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CP3 Surgery > General Surgical > Flashcards

General Surgical Flashcards

1
Q

List the indications for Proctoscopy / Rigid Sigmoid (4)

A

Suspect colon cancer ± biopsies
Prior to ano-rectal surgery

Ix of IBD
Tx of haemorrhoids

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2
Q

List the indications for flexible sigmoidoscopy (5)

A

Pre-op anorectal surgery
Screen: colon cancer
Surveillance: recurrent colon cancer
Stent: endoluminal strictures

Haematostasis intervention for haematochezia

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3
Q

List the indications for a chest drain (3)

A

Pneumothorax
Pleural effusion / empyema
Post-op after thoracic surgery

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4
Q

What colorectal operations leave a colostomy? (3)

A 
L hemisection (temp)
Hartmann's (temp – emergency)
AP resection (permanent)
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5
Q

What operations leave an end-ileostomy (1) + loop-ileostomy (3)

A

End (1 lumen): colon removal in UC (permanent)
Loop (2 lumen): (temporary)
Rest distal bowel (IBD)
Protect distal anastomoses post-op
Functional relief from severe incontinence

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6
Q

List the early (3) and late (5) complications of a stoma

A

Early:
Dehydration (+hypokal)
Ischaemia/necrosis
Retraction / obstrn

Late:
Fistula
Parastomal hernia (incisional)
Bowel prolapse
Skin dermatitis
Psychological
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7
Q

What are the 3 diff types of central line

A

Hickman: tunnelled under skin (stability/prevent inf)
PICC: from arm (brachial vv) into SVC
Portacath: port under skin

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8
Q

List the indications for a central line (6) (IIILLL)

A

ICU pts
Infusing irritants
Infusing narrow TW drugs

Long-term access
Last resort access
Lack of renal func (haemodialysis)

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9
Q

List some complications of a central line (6)

A 
Arterial damage (h'age)
Thoracic duct damage
Lung damage (pneumothorax)

Air embolism
Thrombosis
Infection (catheter-related sepsis)

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10
Q

What precaution advice given for central lines (3)

A

Avoid contact sports
Don’t get wet
Report any s/o infection or bleeding

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11
Q

What are the indications for a Swan-Ganz catheter (4)

A

ITU haemodynamic monitoring
Post-Cardiac (surg/MI) monitoring
Dx high/low pressure pulm oedema
Dx pulm HTN/PE

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12
Q

What are the complications of a Swan-Ganz catheter (3)

A

Arrhythmias
Valve trauma
Pulm infarct

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13
Q

What is the neuroendocrine stress response after surgery

Why may this confuse fluid administration

A

ADH release
Catecholamines
RAAS activation

Pt may be oliguric but euvolaemic

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14
Q

What are the features of dehydration in:
Mild
Moderate
Severe

A

Mild: headache / lethargy
Moderate:
Dry mouth / less alert / sunken eyes / mm cramps
Severe:
Confusion / Tachycardia / Tachypnoea / Low BP

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15
Q 
What electrolyte abnormalities seen in:
Excess vomiting
Diarrhoea
Fistula (pancreatic/ileal/jejunal/bile)
Acute tubular necrosis
A

Vom: metab alk (hypochlor/hypokal/±hyponat)

Diarr: metab acid (hyperchlor/±hypokal), chronic = alk

Fistula: metab acid (normal anion gap / hyperkal)
K displaced w. acidosis despite total body K depleted

ATN: metab acid
Hypocal / Hyperphos
Hyponat / Hyperkal / Hypermag

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16
Q

Outline the DDx causes for SIADH

A 
SIADH-C:
Surgery (major)
Intracranial: injury/infection/CVA
Alveolar: pus (TB/pneumonia/abscess)
Drugs: opiates / psychotropics
Hypothyroid
Cancers: Pulm (small cell) / Prostate / Pancreatic
17
Q

What is the main feature of SIADH

What is seen on investigations (2)

A

Main Sx: dehydration

Ix: U+Es – hyponat / normal urea+creatinine
Urine dip: increased urine sodium (↑SG)

18
Q

What electrolyte abnormalities seen in Diabetes Insipidus

What are the causes (2)

A

Hypernatraemia (dilutional)
Low plasma osmolality (/high urine osmolality)

Cranial DI (post. pituitary ADH secrn)
Nephrogenic (impaired response)
19
Q 
List the specific complications seen in 
General surgery (small/large bowel, chole) operations? (7)
A 
Ileus
SBO/LBO
Anastomotic leaks
Stoma retraction
Intra-abdo collections
Pre-sacral plexus damage
Bile leakage
20
Q

List the specific complications of cardiac (3) + vascular (3) operations

A

Reperfusion arrhythmia
Post-op MI
Need for inotropes (reducing organ perfusion elsewhere)

Failure of graft (h’age/inf/thrombosis/ischaemia)
High risk MI/CVA/PE
Retroperitoneal haemorrhage (endovascular)

21
Q

List the specific complications of ENT operations (5)

A

Thyroidectomy:
Airway obstrn
Hypocal
Recurrent laryngeal nn damage

Parotidectomy: facial nn damage

Neck dissection: CN11/12 damage

22
Q

List the specific complications of T+O operations

A 
All:
Compartment
Neurovascular injury
Prosthesis infection
Failed fixation

THR: sciatic nn damage

Distal radial # repair: EPL tendon rupture

23
Q

List the specific complications of Urology surgery (4)

A

High risk UTI
TURP syndrome
Retrograde ejac
External sphincter damage

CP3 Surgery (10 decks)

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