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Surgical Skills > Joe + Sathya > Flashcards

Joe + Sathya Flashcards

1
Q

Are hands sterile?

A

no they are aseptic

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2
Q

What is asepsis?

A

absence of microbes that cause disease

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3
Q

What is surgically clean?

A

destruction of all accessible microorganisms on the surface

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4
Q

What is contaminated?

A

a surface or structure where microbes are present

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5
Q

When is an infection considered a surgical infection?

A

30 days after regular surgery, 1 year after implant

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6
Q

HOw does anesthesia enourage infection?

A

hypotension and hypothermia decrease perfusion and reduce defence against infection

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7
Q

How much does each hour increase infection chance?

A

30%. higher risk for contamination and more suppressed immune system

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8
Q

How much does each hour increase infection chance?

A

30%. higher risk for contamination and more suppressed immune system

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9
Q

What % of gloves have holes to start? after surgery?

A

1.5% before, 26% after.

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10
Q

What % of gloves have holes to start? after surgery?

A

1.5% before, 26% after.

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11
Q

What are adhesions?

A

scar tissue that forms between organs and tissue after an abdominal surgery.

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12
Q

why aren’t small animals prone to adhesions?

A

they have an active fibrolytic system

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13
Q

What causes adhesions

A

fibrin deposition after an abdominal inflammatory response.

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14
Q

Most common reason to get a horse back in sugary?

A

adhesion

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15
Q

Most common reason to get a horse back in sugary?

A

adhesion, specifically small intestine lesion adhesions (which cause death)

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16
Q

What are the risk factors for adhesions?

A 
SMALL INTESTINAL LESIONS!
prolonged post-op ilius
Repeated exploratories
Young animals
peritonitis and abscesses 
inflammation
ischemia
foreign material
Tight sutures
Intestinal distention
17
Q

What are the risk factors for adhesions?

A 
SMALL INTESTINAL LESIONS!
prolonged post-op ilius
Repeated exploratories
Young animals
peritonitis and abscesses 
inflammation
ischemia
foreign material
Tight sutures
Intestinal distention
18
Q

Adhesion formation is the balance between:

A

coagulation and fibrinolysis - if we increase coagulation (as in inflammation) we decrease fibrinolysis

19
Q

what factor breaks down fibrin?

A

Tissue plasminogen activator (TPA)

20
Q

When do adhesions become permanent (fibrer)

A

1-2 weeks after surgery.

21
Q

Which adhesions rarely cause clinical problems

A

fibrinous, omental,

22
Q

which adhesions cause clinical problems?

A

fibrous adhesions

23
Q

Adhesions: omentum, intestine to mesentary/peritoneium, intestine to intestine, multiple intestine to intestine. Rank from worst to best.

A

ometum, intestine to peritoneum, intestine to intestine, multiple. (massive fiberous)

24
Q

How do you prevent adhesions?

A

minimize inflammation, enhance fibrinolysis, stimulate intestinal motility.

25
Q

How do you prevent adhesions?

A 
aseptic technique!! 
minimize inflammation (be gentle, don't let bleed, remove damaged tissue, minimize suture, no powdered gloves, keep bowel moist, don't expose mucosa or suture), enhance fibrinolysis, stimulate intestinal motility.
26
Q

How do you prevent adhesions? 7

A
  • aseptic technique!!
  • minimize inflammation (be gentle, don’t let bleed, remove damaged tissue, minimize suture, no powdered gloves, keep bowel moist, don’t expose mucosa or suture),
  • end the surgery with an abdominal lavage to rinse contaminants and inflammatory factors + fibrin.
  • Belly Jelly
  • bioresorbable membrane
  • anticoagulants (increases Tpa and enhances fibrinolysis)
  • prevent ilius (lidocaine)
27
Q

How do you treat a less severe adhesion?

A

can manage medically and with diet

28
Q

How do you manage severe restrictive adhesions?

A
  • remove devitalized intestine and break down adhesions surgically
29
Q

survival rate of horses with adhesions?

A

0-20%

30
Q

which plasminogen activator is the key regulator of fibrinolysis?

A

Tissue plasminogen activator!!

Surgical Skills (4 decks)

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