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SA Surgery Final > Principles of Abdominal Surgery > Flashcards

Principles of Abdominal Surgery Flashcards

1
Q

Steps for working up a case

A

A. Make a list of the problems you identified from the patient history and PE

B. Write a list of DDX (differential diagnoses) for each problem

C. Not DDX that are common among the problems and consider which DDX are most likely for your patient

D. Make a diagnostic plan to determine which diagnosis/es is/are correct

E. Add any abnormalities you find as a result of your diagnostic tests to your problem list and list the DDX for these new problems

F. Repeat diagnostics until you’ve made a diagnosis

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2
Q

Know the normal so you recognize the abnormal of the following

A 
A. Anatomy 
B. Physiology 
C. PE 
D. TPR 
E. Blood pressure 
F. PCV, TP, glucose, BUN, lactate
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3
Q

Normal TPR for a cat

A

T: 100-102.5

HR: 140-220 BPM

RR: 20-30 BPM

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4
Q

Normal TPR for a dog

A
  • HR: 60-160 BPM
  • RR: 10-30 BPM
  • 100-102.5
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5
Q

Normal Blood pressure

A

100-150 mm Hg

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6
Q

Normal PCV/TP/Glucose/BUN/Lactate

A
  • Glucose: 80-120 mg/dL about
  • PCV/TP (35-55/5.5-8)
  • BUN (10-30)
  • Lactate (<2.5)
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7
Q

What should you consider when asking yourself when surgery should be performed for a patient?

A
    • If it would be best if done…
  • By a certain time
  • Before or after a certain age
  • Before or after other diagnostics or treatments
  • Is it an emergency
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8
Q

What do you need to have skills and resources for in order to perform a surgery?

A
  • Do the surgery AND
  • Handle potential intra-op complications AND
  • Manage the patient post-op
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9
Q

What systems should you consider before surgery?

A
  • Hydration
  • Electrolytes
  • Cardiovascular system
  • Respiratory system
  • Renal function
  • Nutritional status
  • Infection
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10
Q

What potential risks or complications are common to all procedures?

A
  • Anesthesia
  • Hemorrhage
  • Infection of the incision
  • Infection internally at the site of procedure
  • Dehiscence of the abdominal incision
  • Dehiscence of the procedure’s incision (e.g. enterotomy)
  • Seroma
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11
Q

What else do you need to prepare for and counsel to the client about besides risks common to all procedures?

A
  • Risks specific to that procedure

- Recurrence or failure to resolve the problem

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12
Q

When are therapeutic antibiotics started, and for how long are they continued?

A
  • Started at the time of diagnosis and continued for a duration appropriate for that condition (days/weeks/months)
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13
Q

When are prophylactic antibiotics given and discontinued?

A
  • 30 min pre-op and q90 min intra-op

- Stopped at the end of the procedure

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14
Q

What is a common choice for prophylactic antibiotics at WSU?

A
  • Cefazolin or cefoxitin
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15
Q

What could be an exception to starting Abx pre-op?

A
  • If one of the surgical goals is to get a sample for culture, abx may not be started until the sample is taken
  • This decision is made on a case-by-case basis
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16
Q

What is an exploratory laparotomy or celiotomy?

A
  • Incise into abdomen and examine contents
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17
Q

Why do an exploratory laparotomy or celiotomy?

A
  • Diagnosis and/or treat
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18
Q

Who can do an exploratory laparotomy or celiotomy?

A
  • General practitioners and surgeons
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19
Q

How do you do an exploratory laparotomy or celiotomy?

A
  • Be systemic and thorough
  • Visualize and palpate all structures
  • Know what normal looks like
  • Explore the sameway every time
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20
Q

What do you do if you don’t find significant findings on an exploratory celiotomy?

A
  • Biopsy organs/tissues of interest before closing the abdomen
21
Q

What are three principles to keep in mind during celiotomy?

A
  • Keep tissues moist with sterile saline! Cover with moist laparotomy pads, lavage.
  • Isolate contaminated areas (contamination can mean bacteria or neoplasia)
  • When done with contaminated areas, you should lavage, change gloves, and change instruments
22
Q

What is considered a contaminated area with an exploratory celiotomy?

A
  • Bacteria or neoplasia
23
Q

What should you always do when you are finished with a contaminated area?

A
  • Lavage, change gloves, and change instruments
24
Q

Indications for abdominal cavity lavage

A
  • Eliminate contaminants (bacteria or tumor cells), warm up the patient, improve visualization, find the source of hemorrhage (look for swirl of blood in saline)

-

25
Q

How do you lavage the abdominal cavity in dogs and cats?

A
  • Use warm, sterile saline with no additives
26
Q

Why is it imperative to suction out fluid or blood before closure of the abdomen?

A
  • If you have free fluid, bacteria can be quite happy
27
Q

What are three major considerations for prioritizing multiple surgical procedures?

A
  1. Immediately life threatening first (i.e. patient might die before end of surgery) before non-immediately life threatening problems
  2. Clean before contaminated procedures
  3. Major before minor problem
28
Q

What can be an exception for clean before contaminated procedures?

A
  • Immediately life-threatening goes first, even if it’s contaminated
29
Q

Why do you usually want to do a major before a minor problem?

A
  • Want to make sure major problem is taken care of in case surgery has to be cut short for anesthetic complications
  • Possibly do harder procedure when surgeon is still fresh
30
Q

What could be some exceptiosn for minor vs major procedure?

A
  • Minor procedure is fast

- Minor is clean and major is contaminated

31
Q

What is the term for incising into something?

A
  • otomy
32
Q

What is the term for removing a part of something?

A
  • ectomy
33
Q

What is the term for making a temporary or permanent stoma into another organ or to the outside?

A
  • ostomy
34
Q

Linea suture size and type for <4.5 kg patient?

A
  • 3-0 PDS
35
Q

Linea suture size and type for 4.5-17 kg patient?

A
  • 2-0 PDS
36
Q

Linea suture size and type for 18-45 kg patient?

A
  • 0 PDS
37
Q

Linea suture size and type for >45 kg patient?

A

1 PDS

38
Q

PDS generic name

A

Polydiaxanone

39
Q

Closure pattern for the abdomen

A
  • Simple continuous pattern in the linea with 6 throws (3 square knots) on each end
40
Q

If your incision is off midline or in the caudal abdomen where the linea is narrow, what should you suture?

A
  • External rectus sheath only
  • DO NOT include rectus abdominus muscle, internal rectus sheath, or peritoneum as these don’t add to the strength of closure
41
Q

What 8 things should you consider for postop care of all surgery patients?

A
  1. Monitoring
  2. Hydration and electrolytes
  3. Analgesia
  4. Antibiotics
  5. Nutrition
  6. Treat any underlying disease or concurrent problems
  7. Incision
  8. Exercise
42
Q

Things to consider for monitoring

A
  • TPR
  • Mucous membranes
  • CRT
  • Pulse quality
  • Blood pressure
  • Pain
  • Urination
  • Defecation
  • Also watch for complications specific to a patient’s disease process/surgery
43
Q

Things to consider for hydration and electrolytes

A
  • Fluid type, rate, and route
44
Q

Examples of analgesia to choose

A
  • Fentanyl CRI +/- Lidocaine +/- ketamine CRI
  • Local analgesic (e.g. bupivicaine which lasts 4-6 hours or 72 hours as NOCITA or liposome encapsulated
  • Tramadol (better for acute pain as with soft tissue sx than chronic ortho pain)
  • NSAIDs (think first!)
45
Q

What should you consider before starting NSAIDs on a patient?

A
  • Are there concerns that the patient might become hypotensive?
  • Any renal/liver/GI disease/GI surgery?
  • Is it possible the patient might need steroids?
46
Q

What are some indications that antibiotics may be needed?

A
  • Infection present
  • Marked contamination remains
  • Extensive or severe tissue compromise
  • Immunocompromised
47
Q

Consideratiosn for nutrition

A
  • When to start
  • What to feed
  • How much to feed
  • Route (oral/feeding tube/parenteral)
48
Q

Incision monitoring

A
  • Monitor for redness, swelling, discharge, dehiscence
  • Ice for first 24-72 hours, then +/- warm compresses
  • Manage bandages and drains if present
49
Q

Exercise restriction

A
  • Type and duration of restriction
  • Physical therapy
  • Generally it’s limited leash walks and no running, jumping, or playing for 2 weeks

SA Surgery Final (19 decks)

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