Physiology

Question 1

How much fluid does the stomach produce in 24 hours?

Answer 1

1-2 L

Question 2

Why do you feel nauseous when you have an ileum?

Answer 2

fluid is continually produced and back flows into the stomach and then comes back up the esophagus.

Question 3

How do you manage an ileus?

Answer 3

NG tube, which gives bowel rest

Question 4

etiology of ileus

Answer 4

edematous.

Question 5

Term for dysmotility of colon (basically equivalent of ileus in large bowl)

Answer 5

Ogilvie syndrome

Question 6

What is the connection between the colon and the ileum?

Answer 6

Ileo-Cecal valve, which prevents back flow.

Question 7

Where would perforation occur in the bowel?

Answer 7

Cecum, biggest and has thinnest wall. Picture a balloon, when inflated will burst at widest area with thinnest wall.

Question 8

free air under diaphragm explanation…

Answer 8

1) perforation

2) *post surgery

Question 9

Small bowel dilation that is concerning…

Answer 9

6 cm

Question 10

large bowel dilation that is concerning…

Answer 10

10 cm

Question 11

mgmt of large bowel obstruction

Answer 11

surgical emergency. high mortality.

Question 12

mgmt of small bowel obstruction

Answer 12

can be managed expectantly.

Question 13

large vs small bowel sterility

Answer 13

large bowel is stool and not sterile, small bowel is sucus and is not.

Question 14

other antiemetic options

Answer 14

prochlorperazine (phenergan), haldol (chemo-induced nausea when zofran isn’t working), dexamethasone

Question 15

electrolytes deficient with refeeding syndrome

Answer 15

phosphate, magnesium, potassium

Question 16

at what level of sodium does symptomatic hyponatremia generally occur?

Answer 16

120

Question 17

SIRS

Answer 17

2 or more of following:
temperature >38°C (100°F) or <36°C (97°F), heart rate >90 beats per minute, respiratory rate >20 or PaCO2 <32 mm Hg, WBC count >12,000 or <4000/mm3 or >10% immature neutrophils

Question 18

sepsis

Answer 18

SIRS + documented infection

Question 19

severe sepsis

Answer 19

sepsis + organ dysfunction or hypoferfusion (lactic acidosis, oliguria, or AMS)

Question 20

septic shock

Answer 20

sepsis + organ dysfunction + hypotension (SBP less than 90)

Question 21

feeding approach for patients with expected prolonged recovery after surgery

Answer 21

• early enteral nutrition (small bowel disfunction is misperception after surgery. functions normally)

Question 22

early complications of TPN

Answer 22

hyperglycemia
hyperchloremic acidosis
volume overload with resultant HF

Question 23

when to give FFP for patient with hepatic dysfunction undergoing surgery

Answer 23

• on call to surgery

- need to transfuse prior to incision

Question 24

most common nosocomial infection

Answer 24

UTI

Question 25

RF’s for delayed fistula closure

Answer 25

• same as RF’s for formation
• FRIENDS (foreign body, radiation, inflammation, epitheliazation of the tract, neoplasm, distal obstruction, steroids) (radiation also impairs wound healing)
• high output of fistula (more than 500 cc per day)

Question 26

hemophilia A deficiency

Answer 26

Factor VIII

Question 27

hemophilia A management

Answer 27

• DDAVP for mild hemophilia A (DDAVP also increases levels of factor VIII)
• if severe also need to give inhibitor of fibrinolysis, such as AMICAR (e-aminocaproic acid)

Question 28

how far out NSAIDs need to be stopped

Answer 28

3-4 days before surgery

Question 29

what else can exacerbate a-fib?

Answer 29

fluids