general surgery - recap

Question 1

flluids - Hartmanm’s composition

Answer 1

130 - Na+
109 - Cl-
4 - K+
1.5 - Ca2+
28 - lactate
pH 6.5

Question 2

fluids - 0.9% saline composition

Answer 2

154 - NaCl
nothing
pH 5

Question 3

fluid composition

• 5% dex
• 0.18% dex saline

Answer 3

5% dex
- 50g dextrose, pH 4

0. 15% dex
   - 30 - NaCl
   - 40g dextrose
   - pH 4

Question 4

fluid composition - 5% albumin

Answer 4

<160 - Na+
<2 - K+
136 - Cl-
40-50g - dextrose
albumin
pH 7.4

Question 5

nutritional needs

Answer 5

1mmol/kg/day - Na+, K+, Cl-
50-100g - glucose
25-30mg/kg/day - water

Question 6

stoma complications

• immediate
• early
• late

Answer 6

immediate - hours - ishcaemia, bleeding - theatre
early - 12-72hrs - high output, retraction
late - >72hrs - parastomal hernia, proplapse, psych, stenosis (CD), diversion colitis, dermatitis

Question 7

femoral vs inguinal

Answer 7

inguinal - supermedial to PT

femoral - inferolat to PT

Question 8

hernia exam

Answer 8

inspect - lying and standing - scars, distention, surg drains, stomas, walking aids, swollen, painful, hot (incancerated)
palpate - cough impulse +ve, reducible (pt then you; irreducible then incarcerated), deep inguinal ring palpation (cough and reproduced then direct)
testicular exam if inguinal, abdo exam, imaging (CTl, USS)

Question 9

stoma examination

Answer 9

inspect - redness, swelling, hernia, lumn (1 end, 2 loop), RIF is ileo, LIF is colo, ileal conduit/ urostomy, blood, separation, skin condition, colour of stoma itself (pink), retracted, prolapse, spouted (ileal to avoid acidic irritation)
- should be painless, normal colouring, pink etc
palpate - warmth with back hand, parastromal hernia, ideally remove bag and check for luman patency, put finger through, use proctoscope if in specialist clinic and seek senior help, spouted or flat, if loop the prox should be spouted and inferior with the distal bowel flat)

Question 10

pre-op assessment

Answer 10

explore

• pmh, sx
• adverse anaesthetic reactions
• fhx
• smoking, alcohol
• meds, allergies

assess

• CVD - ecg, echo, UE
• resp disease - ABG, LFT, CXR
• liver - LFT, clot
• group and save - low poss of needing blood
• crossmatch - if likely to need blood
• MRSA screen