General Surgery Flashcards

Question

Gas Embolism

Answer 1

``` Direct needle placement into vessel or gas insufflation into abdominal organ Obstructs VR Acute R ventricle hypertension = paradoxical embolism V/Q mismatch Hypoxemia Sudden ↓ETCO2 Circulatory collapse Hypotension ↑HR Bronchospasm ↑PIP ```

Answer 2

``` STOP insufflation De-sufflate abdomen Place patient in steep Trendelenburg & L lateral decubitus Discontinue N2O Admin 100% FiO2 Hyperventilate Place CVP line & aspirate CPR helps to break up bubbles Consider CPB or inotropes ```

Answer 3

``` 3D view Depth perception intuitive movements ↑precision 10-15x ↑magnification Free movement - less limitations as compared to standard laparoscopic surgery ```

Answer 4

Massive system Limited working space, patient access, & instrument availability Expensive + maintenance costs Longer setup (dock the robot)

Answer 5

Oddi sphincter spasm treatment - Naloxone, Glucagon, NTG Conversion to open risk factors - acute cholecystitis, previous upper abdominal surgery, male, advanced age, obesity, bleeding, bile duct injury Place OG/NG Potential complications - cystic artery bleeding, cystic duct liver laceration, pneumothorax DVT prophylaxis Reverse Trendelenburg L tilt (R side up) Surgeon on patient L (supine) or b/w patient legs (lithotomy)

Answer 6

``` Outpatient elective surgery Incarcerated hernia = URGENT Strangulated = EMERGENT - Potential necrotic bowel requiring resection ↑morbidity & mortality Avoid strain (smooth emergence) EBL ≈50mL Postop pain 4-6 Bradycardia d/t peritoneal retraction ```

Answer 7

``` Appendicitis General anesthesia RSI OG/NG tube Avoid N2O Antibiotics Fluid & electrolyte deficits Aspiration precautions Avoid Metoclopramide w/ obstruction Skeletal muscle relaxation ```

Answer 8

EGD Shared airway/limited access Mouth-piece inserted by endoscopist to prevent biting Airway concerns consider GETA Complications - perforation, bleeding, desaturation, laryngospasm Supine or lateral decubitus Notice food when scope placed abort procedure w/o secured airway

Answer 9

ERCP Diagnose & treat pancreatic/biliary disorders Use contrast dye 30min to several hours Complications - perforation, bleeding, desaturation, laryngospasm L lateral decubitus or prone

Answer 10

``` Cancer screening & treat polyps Colon prep Fluid & electrolyte deficits Complications - perforation, bleeding, desaturation, laryngospasm L lateral decubitus ```

Answer 11

``` Laparoscopic or transthoracic (open) approach Surgical time 3-4hr GETA RSI w/ cricoid pressure H2 blockers, Metoclopramide, antibiotic, antiemetics 54-60Fr esphageal dilator NG tube 12-24hr postop Lithotomy & reverse Trendelenburg Smooth extubation to prevent coughing ```

Answer 12

``` Double-lumen tube Airway fire risk Patient condition - dysphagia, malnourished, cachectic, chronic aspiration, pulmonary complications Potential L RLN damage Smooth emergence Postop pain management (epidural?) ```

Answer 13

GT to provide nutritional support or GI compression Indications - dysphagia or aspiration Laparoscopic, percutaneous, or open approach Surgical time <1hr

Answer 14

``` Malnourished Correct hypovolemia & anemia Chemo/radiation Ensure cross-matched blood available (hemorrhage risk) Full stomach → RSI NG tube Awake extubation ```

Answer 15

Healthy bowel anastomosis or ileostomy created Bowel prep → hypovolemia & hypokalemia Preop EKG, CBC, electrolytes, type & screen Surgical time 2-4hr EBL <500mL Aspiration precautions, RSI w/ cricoid pressure, NG tube, Foley catheter, avoid Metoclopramide, postop pain management (epidural?), 3rd space fluid loss 10-15mL/kg/hr, hypothermia Postop complications - pulmonary effusion, anastomosis leak, short bowel syndrome, sepsis, small bowel necrosis

Answer 16

``` Bowel prep → hypovolemia & hypokalemia Clear liquids 1-2 days preop IV/PO antibiotics preop Postop thoracic epidural Corticosteroid supplements - stress dose ```

Answer 17

Only organ capable to regenerate functional parenchyma w/in 24hrs resection Highly vascular - total blood flow 1.5L/min 80% blood flow supplied by portal vein 20% hepatic artery

Answer 18

CBC PT/PTT/INR Chemistry LFTs Assume full stomach (ascites, ↓gastric & intestinal motility) Pulmonary HTN monitor CVP or PA OG/NG tube Potential complications: Intraop - hemorrhage, coagulopathy, hypocalcemia, hypoglycemia, VAE, pulmonary disturbances Postop - bleeding, bile leak, portal vein/hepatic artery thrombosis, liver failure

Answer 19

Spleen - part lymphatic system, filters foreign substances from blood & removes blood cells (sequestration), highly vascular organ 300mL/min Only way to treat hereditary spherocytosis or splenic cancers Trauma, abscesses, idiopathic thrombocytopenic purpura, Hodgkin's Splenic artery rupture (pregnancy) Preop - evaluate underlying disease process & implications (chemo or ITP) Intraop - asepsis, large bore IV, warming measures, epidural Complications - atelectasis, pneumothorax, infection, hemorrhage, VAE

Answer 20

Malabsorptive, restrictive, combined Pulmonary emboli are 1° cause periop 30 day mortality 3x more frequent than anastomosis leak w/ subsequent sepsis

Answer 21

Jejuno-ileal bypass | Biliopancreatic diversion

Answer 22

Gastroplasty VBG | Adjustable gastric banding AGB

Answer 23

Restrictive & minimal malabsorptive | Roux-en-Y gastric bypass RYGB

Answer 24

``` Less postop pain Lower morbidity Quicker recovery Less fluid 3rd spacing ↓wound infection Smaller incisions ```

Answer 25

Complete NMB important Positioning requirements ↑fall risk High risk R mainstem intubation Higher incidence rhabdomyolysis

Answer 26

Laparoscopic placement Stimulate gastric smooth muscle ↓peristalsis Patient feels less hungry (theoretically) Avoid N/V Valsalva maneuver potential to dislodge electrodes EKG interference

Answer 27

Pre-medication Anxiolysis & aspiration pneumonitis precautions IM injections unreliable - longer needles required DVT prophylaxis Pulmonary embolism risk → early ambulation OSA/OHS potential difficult airway Preop ABG Airway assessment neck circumference = most important factor Pre-oxygenation = most important step ↓FRC ↑O2 consumption Higher difficult airway incidence Awake intubation or RSI

Answer 28

LMW heparin - Limits postop pain management options Preop ASA & Warfarin Exercise, antithrombotic drugs, prophylaxis, nonpolycythemic Hct, ↑CO, early ambulation