General surgery Flashcards
What is a ‘clean’ surgery? Give an example.
Does not enter a colonised viscus or lumen. Infection only from environment or surgeons.
e.g. thyroid removal 2% risk SSI
What is a ‘potentially-contaminated’ surgery? Give an example.
Procedure enters into a viscus or cavity but under elective circumstances. 10% risk SSI
e.g. elective lap chole
What is a ‘contaminated’ surgery? Give an example.
Contaminated area within viscus but without infection e.g. diverticulitis, rectal surgery
risk 20%
What is a ‘dirty’ surgery? Give an example.
Active infection already present e.g. intra-abdo abscess and perforation, peritonitis
Complications of stoma (early and late)
Early: Infarction, infection, high output causing dehydration
Late: parastomal hernia, stoma prolapse, stoma retraction, stenosis
Indications for a chest drain
Pneumothorax, pleural effusion, post op (thoracotomy)
Name two contraindications to urethral catheters
Urethral injury (pelvic fracture) or acute prostatitis
When would you consider a suprapubic catheter
Pelvic trauma and suspected urethral injury
Name some complications of catheterisation
Retrograde infection, paraphimosis, creation of false passage, urethral strictures, bleeding
Describe the difference between active drain, passive drains, open drains, closed drain
Superficial = placed in skin wound
Active drains = suction from a vacuumed container (draws out collections)
Passive drains = uses gravity (risk of reverse of pressures and infection)
Open drains = always passive, leading into a dressing or stoma. Can be tubes or sheets
Closed drains = tubes into a container with or without suction (active or passive)
Indications for central venous catheters
- Critically ill patients needing continuous CVP monitoring of fluid status
- Infusion of irritant substances
- Long term access: parenteral nutrition, chemo, antibiotics
- Haemdialysis
Difference between a tidy wound and an untidy wound
Tidy: can be closed if <12h old e.g. lacerations
Untidy: marginal necrosis, crush injuries, tearing injuries. Need wound excision with removal of debris and dead tissue
Describe primary and secondary healing
1y = Close apposition of wound edges. Healing without tissue loss. Fibrosis and epithelialisation leaves a smooth scar 2= Phagocytosis removes debris, granulation tissue forms to fill defect. Slower. Leaves a broader, hypertrophied and contracted scar. Need daily wound care.
What triggers RAAS
- Unloading of high pressure on baroceptors in arterial system (left atrium, carotid body, aortic arch)
- Decreased flow to the juxta glomerular apparatus
Name factors that can contribute to an infection following a surgical procedure
Patient factors: age, malnutrition, immunosuppression, malignancy, obesity, hypoxia, anaemia
Local factors: type of surgery, length of procedure, foreign body insertion, ischaemia
Microbiological factors: lack of antibiotic prophylaxis, virulence of organism
Name some common causes of post-op fever
Pneumonia, PE, UTI, deep or superficial wound infection, abscess, DVT, drug reaction, infected line
Normal response to surgery
Wind, Wound, Walking, Wonder drugs, Water
Symptoms of an intra-abdo abscess
Swinging fever, malaise, anorexia, tachycardia, +/- mass
Treatment of an intra-abdo abscess
- CT to diagnose
- IV empirical Abx + CT/USS guided drainage if possible.
- Surgical drainage last line
Parameters for SIRS
Need +2 of: -Temp >38.3 or under 36 -RR >20 -HR >90 -WCC <4 or >12 (or glucose of >7.7 non diabetic)
Difference between SIRS, sepsis, severe sepsis and septic shock
SIRS = presence of (temp, RR, HR, WCC) paramaters
Sepsis = SIRS and suspected site of infection
Severe sepsis = Sepsis + hypotension or end organ dysfunc (oliguria, confusion, lactate >2, O2 <94%)
Septic shock = severe sepsis with hypotension not responding to fluid resuscitation
Classification of haemorrhagic shock + basic management of each
Class 1 750ml <15%
Class 2 <1500ml <30%
Class 3 <2000ml <40%
Class 4 >2000ml >40%
Give fluids class 1 Consider giving blood at class 2 Consider surgery at class 3 Needs surgery at class 4
What is Gas gangrene
- Life threatening infection by Clostridium (most often perfringens).
- Usually following trauma or surgery, spontaneous infection is rare.
- Muscle necrosis, sepsis, gas production
- Associated with soil contact
- Also known an anaerobic gangrene
What is the treatment of Gas gangrene
- Antibiotic combination
- Surgery - wound debridement
- Systemic support (O2, fluids, pain relief)
