General Surgery Flashcards
Give types of abdominal incisions
Midline incision
Paramedian incision
Battle
Kocher’s
Lanz
Gridrion
Gable
Pfannenstiel’s
McEvedy’s
Rutherford Morrison
How is abdominal wound dehiscence managed?
Coverage of the wound with saline impregnated gauze, on the ward
IV broad-spectrum antibiotics
Analgesia
IV fluids
Arrangements made for a return to theatre
What is shock?
Insufficient tissue perfusion
What are the causes of shock?
Septic
Haemorrhagic
Neurogenic
Cardiogenic
Anaphylactic
What is anaphylactic shock?
Severe, life-threatening, generalised or systemic hypersensitivity reaction
How is anaphylaxis managed?
IM adrenaline, can be repeated every 5 minutes
What is neurogenic shock?
Occurs most often following a spinal cord transection, usually at a high level, causing resultant interruption of the autonomic nervous system, therefore causing either decreased sympathetic tone or increased parasympathetic tone, the effect of which is a decrease in peripheral vascular resistance mediated by marked vasodilation
How does neurogenic shock present?
Bradycardia
Hypotension
Post-trauma
Warm flushed peripheries
How does haemorrhagic shock present?
Post-trauma
Tachycardia
How does cardiogenic shock present?
Post MI
Peripherally poorly perfused
How does septic shock present?
Increased temperature
Tachycardia
Give types of stomas
Gastrostomy
Loop jejunostomy
Percutaneous jejunostomy
Loop ileostomy
End ilestomy
End colostomy
Loop colostomy
Caecostomy
Mucous fistula
Describe a loop ileostomy
Right iliac fossa
Typically temporary
Used to protect distal anastomoses by temporarily defunctioning the bowel
Describe an end ileostomy
Right iliac fossa
Permanent or temporary, although reversile is more difficult than loop
Used following complete excision of colon or where ileocolic anastomosis is not planned
Describe a loop colostomy
Any region of abdomen
Typically temporary
Used to protect distal anastomoses and defunction a distal segment of colon
Describe an end colostomy
Either left or right iliac fossa
Typically permanent
Used when anastomosis is not primarily achievable or desirable
What is the difference between ileostomy and colostomy bag contents?
In ileostomy, there is liquid
In colostomy, there is faeculant matter as bowel has had more time to thicken
What is the difference between ileostomy and colostomy appearance?
Ileostomy is pink and spouted to prevent the surrounding skin coming into contact with alkaline enzymes of the small intestine
Colostomy is flat
Give ileostomy complications
Volume depletion
Metabolic acidosis due to increased ileostomy output
What investigation is used to ensure anastamosis healing before ileostomy reversal?
Gastrografin emema
Give features of anastomatic leak
AF
Feculent or purulent material in the wound drain
Distended and rigid abdomen
Fever, tachycardia
How is anastomatic leak managed
CT abdomen and pelvis with rectal contrast for diagnosis and location
Give features of chyle leak
Pale opalescent liquid within drain
Give features of air leak
Persistent pneumothorax despite chest drainage
Bubbling when suction is applied to chest drainage
Give features of post operative ileus present
Occurs in the few days following surgery
Loss of electrolytes
N&V
Abdominal distention and tenderness
How is post operative ileus managed?
Nil by mouth
NG tube
Give features of wound dehiscence
Open wound site with discharge and fat protruding through it
How is wound dehiscence managed?
Apply sterile wet gauze and sutute in theatre
What are early causes of post operative pyrexia (less than 5 days)?
Blood transfusion
Cellulitis
Urinary tract infection
Physiological systemic inflammatory reaction, usually within a day following the operation
Pulmonary atelectasis
What are late causes of post operative pyrexia (more than 5 days)?
Venous thromboembolism
Pneumonia
Wound infection
Anastomotic leak
Give examples of iatrogenic nerve injury and their associated surgery
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 and sural and saphenous nerves.
Posterior approach to the hip and sciatic nerve
Carotid endarterectomy and ipsilateral hypoglossal nerve
Give complications of massive haemorrhage
Hypothermia
Hypocalcaemia
Hyperkalaemia
Transfusion related lung injury
Coagulopathy
Delayed type transfusion reactions
Why is epidural analgesia used in abdominal surgery?
Accelerates the return of normal bowel function after abdominal surgery
Describe the enteral feeding pathway
Stomach can function
- Short term, NG tube
- Long term, PEG
Stomach cannot function
- TPN
Describe the different types of surgicla transplants
Allograft, non identical donor
Isograft, identical donor
Autograft, same individual
Xenograft, another species
