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Clinical Surgery > Principles of Surgery > Flashcards

Principles of Surgery Flashcards

1
Q

Causes of RUQ Abdominal Pain (5)

A
  • Biliary Colic
  • Cholecystitis
  • Cholangitis
  • Hepatitis
  • Right Lower Lobe Pneumonia
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2
Q

Causes of Epigastric Pain (5)

  • Radiations
  • Relieving Factors
A

Pancreatitis (Acute/Chronic)

Peptic Ulcer Disease/Gastritis

GORD

Cardiac – Inferior MI / Pericarditis

Ruptured AAA

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3
Q

Causes of LUQ Pain (4)

A

Splenic abscess/infarct

Gastric Ulcer

Gastritis

Left Lower Lobe Pneumonia

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4
Q

Causes of Right/Left Flank Pain (3)

A

Renal Colic

Pyelonephritis

MSK: lumbar disc / sciatica / bony metastases

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5
Q

Causes of Umbilical Pain (3)

A

Appendicitis

Small Bowel Obstruction

UTI

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6
Q

Causes of RIF Pain (7)

A

Appendicitis

Ovarian Cyst Rupture/Torsion

PID

Inguinal Hernia

IBD

Renal Colic

Psoas Abscess

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7
Q

Causes of Suprapubic Pain (6)

A
  • PID - infection of the upper reproductive organs, including the uterus, fallopian tubes, and ovaries
  • UTI/Cystitis
  • Urinary retention
  • Prostatitis
  • IBD
  • Osteitis pubis inflammation in the joint between your left and right pubic bones (pubic symphysis)
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8
Q

Causes of LIF Pain (7)

A

Diverticulitis

Ovarian Cyst Rupture/Torsion

PID

Inguinal Hernia

IBD

Renal Colic

Psoas Abscess

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9
Q

Things to always consider in presentations of adults with Acute Abdomen?

A
  • Always consider a ruptured abdominal aortic aneurysm in any adult presenting with abdominal pain
  • In a female of childbearing age presenting with abdominal pain, always consider a ruptured ectopic pregnancy.
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10
Q

Biliary causes of RUQ pain (3)

  • Signs
  • Etiologies
A
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11
Q

Triad of symptoms associated with Ascending Cholangitis

A

Charcot’s Triad:

  • Fever/Rigors
  • Jaundice
  • RUQ Abdominal Pain
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12
Q

Hepatic causes of RUQ pain (3)

  • Signs
  • Etiologies
A
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13
Q

Triad of symptoms associated with Budd-Chiari Syndrome

A

Caused by occlusion of the hepatic veins:

  • Abdominal Pain
  • Ascites
  • Hepatomegaly
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14
Q

Causes of Lower Abdominal Pain (7)

  • Pain Localization
  • Clinical Features
A
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15
Q

Investigations/Indications for Acute Abdomen

A
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16
Q

Bedside Investigations for Acute Abdomen?

A
17
Q

Urine investigations for Acute Abdomen?

A
18
Q

Blood investigations for Acute Abdomen?

A
19
Q

Imaging/Invasive Investigations for Acute Abdomen?

A
20
Q
A
21
Q
A
22
Q

5 R’s of IV Fluids

A

o Resuscitation

o Routine Maintenance

o Replacement

o Redistribution

o Reassessment

23
Q

Fluid Resuscitation Protocol

A

o Initial fluid bolus – 500ml Crystalloid solution (e.g. Hartmann’s) within 15 minutes

o Reassess – ABCDE

o Repeat process up to 2000ml of fluid

24
Q

Fluid Maintenance Therapy

  • Water
  • Na/K/Cl
  • Glucose
A

Maintenance Therapy to replace ongoing losses of water and electrolytes under normal physiological conditions – sweat, urine, respiration, stool.

25
Q

Fluid Replacement Therapy

A

Replacement therapy – corrects existing water and electrolyte deficits

26
Q

Causes of Abnormal FLuid/Electrolyte Losses

A

Vomiting/NG Tube Loss

Biliary Drainage Loss

Diarrhoea/Excess Colostomy Loss

High/Low Volume Ileal Stoma Loss

Ongoing Blood Loss (Malaena)

Urinary Loss e.g. Polyuria, Post AKI

Pancreatic/Jejunal Fistula/Stoma Loss

Sweating/Fever/Dehydration

27
Q

How to decide on fluid replacement type?

A
28
Q

Complications of Drains/When they are withdrawn

A

Complications
o Infection
o Haemorrhage
o Hernia formation
o Kinking
o Damage to surrounding structures if migration occurs

Drains are left in place until drainage has decreased to <25-30mL per day for two consecutive days

29
Q

Indications for T-Tubes

A

■ Placed in common bile duct following CBD exploration with choledochotomy or post repair of CBD damage

■ Facilitates external drainage of bile to allow healing

■ Drains ~600ml a day and then reduces

■ Before removing should be clamped for 24 hours and patient monitored for signs of
obstructive jaundice

■ Generally has been superseded by ERCP

30
Q

What are complications of poor nutrition generally/surgically?

A

Poor nutrition results in:

o Impaired albumin production

o Skeletal muscle weakness

o Impaired wound healing

o Reduced neutrophil, macrophage and lymphocyte function

Malnutrition in surgical patients is associated with:

o Poor wound healing

o Increased risk of infection

o Increased frequency of decubitus ulcers

o Overgrowth of bacteria in the GI tract

o Abnormal nutrient loss through stool

31
Q

When is Malnutrition Diagnosed?

A

Malnutrition is diagnosed if a patient has two or more of the following:

o Insufficient energy intake

o Loss of muscle mass

o Weight loss

  • <18.5 Kg/m2 – Underweight
  • 18.5 – 24.9 Kg/m2 – Normal
  • > 25 Kg/m2 – Overweight

o Loss of subcutaneous fat

o Localised or generalised fluid accumulation

o Diminished functional status (handgrip strength)

32
Q

Enteral vs. Parenteral Nutrition

A

Enteral Nutrition

■ Oral
■ Feeding tube – nasogastric/nasojejunal
■ Gastrostomy/Jejunostomy

  • Gastrostomy: for patients who have a functioning gastrointestinal tract but are unable to swallow
  • Jejunostomy: used when stomach needs to be bypassed e.g. due to ulcers, or after major oesophagogastric surgery

Parenteral Nutrition
■ Oral/NG/NJ routes not possible e.g. bowel resection, fistula

■ Can be given peripherally or centrally

■ Peripheral parental nutrition should be given via a large diameter venous catheter

■ Parental nutrition should be given via a central venous catheter if indicated for more than a few days, as high osmotic load is not tolerated by peripheral veins and extravasation can lead to tissue damage

  • PICC Line (Peripherally inserted central venous catheter)
  • Hickman line (dedicated tunneled catheter)
33
Q

Complications of Total Parentaeral Nutrition?

Monitoring?

A

Clinical Surgery (20 decks)

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