How'll App Flashcards
fluid maintenance rate of elderly
why?
25 mL/Kg
older pts are unlikely to tolerate the robust fluid
fluid maintenance regimen for young?
4 ml/kg for the first 10 kg
2 ml/kg for the second 10kg
1 ml/kg for every kg remaining
blood sugar goal for surgical patients
why?
180-200 mg/dL
can’t risk hypoglycemia- when body is stressed it has slight elevations of glucose that will normalize shortly after surgery
why would you think of an obstruction in a surgical patient
starts to complain of n/v, obstipation and constipation, distention
large surgical history (suggestive of adhesions)
test to determine if pt has obstruction?
CT of abdomen
how do you treat obstruction (N/V)
NG tube
esp Salem Slump
Abdominal pain and urgency to void, but with challenges in initiating and completing micturation
DISTENDED BLADDER
tx of distended bladder
foley Cath
urology consult
low urine output but normal bladder scan
pre-renal (hypovolemia)
5 W of post op fever
Wind (atelectasis, PNA) Water (UTI, iV line) Wound (infxn, abscess) Walking (DVT, PE) Wonder drug (B-lactam abx)
Signs of likely infection: (6)
Fever occurring > 48hrs post-op
Pre-operative trauma
An initial temperature elevation above: 38.6°C (>101.5°F)
Leukocytosis greater than 10,000/L
Post-op BUN of 15 mg/dL+
Poor protoplasm
PE of post op fever
1 check the wound/surgical site
the MC pancreatic carcinoma?
Adenocarcinoma
Where is the MC location of pancreatic carcinoma?
Head of the pancreas, followed by body and then the tail.
What are some genetic variants/risks associated with pancreatic carcinoma?
First degree relative,
BRCA gene, HNP-CC, FAP
social hx risk factors of pancreatic CA
Smoking, Drinking and DM
What is the palpable mass of the RUQ called?
Courvoisier Sign
palpable gall bladder
pancreatitis and jauncie
painless obstructive jaundice due to mass in head of pancreas causing biliary obstruction
pruritus and pancreatic CA
common in pts due to biliary obstruction
Benadryl will not help (not histamine issue)
ERCP stent placement to expand duct
virchow’s node
Palpable cervical node,
most prominently in the medial end of the supraclavicular aspect
blumer’s shelf
presence of metastatic mass in the rectal pouch
sr. Mary joseph’s nodule
Periumbilical subcutaneous nodule
highly suggestive of metastatic disease
what study should be done to evaluate a pancreatic mass?
Abdominal CT with contrast
MRCP would also work
lab marker for pancreatic CA
CA 19-9
> 100 highly specific for malignancy