves)
Pelvic dissection during rectal surgery Hypogastric nerves and nervi erigentes
Asymptomatic hernia strangulation risk
In patients presenting with asymptomatic hernia, the risk of strangulation is approximately 3% per annum.