General Surgery Flashcards
An – is used to identify bowel perforation
An erect chest x-ray is used to identify bowel perforation
Minor surgery
Local anaesthetic (LA)
Lidocaine is the most widely used LA. It has a rapid onset of action and anaesthesia lasts for around - hours.
the maximum safe dose is -mg/kg.
The BNF states 200mg (or 500mg if given in solutions containing adrenaline), which equates to -mg/kg for a 66kg patient.
This is the equivalent of -0ml of 1% solution or -0ml of 2% solution
lidocaine is available pre-mixed with adrenaline. This increases the duration of action of lidocaine and reduces blood loss secondary to vasoconstriction. It must never be used near extremities due to the risk of ischaemia
Suture material Non-absorbable: Silk Novafil Prolene Ethilon
Absorbable: Vicryl, Dexon, PDS
Non-absorbable sutures are normally removed after 7-14 days, depending on the location.
Absorbable sutures normally disappear after – days. Removal times for non-absorbable sutures are shown below:
Area Removal time (days)
Face -
Scalp, limbs, chest -
Hand, foot, back -
Local anaesthetic (LA)
Lidocaine is the most widely used LA. It has a rapid onset of action and anaesthesia lasts for around 1 hour.
the maximum safe dose is 3mg/kg. The BNF states 200mg (or 500mg if given in solutions containing adrenaline), which equates to 3mg/kg for a 66kg patient. This is the equivalent of 20ml of 1% solution or 10ml of 2% solution
lidocaine is available pre-mixed with adrenaline. This increases the duration of action of lidocaine and reduces blood loss secondary to vasoconstriction. It must never be used near extremities due to the risk of ischaemia
Suture material Non-absorbable: Silk Novafil Prolene Ethilon
Absorbable: Vicryl, Dexon, PDS
Non-absorbable sutures are normally removed after 7-14 days, depending on the location. Absorbable sutures normally disappear after 7-10 days. Removal times for non-absorbable sutures are shown below:
Area Removal time (days)
Face 3 - 5
Scalp, limbs, chest 7 - 10
Hand, foot, back 10 - 14
The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the –
The definition of an Upper GI Bleed is a haemorrhage with an origin proximal to the ligament of Treitz
– nerve is at risk during a total hip replacement
Sciatic nerve is at risk during a total hip replacement
The following operations and their associated nerve lesions are listed here:
Posterior triangle lymph node biopsy and —nerve lesion.
Lloyd Davies stirrups and – nerve.
Thyroidectomy and – nerve.
Anterior resection of rectum and hypogastric autonomic nerves.
Axillary node clearance; — nerve, – nerve and — nerve.
Inguinal hernia surgery and – nerve.
Varicose vein surgery- –+– nerves.
Posterior approach to the hip and – nerve.
Carotid endarterectomy and – nerve.
The following operations and their associated nerve lesions are listed here:
Posterior triangle lymph node biopsy and accessory nerve lesion.
Lloyd Davies stirrups and common peroneal nerve.
Thyroidectomy and laryngeal nerve.
Anterior resection of rectum and hypogastric autonomic nerves.
Axillary node clearance; long thoracic nerve, thoracodorsal nerve and intercostobrachial nerve.
Inguinal hernia surgery and ilioinguinal nerve.
Varicose vein surgery- sural and saphenous nerves.
Posterior approach to the hip and sciatic nerve.
Carotid endarterectomy and hypoglossal nerve.
Gastrointestinal bleeding: Management
Prompt correction of any haemodynamic compromise is required.
Unlike upper gastrointestinal bleeding the first line management is usually supportive.
This is because in the acute setting –is rarely helpful.
When haemorrhoidal bleeding is suspected a – is reasonable as attempts at full colonoscopy are usually time consuming and often futile.
In the unstable patient the usual procedure would be an – (either CT or percutaneous), when these are performed during a period of haemodynamic instability they may show a bleeding point and may be the only way of identifying a patch of angiodysplasia
In others who are more stable the standard procedure would be a – in the elective setting.
In patients undergoing angiography attempts can be made to address the lesion in question such as coiling. Otherwise surgery will be necessary.
In patients with ulcerative colitis who have significant haemorrhage the standard approach would be a — particularly if medical management has already been tried and is not effective.
Management
Prompt correction of any haemodynamic compromise is required. Unlike upper gastrointestinal bleeding the first line management is usually supportive. This is because in the acute setting endoscopy is rarely helpful.
When haemorrhoidal bleeding is suspected a proctosigmoidoscopy is reasonable as attempts at full colonoscopy are usually time consuming and often futile.
In the unstable patient the usual procedure would be an angiogram (either CT or percutaneous), when these are performed during a period of haemodynamic instability they may show a bleeding point and may be the only way of identifying a patch of angiodysplasia.
In others who are more stable the standard procedure would be a colonoscopy in the elective setting. In patients undergoing angiography attempts can be made to address the lesion in question such as coiling. Otherwise surgery will be necessary.
In patients with ulcerative colitis who have significant haemorrhage the standard approach would be a sub total colectomy, particularly if medical management has already been tried and is not effective.
Uncontrollable splenic bleeding in trauma patients is an indication for –
Uncontrollable splenic bleeding in trauma patients is an indication for splenectomy
Post splenectomy blood film features:
- – bodies
- bodies
- cells
- – erythrocytes
Post splenectomy blood film features: Howell- Jolly bodies Pappenheimer bodies Target cells Irregular contracted erythrocytes
Transplants
Allograft
Isograft
Autograft
Xenograft
Allograft Transplant of tissue from genetically non identical donor from the same species Solid organ transplant from non related donor
Isograft Graft of tissue between two individuals who are genetically identical Solid organ transplant in identical twins
Autograft Transplantation of organs or tissues from one part of the body to another in the same individual Skin graft
Xenograft Tissue transplanted from another species Porcine heart valve
Cardiogenic Shock:
e.g. MI, valve abnormality
- –SVR
- HR (sympathetic response)
- cardiac output
- blood pressure
Hypovolaemic shock:
blood volume depletion
e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations
- SVR
- -HR
- cardiac output
- blood pressure
Septic shock:
occurs when the peripheral vascular dilatation causes a fall in SVR
similar response may occur in anaphylactic shock, neurogenic shock
- SVR
- HR
- -cardiac output
- blood pressure
Cardiogenic Shock:
e.g. MI, valve abnormality
increased SVR (vasoconstriction in response to low BP)
increased HR (sympathetic response)
decreased cardiac output
decreased blood pressure
Hypovolaemic shock:
blood volume depletion
e.g. haemorrhage, vomiting, diarrhoea, dehydration, third-space losses during major operations
increased SVR
increased HR
decreased cardiac output
decreased blood pressure
Septic shock:
occurs when the peripheral vascular dilatation causes a fall in SVR
similar response may occur in anaphylactic shock, neurogenic shock
reduced SVR
increased HR
normal/increased cardiac output
decreased blood pressure
