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General Surgery Flashcards

1
Q

What are 6 Risk Factors for Surgical Site Infection

A
  • Duration of surgery
  • Duration of anesthesia
  • Surgical site preparation
  • Method of wound closure
  • Antimicrobial prophylaxis
  • Comorbidities
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2
Q

Fill in the blank: Risk of infection ____ with each hour of surgery

Infection Risk - Duration of Surgery/Anesthesia

A

Doubles

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3
Q

Fill in the blank: ____ body temperature secondary to anesthesia can impact/alter immune system

Infection Risk - Duration of Surgery/Anesthesia

A

Decreased

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4
Q

Infection Risk Factors - Surgical Site Preparation

A
  • Traumatic clipping, use of poorly maintained clippers, excessive scrubbing, use of harsh biocides, recontamination of prepared sites, and inadequate contact time for biocides
  • Clipping or shaving well in advance of surgery allows for bacterial proliferation -> patients should be clipped as close to surgery as possible
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5
Q

What is associated with surgical site infection risk?

A

Further studies are required to evaluate this association.

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6
Q

Is there data supporting one wound closure method being more likely to result in infection?

Method of Wound Closure

A

NO

There is no data supporting that staples, intradermal, or skin sutures differ in infection rates. There is no consensus on the effectiveness of skin staples.

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7
Q

Fill in the blank: Prophylactic post-op antimicrobials are not typically recommended for more than ____ following surrgery.

A

24 hours

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8
Q

What is the suggested temporary ligation time for the descending thoracic aorta?

A

5 to 10 min

This time frame is critical to minimize ischemic damage.

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9
Q

What is the suggested temporary ligation time for the portal triad (Pringle maneuver), hepatic artery, portal vein, and common bile duct?

A

10 to 15 min

This technique helps control bleeding during liver surgeries.

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10
Q

What is the suggested temporary ligation time for the hepatic artery?

A

30 min

Extended ligation time can lead to liver ischemia.

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11
Q

What is the suggested temporary ligation time for the splenic artery and vein?

A

15 to 20 min

This duration helps to preserve splenic function.

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12
Q

What is the suggested temporary ligation time for the renal artery and vein?

A

30 min

Prolonged ligation risks renal injury.

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13
Q

What is the suggested temporary ligation time for the abdominal aorta?

A

30 min

Careful monitoring is required to prevent organ damage.

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14
Q

What are the three types of surveillance?

A

Active, passive, and syndromic

These types of surveillance are used to monitor health-related events.

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15
Q

Which type of surveillance is the most common in veterinary medicine?

A

Passive

Passive surveillance involves the reporting of health events by individuals or institutions.

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16
Q

What is the recommended oxygen flow for nasal insufflation?

A

50 to 100 mL/kg/minute

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17
Q

Day associated with Surgical Site infections:

  • Superficial SSI _____________________
  • Deep SSI ______________________
  • Organ/space _____________________
A
  • Superficial SSI - within 30 days
  • Deep SSI - within 30 days till 90 days in some cases
  • Organ/space - 30 till 90 days in some cases
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18
Q

Class of SSI

A
  • Clean: No break in aseptic technique
  • Clean-contaminated: Minor break in aseptic technique
  • Contaminated: Major break in aseptic technique
  • Dirty
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19
Q

Overall rate of SSI?

Rate of SSI of All Clean procedures

Rate of SSI with clean Orthopedic?

Rate of SSI of Clean contained procedures?

A

Over rate of SSI is 3% (2.5%)

All Clean SSI rate is 4.8%

Orthopedic Clean SSI rate is 7.1%

Clean-contained SSI rate 5.9%

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20
Q

Anticipated bacteria associated with:

  • Skin
  • Orthopedic
  • Hepatobiliary
  • Urinary
A
  • Skin - Staphylococcus spp.
  • Orthopedic - Staph spp., Streptococcus, Anaerobes
  • Hepatobiliary - Clostridium spp., Gram negative bacilli, Anaerobes
  • Urinary - Strep spp., Stap spp., E.coli, Anaerobes
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21
Q

What is Nosocomial Infection?

A

Development of infection 48 hours after hospital admission.

naa · suh · kow · mee · uhl

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22
Q

Causes that increase SSI?

A
  • Duration of Surgery
  • Duration of anesthesia time
  • Method of wound closure (there is no clear difference between skin suture vs staples vs intradermal)
  • Antimicrobial prophylaxis - over dose can predispose to averse effects and resistance
  • Comorbidities
23
Q

Prevalence vs Incidence

A

Prevalence = proportion of cases in the population at a given time (aka how wide spread it is)

Incidence = rate of new diagnosed cases/ period of time

24
Q

What are HALSTED principles?

A
  • H - Hemostasis
  • A - Aseptic technique
  • L - Light touch surgery
  • S - Supply of blood preserved
  • T - Tension free closure / anastomosis
  • E - Even tissue apposition
  • D - Dead space obliteration
25
Q

What are the four main categories of surgical hemostasis?

A
  1. Reduction of blood flow
  2. Hemostatic agents
  3. Antifibrinolytics
  4. Miscellaneous Agents (see table)

Includes Epi/Adrenaline/Ephedrine, Hypotension/Hypothermia/Reduced Perfusion, Tourniquet, Hemostatic agents, Antifibrinolytics, and Miscellaneous.

26
Q

Four ways to reduce surgical blood flow

A
  • Pressure/Tamponade
  • Topical Vasoconstrictors
  • Hypotension/Hypothermia/Reduced Perfusion
  • Distal control of Blood Flow

This technique is often used in combination with other methods.

27
Q

Name three topical vasoconstrictors used in surgical hemostasis.

A

Epinephrine, Adrenaline, Ephedrine

These agents help constrict blood vessels at the site of bleeding.

28
Q

Fill in the blank: _______ is a method used to control blood flow by applying pressure to a limb.

A

Tourniquet

29
Q

What are hemostatic agents?

A

Substances used to promote hemostasis

They can include various materials and medications that help stop bleeding.

30
Q

True or False: Antifibrinolytics are used to promote bleeding.

31
Q

List some what can be occluded on a Temparory basis to assist in surgery?

32
Q

Vessels that can’t be permanently ligated in cat?

A
  • Both common carotid arteries
  • Both jugular veins
  • Left renal vein
33
Q

Which vessels can be permanently ligated if the vertebral artery is preserved and the circle of Willis is functional?

A

Both common carotid arteries

This is not applicable in cats.

34
Q

Which veins can be permanently ligated in dogs, but not in cats?

A
  • Both common carotid arteries
  • Both jugular veins
  • Left renal vein

This is not applicable in cats.

35
Q

Which arteries can be permanently ligated?

A
  • Brachial arteries
  • Femoral arteries
  • Both external iliac arteries

  • Both femoral veins
  • Both common iliac veins
  • Hepatic vein
  • Brachiocephalic veins
36
Q

What can be permanently ligated in the abdominal region under certain conditions?

A

Abdominal vena cava caudal to liver

This is applicable in the case of chronic compression and established collateral circulation or concurrent right nephrectomy.

37
Q

What is held off in a Pringle Maneuver?

A

Temporary ligation of hepatic artery and portal vein, common bile duct for 10-15min max

38
Q

Suggested Temporary Ligation Times in Normothermic Animals for:
* Descending thoracic aorta: ____
* Portal triad (Pringle maneuver), hepatic artery, portal vein, common bile duct: ____
* Hepatic artery: ____
* Splenic artery and vein: ____
* Renal artery and vein: ____
* Abdominal aorta: ____

A
  • Descending thoracic aorta: 5 to 10 min
  • Portal triad (Pringle maneuver), hepatic artery, portal vein, common bile duct: 10 to 15 min
  • Hepatic artery: 30 min
  • Splenic artery and vein: 15 to 20 min
  • Renal artery and vein: 30 min
  • Abdominal aorta: 30 min
39
Q

What is the suggested temporary ligation time for the descending thoracic aorta?

A

5 to 10 min

40
Q

What is the suggested temporary ligation time for the portal triad (Pringle maneuver), hepatic artery, portal vein, and common bile duct?

A

10 to 15 min

41
Q

What is the suggested temporary ligation time for the hepatic artery?

42
Q

What is the suggested temporary ligation time for the splenic artery and vein?

A

15 to 20 min

43
Q

What is the suggested temporary ligation time for the renal artery and vein?

44
Q

What is the suggested temporary ligation time for the abdominal aorta?

45
Q

What is the maximum recommended application time for an Esmarch tourniquet?

A

1.5 – 2 hours

Exceeding this time increases the risk of systemic and limb complications.

46
Q

What is the effect of reapplication of a tourniquet?

A

Increases risk of systemic and limb complications

Reapplication should be approached with caution.

47
Q

True or False: Exsanguination is recommended before the application of a tourniquet in all cases?

A

False
Not recommended with infection or neoplasia.

Exsanguination is NOT recommended in these cases.

48
Q

When do energy stores (ATP) deplete after applying a tourniquet?

A

2-3 hours

Mitochondrial changes are visible after 1 hour.

49
Q

What is visible after 1 hour of applying a tourniquet?

A

Mitochondrial changes

Microvascular damage becomes evident after 2 hours.

50
Q

What is the recommended setting for a pneumatic tourniquet relative to the patient’s systolic pressure?

A

100 mmHg above patient systolic pressure

Alternatively, try to find the lowest effective tourniquet pressure.

51
Q

What does La Place’s Law state regarding pressure and tourniquet width?

A

P = T(N)/RW

There is an inverse relationship between pressure applied and the width of the tourniquet.

52
Q

True or False: The application of a tourniquet can last longer than 2 hours for effective results.

A

False

It is recommended to apply for a maximum of 1.5 to 2 hours.

53
Q

Fill in the blank: Energy stores (ATP) are depleted within _______ hours of tourniquet application.

A

2-3

This depletion can lead to complications if the tourniquet is left on too long.

54
Q

True or False: All collagens share a tertiary structure.

Anki PI (22 decks)

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