General Surgery Flashcards
What are you allowed to have up to two hours from surgery.
Clear Fluids
Fruit Juice no bits
Ice Lollies
Coffee Tea no Milk
How long before surgery should a patient be fasted for?
6 hours
How should a patient on oral medication for well controlled diabetes be managed during surgery?
Take medication as normal up to day before surgery.
How should a patient on insulin be managed during surgery?
Good Glycemic control and a non invasive surgery - Control using normal methods
Poor glycemic control or invasive surgery - Variable rate insulin infusion
What is the advice for stopping the COCP prior to Surgery?
Stop 4 weeks prior
What diabetic mediation should be stopped the day of surgery?
Sulfonylurea
SGLT2i
What diabetic medication can be taken throughout the day of surgery?
DDP-4i - gliptins
GLP-1 analogues - tides
Whats the surgery of choice in a vaginal vault prolapse?
Sacrocolpopexy
A 3 year old presents with a large symptomatic umbilical hernia what is the management?
Elective repair in those with a symptomatic umbilical hernia who are presenting around 2 or 3 years old.
When is an asymptomatic umbilical hernia surgically managed?
If it hasn’t resolved by 4-5 years.
Describe DUKEs staging and how it relates to the management of Colon Cancer.
A - Doesn’t extend beyond muscularis - Hemicolectomy
B - Extends beyond muscularis but still limited to the colon - Hemicolectomy
C - Local Lymph node involvement - Surgery + Chemotherapy
D - Distant Metastasis - Surgery + Radiotherapy
In rectal carcinoma when is a Anterior Resection used?
If >8cm from anal canal or involving proximal 2/3 of rectum
In rectal carcinoma resection when is an Abdomino perineal method used?
If <8cm from anal canal or involving distal 1/3 of rectum.
Alongside surgery what is used in Stages III and IV in rectal carcinoma?
Stage III - Chemotherapy
Stage IV - Chemoradiotherapy
How long should most DOACs be stopped prior to surgery. What is the exception to this?
48 hours
Edoxaban may need 72 hours if eGFR is below 50
Short acting local anaesthetic
Lidocaine
Longer acting local anaesthetic
Bupivocaine
Local anaesthetic of choice in IV regional anaesthesia
Prilocaine
Inguinal hernia repair in children
<6 weeks - 2 day wait
<6 months - 2 week wait
<6 years - 2 month wait
When is endovascular surgery done in peripheral vascular disease?
Percutaneous transluminal angioplasty
<10cm
Aortic or iliac disease
High risk
When is open bypass or endarterectomy done in peripheral vascular disease?
> 10cm
Multifocal
Infrapopliteal
General rule around VTE prophylaxis in surgery?
Any lower limb or pelvic procedure requires LMWH from 6 house after surgery for up to a month
Elective hip replacement - VTE prophylaxis
Dalteparin from 6 hours for 28 days
TED stocking
Elective knee replacement - VTE prophylaxis
LMWH - 14 days
TED stocking
Fragility fracture of Hip Pelvis or Femur
1 month of LMWH
Platelets targets in surgery
> 50 for everything
50-75 for high risk
100 for invasive surgery, intracranial bleeds or major bleeding
Platelets transfusions are used to elevate levels
What test is used to categorise Varicose veins?
Trendelenburg - raise the leg and massage veins to empty them
- place tourniquet at the top of the leg and ask patient to stand up
- if vein doesn’t fill up this is a positive test
What does a positive Trendelenburg test indicate?
As the veins do not fill this indicates a saphenofemoral valve insufficiency
A groin swelling which disappear when lying down and is worse on coughing.
Bluish tinge
Sapheno Varix
What is the commonest vein used in vein grafting?
Great saphenous
If the pre assessment MRSA screen comes back positive what is done?
Mupirosin nasally
Chlorhexidine for the skin
Pain Purulent discharge and fluctuant swelling at the top of the buttocks
Pilonidal disease
Management of Pilonidal disease
Acute - incision and drainage
Chronic - Cystectomy
Tumour arising in the caecum, ascending or proximal transverse colon.
Right hemicolectomy
Ileocolic anastomoses - this anastomoses doesn’t need to be defunct whilst healing.
Tumour arising from distal transverse or descending colon.
Left Hemicolectomy
Colo-Colon anastomoses
Tumour arising from sigmoid colon.
Anterior resection
Colo rectal anastomoses
Tumour rising from anal verge or within 8 cm.
Abdominal perineal excision of the rectum.
If any tumour has perforated what is the surgery of choice?
Hartmans procedure
Resect sigmoidcolon + end colostomy
End colostomy can be reversed at a later date
Post Operative Complication - Wind Water Wound Walking
Days 1 - 2 = Pneumonia, PE
Days 2 - 5 = UTI
Days 5 - 7 = Wound infection or abscess
Days >5 = DVT PE etc
When does acute limb ischaemia become critical limb ischaemia?
When there is tissue loss and duration of rest pain in foot for over two weeks.
What is involved in acute limb ischaemia?
6 Ps Pulseless Palour Parasthesia Perishingly cold Paralysed Pain
What are the two causes of acute limb ischaemia?
Embolic disease - acute onset no preceding claudication, other leg no signs or symptoms, evidence of aneurysm above.
Thrombotic disease - preceding history of claudication, other leg shows signs of PVD,
Management of Acute Limb Ischaemia
Handheld Doppler -> ABPI -> IV heparin -> vascular surgeons
What is the name of the surgery used in Achalasia
Hellers Cardiotomy
How can local anaesthetic toxicity be reversed?
20% lipid emulsion IV
An isolated raised temperature within 24 hours of a surgery.
Likely to be physiological
If someone is one once daily insulin. How should the be altered prior to surgery?
Reduce dose by 20% on the day prior to and the day of surgery.
Most accurate way to assess burn percentage in a child?
Lund and Browder chart
When are graduated compression hosiery used?
In non ulcerated legs
When are compression bandages used?
In ulcerated or post surgical
Management of splenic trauma
Conservative - analgesia and observation
- Small haematoma and minimal intra-abdominal fluid
Laparotomy with conservation - Increased intra-abdominal fluid, moderate haemodynamic instability and <50% of spleen affected
Resection - Hilar injury and major haemorrhage
What is a Richters hernia?
Signs of bowel strangulation but no bowel obstruction
Incision commonly used in C section
Pfannenstiel
Incision commonly used in cholecystectomy
Kuchers - right subcostal margin
Incision commonly used in appendicectomy
Lanz
Incision used in emergency strangulated femoral hernia
Mc Evedys
What is the commonest incision for gaining access to the abdomen?
Midline incision
What is the commonest incision used in renal transplant?
Rutherford and Morrison
Hydrocoele management in paediatrics
Refer to surgery if not closed by 1 year
When do you refer burns to secondary care?
All deep dermal or full thickness
Superficial dermal - >3% TBSA in men >2% in women
- genitalia, face, hands, feet, flexural surfaces, neck and torso
All inhalation, chemical or electrical burns
Query Non accidental injury
Wound dehiscence
Superficial - cover with sterile saline soaked gauze + non urgent senior review
Deep - Cover with sterile saline soaked gauze + urgent senior review
What is the best form of analgesic control post operatively?
Patient controlled analgesia
Metformin on the day of surgery?
If taken OD or BD - taken as normal
If taken TDS - omit lunch time dose
Coarse of antibiotics in uncomplicated appendicitis
1 day IV abx is enough
If someone is on longterm steroids how should they be managed during surgery?
Supplement with hydrocortisone
What is regarded as poor glycaemic control in surgery? Indicating the need for isulin during surgery.
> 69
Acute Limb ischaemia
< 2week duration
6 P’s
Critical limb ischemia
> 2 weeks
Gangrene
Non healing wounds
ABPI and critical limb ischaemia
<0.5 = suggestive of critical limb ischaemia <0.3 = impending threat
In a patient with respiratory disease what is the preferred method of post operative analgesia?
Epidural
Opioids should be avoided
