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SF quizzes > Pregnany & Surgery > Flashcards

Pregnany & Surgery Flashcards

1
Q

What explains physiologic anemia of pregnancy?

A

Increased intravascular volume > increased RBC mass

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2
Q

What are two common laboratory changes in pregnancy?

A
  • Physiologic anemia

- Leukocytosis

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3
Q

What are the two different ranges of leukocytosis ?

A

10 000 to 14 000 Late pregnancy

20 000 to 30 000 in Labour

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4
Q

What diagnosis must you rule out with RLQ in a pregnant lady?

A

Rule out ECTOPIC pregnancy

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5
Q

In which trimester is appendicitis most frequent?

A

Second trimester

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6
Q

What is the most common non-obstetrical surgery performed in pregnancy?

A

Appendectomy (25% of non-obs operations)

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7
Q

Rate of rupture (appendicitis) higher or lower in pregnancy?

A

Higher

4-57% vs 4-19% in non-pregnant patients

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8
Q

Prevalence of appendicitis in pregnant vs non-pregnant?

A

Prevalence is about the same

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9
Q

What proportion of appendicitis patients demonstrate the classic signs?

A

Less than 1/3rd

obturator, psoas, rovsing

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10
Q

Most common signs in appencitis of pregnancy?

A

RLQ 85%, Rebound tenderness 80%

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11
Q

What physiologic change explains 1)GERD and 2) constipation in pregnancy?

A

1) Progesterone relaxes smooth muscle at LES (decreased tone)
2) Decreased bowel peristalsis increases bowel transit time

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12
Q

What percent of pregnant women are afftected by GERD? Which trimester most often?

A

30-70%

Third trimester

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13
Q

Where is the appendix displaced in pregnancy?

A
  • Displaced superiorly and away from RLQ, due to enlarging uterus
  • Pain localizes to back or flank instead
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14
Q

List 3 Maternal Complications of Appendicitis in pregnancy

A

1) Infectious
2) Ileus
3) Increased risk of VTE post-op

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15
Q

In the infectious category of maternal complications of appendicitis, what 3 can occur?

A
  • Sepsis
  • Wound infection
  • Pneumonia
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16
Q

What fetal complications can occur due to appendicitis in pregnancy?

A

-Fetal loss (3-15% 1T , high as 20-30%)
-PTL and delivery (11-22%)
(Loss rate 7.3 % laparoscopy, 3.3 % laparotomy)

17
Q

Rate of VTE in pregnancy?

A

0.7/1000 pregnant women

3-4x more post partum

18
Q

By what percent are PT and pTT times decreased in pregnancy?

A

20% Reduction

19
Q

What explains the reduction in PT and pTT times? (4 things)

A
  • Increased resistance to activated protein C
  • Protein S increases
  • Factors 1, 2, 5, 7, 8, 10, and 12 increase
  • Activity of fibrinolytic inhibitors (PAI-1 and PAI-2) increase
20
Q

Side effects of CT in pregnancy?

A

Teratogenesis

Carcinogenesis

21
Q

Side effects of MRI in pregnancy?

A
  • Heat

- Avoid gadolinium

22
Q

Amount of radiation exposure from CT pelvis, vs AXR?

Allowed Threshold?

A

CT 5 rads vs AXR 0.1 to 0.3 rads

Allowed threshold 5-15 rads

23
Q

What is the change in the fatal childhood cancer rate, due to CT?

A

increases from 1/2000 to 2/2000

24
Q

Upper limit gestational age for lapaarscopic Appy in pregnancy?

A

26 to 28 weeks GA

25
Q

Effect of pneumoperitoneum (insufflation) in pregnancy?

A

-No adverse outcome with 10-12 mmHg with 60 min OR (Gilo)

-

26
Q

Optimal maternal positioning during OR?

A

Wedge under R side
30 deg left lateral tilt
Reduces IVC compression (which dec CO by 25-30%)

27
Q

What 4 factors increase the likelihood of technically difficult airway management in a pregnant patient?

A
  • Laryngeal edema
  • Wt gain affecting neck soft tissue
  • Increased AP chest wall diameter
  • Breast enlargement
28
Q

Rate of FATAL intubation in obstetrical population?

A

13x HIGHER than non-obstetrical population

29
Q

What is the #1 cause of death in obstetrical anaesthesia?

A

Aspiration

30
Q

3 factors that increase risk for gastric aspiration?

A
  • Mechanical changes in position due to uterus
  • Decease G-E sphincter tone
  • Decreased gastric motility (labor, opioids, pain etc)
31
Q

What Fetal anaesthetic consideration must one consider?

A

Avoid maternal hyperventilation

-Decreases Venous Return, CO and uterine BF

32
Q

Are anaesthetics teratogenic?

A

No definitive data

33
Q

2 things to watch for post-op Appe in pregnant lady?

A

PTL

DVT

34
Q

What prophylactic antibiotics should be given in OR for pregnant lady

A

-Second gen cephalosporin

+ Flagyl or clinda

35
Q

Should routine use of steroids and tocolytics be used in pregnant patients with appendicitis?

A

Studies do not recommend it

36
Q

List 3 physiologic changes associated with pregnancy

A
  • Increased cardiac output (30-50%, inc blood vol and preload)
  • Decreased Systemic vascular resistance (dec after-load)
  • Increased HR (by 15-20 bpm)

SF quizzes (9 decks)

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