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RCSI SURGERY COPY > Nutrition / Incision / Drain / Hernia > Flashcards

Nutrition / Incision / Drain / Hernia Flashcards

1
Q

Poor nutrition leads to

A

impaired albumin production
impaired wound healing and colleges deposition
skeletal muscle weakness (ICU myopathy)
REDUCED neutrophil and lymphocytes

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2
Q

Good measurement of BMI

A

GRIP STRENGTH

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3
Q

what improves GI function

A

chewing gum

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4
Q

NG and NJ tube used if

A

severe vomititng
gastric reaction
gastic outlet obstruction

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5
Q

TPN use

A

when oral and TPN cannot be used

  • extensive bowl resection
  • w/ fistula and bowl resection like Chrons
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6
Q

TPN is ass. w/

A

hyperosmolarity
Fluid overload

lack of glycemic control
Nutrient deficiencies

Liver disfunction - cholestatsis an pancreatic atrophy

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7
Q

how to give TPN

A

HACKMAN line - dedicated tunnelled catheter

PICC - peripherally inserted central venous catheter

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8
Q

Risk of central VENOUS CAtheritization

A
  • hematoma / haemorrhage
  • superinfective line / infection to surrounding skin
  • line obstruction / kinking / malplacement
  • damage to surrounding skin from malplacement including
    • pneumothorax
    • air embolism
    • cardiac dyshythmias
    • cardiac dissection
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9
Q

what monitoring do patients with TPN require

A

DAILY - urea, electrolytes, glucose (UNTIL STABLE)

TWICE WEEKLY - liver function test

WEEK - Mg, Cu, manganese, zinc, phosphate

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10
Q

Open passive drain

A

provides a conduit for drainage of secretions

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11
Q

Closed ACTIVE drain

A

generates active suction

  • redivac drain
  • minivan drain
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12
Q

closed passive drain

A

drain by siphon effect of gravity and capillary action

  • Robinson
  • NGT
  • VP shunt
  • Chest tube (tube thoaractomy)

Siphon - allows fluid to drain upwards and then pulled down by gravity

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13
Q

T-tube

A

RARELY used after ERCP to compress the bile duct system and make sure there are no further stones

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14
Q

s/e 1 week after removal of Tube

A

binary asites

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15
Q

Causes of weakness of abdominal wall

A

PPASS
previous surgery
post op surgical site infection

Ageing

Smoking
steroid use

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16
Q

Causes of Incease abode pressure

A 
POCAH 
Pregnancy 
Obesity 
CHRONIC COUGH 
Ascites
heavy lifting
17
Q

Richter’s hernia

A

Hernia where ONLY part of the bowl circumference trapanned within hernial wall and therefore presents with partial bowl obstruction where its vomits but still passes flatus

18
Q

Pantaloon

A

is when both indirect and direct hernia occur together

19
Q

Sliding hernia

A

retroperitoneal structure such as COLON for URINARY BLADDER slides down and dorms the wall of the hernia sac

20
Q

Pathogenesis of indirect hernia

A

Leave the abdomen via DIR

  • follows oblique corse through IC
  • patent process vaginalisis

lies in the canal

21
Q

Direct hernia pathogenesis

A

protrude anteriorly though transversals facia (hesselback triangle)

22
Q

(hesselback triangle)

A

medical by rectus abdomens
superior IL
Laterally inferior epigastric artery

23
Q

Boundaries of Inguinal Canal

A

ANTERIOR
- EO (entire) and IO (1/3)

POSTERIOR

  • CJ tendon
  • TF

SUPERIOR
- IO and TA

Inferior
- IL

24
Q

Contents of inguinal canal

A

spermatic cord
vas deference

external / internal spermatic facia
cremastic facia

Testicular artery , artery to vas deference, cremasteric artery
Pampiniform plexus

Lymphatics

NERVE to cremasteric, sympathetic nerve, ilioinguinal nerve , genital branch of GF nerve

25
Q

treatment of hernia

A

Small - conservative

Larger - operation
Open
- Lichtenstein tension free repair
- Stich repair

Lap

  • TAP (transabdominal )
  • TEC (total extraperitoneal)
26
Q

complication of hernia

A 
HEAMATOMA 
Infection 
Urinary retention 
Nerve damage - chronic groin pain 
Testicular artery damage - T Atrophy 
Recurence (5-10%)
27
Q

what can cause recurrence after hernia surgery repair

A

Infection
post op
avoid mesh
conditions such as - chronic cough, constipation , bladder, outlet obstruction

28
Q

boundaries of femoral triangle

A

SUPERIOR: IL
Lateral: medical boarder of sartoris
Medially: lateral boarder of the abductor canal
Floor: iliac, psoas, pectines, adductor longus
ROOF: superficial fascia and GSV

29
Q

femoral canal boundaries

A

A: LL
P: Perineal ligament
M: lacunar ligament
L : femoral ligamant

30
Q

spigelian hernia

A

perfect in the lateral boarder of the RA and lines semilunaris
hernia lies between the two layers of internal and external oblique and transversals abdomens

NEED CT to DX
Surgery repair

RCSI SURGERY COPY (7 decks)

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