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Residency -- Surgery Pimp Questions > General > Flashcards

General Flashcards

1
Q

Normal color of the gall bladder

A

Robin Egg Blue

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2
Q

Function of the gallbladder

A

Store and concentrate bile

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3
Q

What is emulsification

A

Combination of two immiscible liquids.

Bile increases the surface area of fat by clumping them together to allow enzyme action, digestion, and absorption.

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4
Q

Arterial supply of the gallbladder, where does that come from

A

Cystic artery from right hepatic

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5
Q

Innervation of the gallbladder

A

Sensory —coeliac plexus (Greater/Lesser Splanchnic)

Sympathetic — coeliac plexus (Greater/Lesser Splanchnic)

Parasympathetic — Vagus

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6
Q

Lymph node of the gallbladder

A

Lund/Mascagni’s node — In triangle of calot inferior to cystic artery.

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7
Q

What are you looking for during gallbladder surgery?

A

Cystic Artery, Cystic Duct, Common Bile Duct

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8
Q

What is calot’s triangle

A

common hepatic duct medially, the cystic duct laterally, and the inferior edge of the liver superiorly.

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9
Q

What are ducts of lushka

A

Carry bile from liver to gallbladder

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10
Q

Function of the appendex

A

Production of immunoglobins
Used in reconstruction surgery
Store ‘good’ bacteria

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11
Q

Arterial supply of appendix -

A

Appendicular artery from Ileocolic from SMA

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12
Q

What does sma stand for

A

Superior Mesenteric Artery

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13
Q

Falciform ligament (function)

A

Attaches the liver to the anterior wall and divides the liver in left/right lobes.

Contains the round ligament which is the embryologic remanent of the umbilical vein

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14
Q

Stomach arterial supply

A

Greater Curvature — Right Gastroepiploic (inf), Left Gastroepiploic (sup), Short Gastric (upper)
Lesser Curvature — Right Gastric (inf), Left Gastric (sup)
Fundus — Short Gastric

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15
Q

Origins of the stomach arteries.

A

Left Gastric&raquo_space; Celiac Trunk&raquo_space; Aorta

Right Gastric&raquo_space; Hepatic Proper&raquo_space; Cmn Hepatic&raquo_space; Celiac Trunk&raquo_space; Aorta

Right Gastroepiploic&raquo_space; Gastrodoudenal&raquo_space; Cmn Hepatic&raquo_space; Celiac Trunk&raquo_space; Aorta

Left Gastroepiploic&raquo_space; Splenic&raquo_space; Celiac Trunk&raquo_space; Aorta

Short Gastric&raquo_space; Splenic&raquo_space; Celiac Trunk&raquo_space; Aorta

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16
Q

Where does the short gastric branch from

A

Splenic Artery

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17
Q

Name some pathologies of the bile duct

A

Stricture, Cholangitis, Bile duct leaks

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18
Q

What do we order after doing a port?

A

CXR

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19
Q

Why do we order CXR following a port insert

A

Risk for pneumothorax

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20
Q

What is a pneumothroax?

A

air leaks into the space between your lung and chest wall.

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21
Q

Why are we worried about pneumothorax

A

Cause death second to cardiovascular compromise

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22
Q

How does pneumothorax cause cardiovascular compromise

A

Compresses the SVC or IVC

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23
Q

How do we treat a pneumothroax?

A

Needle decompression

O2 therapy

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24
Q

What are the needles we use to treat a pneumo

A

3.25 inch 14 gauge

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25
Q

What’s the function of a NG tube?

A

Drain bile
Aspiration of stomach
Nutrition

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26
Q

How much bile produced a day?

A

2 liters

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27
Q

How much urine does adult produce?

A

0.5-1.0 cc/kg/hr (800-1500 mL/day)

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28
Q

How much urine does peds produce?

A

Neonate (<1yo): 2 cc/kg/hr
Toddler (1-3yo): 1.5 cc/kg/hr
Child/Teen: 1.0 cc/kg/hr

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29
Q

How long does it take a wound to heal?

A

Hemostasis, Inflammation, Proliferation, Maturation

6-8 weeks

30
Q

What percentage of sleeve patients has gallstones

A

40%

31
Q

What infections are there in the gallbladder when u have cholangitis

A

Escherichia coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas, and anaerobes

32
Q

What is cholangitis

A

Inflammation/infection of the bile duct system

33
Q

What antibiotics do we use to treat cholangitis

A

piperacillin-tazobactam (Zosyn),
ticarcillin-clavulanate (Timentin),
ceftriaxone + metronidazole or ampicillin-sulbactam (Unasyn)

34
Q

What size are we worried about adrenal masses

A

6cm

35
Q

What are the layers of the abd - think in terms of above arcuate line

A

External oblique aponeurosis&raquo_space; Anterior lamina of the internal oblique aponeurosis&raquo_space; Rectus abdominis muscle&raquo_space; Posterior lamina of the internal oblique aponeurosis&raquo_space; Transversus abdominis aponeurosis.

36
Q

What is GIST

A

gastrointesntial stromal tissue

37
Q

What does ERCP stand for

A

Endoscopic retrograde cholangiopancreatography

38
Q

What does MRCP stand for

A

Magnetic resonance cholangiopancreatography

39
Q

Who do we call if we want ERCP or MCRP done?

A

GI

40
Q

How do we treat pancreatitis

A

IV fluids and NPO (bowel rest)

41
Q

What are we worried about for sleeve complication wise

A

Perf and acid reflux

42
Q

What infections you worried about after surgery

A 
Wind — Lungs (PNA, Aspiration, etc…)
Water — UTI
Walking — DVT
Wound — Incision
Wonder Drugs — Meds/Blood Products
Wabscess
Waterway — Line infection
43
Q

Know dosage of heparin for active pe patient

A

80 units/kg followed by 18 units/kg/hr

5000 unit bolus followed by 1300 units/hr

44
Q

What is D-dimer

A

protein fragment from breakdown of blood clot

45
Q

What antibiotics gives redman syndrome

A

Vancomycin

46
Q

Why do you get liver enzyme elevation after sleeve or gallbaldder surgery

A

Manual manipulation/palpation

47
Q

Where does white bile come from

A

colorless fluid found due to blockage of the bile duct

48
Q

Know compositions of cholesterol stones

A

20%-80% cholesterol

49
Q

Pigmented gallstone composition

A

Excess bilirubin

50
Q

Risk factors for gallbladder stones

A

Pancreatitis, Cholangitis

51
Q

What vein are you going for in port insertions

A

Subclavian, sometimes jugular, femoral

52
Q

Where do you insert the port

A

MCL 2nd ICS

53
Q

Where do you insert needle decompressioin to treat pneumos

A

MCL 2nd ICS

54
Q

What’s the function of a hida scan

A

Radioactive dye is injected in the blood stream and followed by x-ray.
Detects issues in the GB and biliary tree.
Normal Ejection fraction 35%-65%.

55
Q

Where does ureter pass under

A

Internal iliac

Uterine arteries

56
Q

What is it called when stomach isn’t working?

A

Gastroparesis

57
Q

What are the 3 most likely starting points for carcinoid tumor?

A

Tip of the appendix
Rectum
Small intestine

58
Q

Symptoms of carcinoid tumor

A

Flushing, Diarrhea, Wheezing

59
Q

Dx/Treatment for pheo

A

24 hour metanephrines and you can do 24 hour unfractioned catheolamines

Control HTN/Surgery

60
Q

What is caput medusa

A

distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen

61
Q

What causes caput medusa

A

portal vein hypertension

62
Q

What is cirrhosis

A

chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue

63
Q

What is pneumatosis

A

Gas in the bowel wall (gas cysts) from mucosal disruption second to trauma, infection, immunosuppression, ulceration, and erosions.

64
Q

Where does that air come from in a pneumatosis

A

Three Theories:
Mechanical
Bacterial gas
Retroperitoneal Pulmonary

65
Q

What age for colonscopy

A

50

66
Q

For colon cancer, what length do you have to leave from the proximal start of the cancer?

A

5 inches

67
Q

What does kvo stand for?

A

Keep Vein Open

68
Q

What structures are retroperitoneal?

A 
S =Suprarenal (adrenal) glands
A =Aorta/Inferior Vena Cava
D =Duodenum (second and third segments)

P =Pancreas
U =Ureters
C =Colon (ascending and descending only)
K =Kidneys
E =Esophagus
R =Rectum
69
Q

Lesser and great omentum - attachments

A

Greater — Greater curvature of the stomach, Anterior transverse colon, Posterior abdominal wall

Lesser —Diaphragm, Lesser curvature of stomach, Liver

70
Q

What’s the purpose of the omentum?

A

Fat deposition, having varying amounts of adipose tissue.
Immune contribution, having milky spots of macrophage collections.
Infection and wound isolation; It may also physically limit the spread of intraperitoneal infections.

71
Q

How many times stronger is dilaudid than morphine?

A

5-10

72
Q

Post drainage fluid from gallbladder is white, why?

A

White bile like substance is excreted from the biliary tree. If the fluid drained is white, there is an obstruction above the biliary tree.

Residency -- Surgery Pimp Questions (1 decks)

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