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CPS > Principles of surgery > Flashcards

Principles of surgery Flashcards

1
Q

Where do we make surgical incisions?

A 
Inguinal,
Paracostal
Sublumbar 
Parapenile 
Flank 
Ventral midline
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2
Q

What is the critical layer to close on the ventral midline?

A

External sheath of rectus abdominus muscle is the critical layer

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3
Q

If you cut high up on the ventral midline then what can you excise?

A

The falciform fat

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4
Q

What does the duodenal manoeuvre allow you to get access to?

A

Duodenum normally ventrally on right side – retract it across the abdominal cavity, which enables the small and large intestine to be retracted, exposing:
right urogenital structures
vena cava and portal system

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5
Q

What does the colonic manoeuvre allow you to get access to?

A

Retraction of the descending colon provides exposure of the left side of the abdomen

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6
Q

What should you give after GI surgery?

A

Avoid spillage of contents – laparotomy swabs, Lavage + suction
Peri-operative antibiotics - contaminated surgery

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7
Q

What kind of clamp should you use in H

GI surgery?

A

Use Doyen (non-crushing) clamps

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8
Q

In an intussusception which end tends to go into which?

A

Often the oral end goes into the aboral end

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9
Q

What suture material should you use to close the GI tract?

A 
Polydioxanone (PDS), polyglyconate (Maxon), Glycomer 631 (Biosyn), Poliglecaprone 25 (Monocryl) 
3/0 or 4/0
Good early tensile strength (days 5-7)
Resist absorption for > 21 days
Simple interrupted appositional sutures
2-3mm apart, 2-3mm from edge
Use a thread-attatched needle
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10
Q

Should you starve an animal after GI surgery?

A

Starvation after GI surgery detrimental.
Ð Villous atrophy
Ð Ulceration
Ð Breakdown in gut barrier
Early enteral nutrition indicated in most circumstances
Oral route best but other routes in different circumstances

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11
Q

What should you do before closing the abdomen post Gi surgery?

A

Omentum is draped over the site of incision

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12
Q

How do you close a Cystotomy?

A

Full thickness, generally single layer, simple continuous or interrupted
Avoid non-absorbable sutures nidus formation
Weak tissue, but regains ≈ 100% strength within 14-21d
PDS, monocryl and vicryl, 3-0 to 5-0, swaged on taper-point needle
More rapid loss of strength in contact with urine esp. infected (PDS best)

Two layer closure if worried by a thin bladder

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13
Q

To close the external rectus sheath should you go through the muscle?

A

In the cranial two thirds yes but in the lower 3rd don’t go full thickness though just scoop it up

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14
Q

When closing the abdomen should you do interrupted or continuous sutures?

A

Continuous suture patterns preferable

  • even distribution of tension along length of closure
  • more rapid closure
  • less suture material (= less foreign material)
  • 6 throws at each end
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15
Q

How many layers should you close in the abdomen?

A
  1. Subcutaneous layer
    - simple continuous, PDS or monocryl
    - eliminate dead space - use tacking sutures if necessary
  2. Intra-dermal layer
    - simple continuous, PDS or monocryl
  3. Skin sutures
    - non-absorbable, usually nylon
    - interrupted or continuous pattern
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16
Q

Define Asepsis

A

absence of pathogenic microbes or infection in living tissue

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17
Q

Define Antisepsis

A

use of antimicrobial chemicals on living tissue

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18
Q

Define Disinfection

A

destruction of pathogenic microbes, e.g.use of germicidal substances on inanimate objects

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19
Q

Define Sterilization

A

destruction of all microorganisms (only possible in inanimate objects)

20
Q

Are surgical wounds sterile?

A

Surgical wounds are not sterile – all become contaminated with bacteria, but not all contamination infection

21
Q

What are the pros and cons of removing hair prior to surgery?

A

Hair is gross contaminant and significant reservoir for microbes and organic debris
All methods of hair removal some trauma = bacterial multiplication:

22
Q

How do you clip around wounds?

A

first flush and cover with sterile gel

23
Q

Why do we not use hair removal creams (depilatories)?

A

Depilatories: atraumatic, but can be messy, irritant and expensive, not good on coarse hair

  • frequent skin reactions esp. cats
  • good for rabbits
24
Q

How do we deal with paws?

A

Cover it with a drape or a glove

25
Q

What are the aims of skin prep?

A
  1. remove gross dirt and transient microbes
  2. rapidly reduce resident microbial count to sub-pathogenic levels, with minimal tissue irritation
  3. inhibit rapid rebound growth of microbes
    Skin is not made sterile – antiseptic doesn’t reach deeper layers of skin (20% bacteria there)
26
Q

When skin prepping why do we use warm water?

A

Use warm water, and avoid wetting the patient excessively –> hypothermia

27
Q

What should the final stage of prep always be?

A
  • final stage of prep should always be ‘no-touch’ technique with alcoholic tincture
  • allow alcohol solutions to dry completely
  • wipe up any pools of fluid
28
Q

What should the final stage of prep always be?

A
  • final stage of prep should always be ‘no-touch’ technique with alcoholic tincture
  • allow alcohol solutions to dry completely
  • wipe up any pools of fluid
29
Q

Povidone iodine is an iodophor, what does this mean and how doe sit work?

A

Damages the cell wall, and inhibits protein synthesis
Iodophor = iodine complexed with high MW carrier to reduce staining and local tissue toxicity
Greater dilution paradoxical increase in bactericidal activity (10% povidone-iodine diluted to 0.1% solution has most free iodine)

30
Q

What does povidone iodine work against?

A

protozoa, yeasts and mycobacteria

Sporicidal with prolonged contact (15mins-2 hrs)

31
Q

How long do the effects of Povidone Iodine last for?

A

Effective at reducing bacteria for 1 hour
- Some persistent activity for 4-6hrs (eluted from deeper tissues)
- Minimal residual activity
Activity decreased in presence of organic material

32
Q

What are some of the drawbacks of povidone iodine?

A

Relatively high incidence of skin reactions (up to 50% animals)

  • acute contact dermatitis
  • sensitivity in people

Systemic toxicity if used on open wounds, mm and peritoneal surfaces

33
Q

How do biguanide compounds work and what are they effective against?

A

Alter cell wall permeability and cause protein precipitation
• rapid action
• bactericidal, broad-spectrum (better against +ve’s than –ve’s),
• effective against some resistant bacteria incl. MRSA
• good against most yeasts
• variable against fungi and some viruses
• minimal effect against spores
• no effect against mycobacteria

34
Q

Are biguanide compounds active in the presence of organic material?

A

Active in presence of organic matter

35
Q

Do biguanide compounds have lasting activity?

A

Excellent persistent and residual activity as binds to stratum corneum – repeated applications have cumulative effect

36
Q

Do biguanide compounds cause skin reactions?

A

Skin reactions uncommon, sporadic with prolonged use (photosensitivity, contact dermatitis and hypersensitivity)

37
Q

Can biguanide compounds be used on neonates? Where should they not be used?

A

Minimal skin absorption so OK for neonates
• ototoxic: middle or inner earà deafness
• neurotoxic: avoid brain and meninges
• concs ≥0.05% toxic to cornea and conjunctiva

38
Q

Alcoholic tinctures are uses as step two in prep, what are they active against?

A

increases effectiveness of chlorhexidine and iodophors
Bactericidal, broad-spectrum
Good activity against bacteria and fungi, variable for viruses, poor against spores
Rapid kill, but max bactericidal activity requires 2 mins contact, best if 60-70% concentration

39
Q

Does alcohol work in the presence of organic material?

A

Efficacy decreased in presence of organic matter

40
Q

What are some of the drawbacks of using alcohol in the two step process?

A
  • relatively non-toxic, except in newborns
  • avoid open wounds
  • skin drying, and degree of hypothermia via evaporation
  • explosions and fire hazard
41
Q

What is better Pov I or Chlorhexidine?

A

Chlorhexidine may be superior to Povidone Iodine due to:
– broader spectrum of antimicrobial activity
– longer persistent and residual activity
– minimal loss of activity in organic matter
– fewer skin reactions and toxicity

42
Q

How do you prep eyes?

A

EYES: gently flush
– 1:10 dilution around eyelids
– 1:50 dilution on ocular surfaces and conjunctival sac
Remove residual solution with sterile saline or Hartmann’s
Never use products containing detergents or soaps

43
Q

How do you prep ears?

A

Pinna and surrounding skin can be prepared routinely (PI + alcoholic tincture)
Ear canal: use 1:10 dilution PI to flush, no alcohol
Don’t use chlorhexidine gluconate - causes neurosensory deafness

44
Q

How do you prep an open wound?

A

All antiseptics cause tissue damage in an open wound
Can use chlorhexidine – at 0.05% (cf 2-4% for scrub)
Pack wound with sterile KY jelly or intrasite
Clip routinely
Lavage copiously with (several litres) sterile warm Hartmann’s or saline: dilution = solution to pollution
Pack moist swabs into site while rest of area prepared

45
Q

What is sterrillium effective against?

A
  • kills ≥ 99.9% of pathogens within 15 seconds

* kills bacteria, yeasts, TB, mycobacteria and viruses (incl.HIV)

46
Q

What fabrics are better for gowns and drapes?

A 
Overall, non-woven materials:
–	lower no’s of +ve cultures at end of surgery - randomly oriented fibers should prevent penetration of fluid and bacteria 
–	lower particle counts 
–	more expensive
...than woven.

CPS (16 decks)

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