Random facts 2 Flashcards
If a patient takes prednisolone, what does need to be prescribed before moderate-major surgery?
Hydrocortisone
* this is due to chronic Prednisolone Rx may suppress hypothalamic-pituitary-adrenal axis at the times of a stress e.g. surgery - may not respond appropriately
What’s Boas sign?
- Hyperaesthesia (altered sensation/sensitivity) below the R scapula
- maybe sign of acute cholecystitis
Treatment of rectal Ca that involves sphincter or lower part of the rectum
- abdomino-perineal excision of rectum (APER)
- radiotherapy (possible as rectum is a retroperitoneal structure)
How much of clearance margin is required in the rectum (in case of cancer)
at least distal 2 cm
Difference between external and internal haemorrhoids
External
- originate below the dentate line
- prone to thrombosis, may be painful
Internal
- originate above the dentate line
- do not generally cause pain
Grading of internal haemorrhoids
Grade I Do not prolapse out of the anal canal Grade II Prolapse on defecation but reduce spontaneously Grade III Can be manually reduced Grade IV Cannot be reduced
Management of haemorrhoids (routine - not acutely thrombosed)
Management
- soften stools: increase dietary fibre and fluid intake
- topical local anaesthetics and steroids may be used to help symptoms
- outpatient treatments: rubber band ligation is superior to injection sclerotherapy
- surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments
- newer treatments: Doppler guided haemorrhoidal artery ligation, stapled haemorrhoidopexy
Common causes of small bowel obstruction (adults)
- incarcerated hernia
- Crohn’s
- internal malignancy
- adhesions (e.g. previous surgery)
Management of endometrial Ca
stage I and II (within the uterus)
stage III and IV (beyond the uterus)
Endometrial Ca
- Stage I and II: total hysterectomy with bi-laterral salpingo- oophorectomy + possible radiotherapy
- Stage III and IV: radiotherapy and high doseprogesterone (to shrink the tumour)
ASA classification criteria
ASA I
ASA II
- ASA I - healthy, non-smoker, minimal or no alcohol use
- ASA II - Including, but not limited to, well-controlled diabetes, hypertension. Social drinker. Smoker
ASA classification criteria
ASA III
ASA IV
ASA V
- ASA III - Including, but not limited to: poorly control diabetes, hypertension. BMI > 40. Previous MI > 6m ago.
- ASA IV - Including, but not limited to: recent MI (<3m), severe reduction in ejection fraction
- ASA V - Including, but not limited to: ruptured AAA, massive trauma
Parkland’s formula for the fluid resuscitation (required ml) in burns
Requirements for fluid resuscitation over hours:
SA of the body burnt % x weight (in kg) x 4ml
Fluid resuscitation in burns
- what’s used
- how much over 8 hours and then over 16 hours (24 hours in total)
- when to end
- when to start
Fluid resuscitation formula
Parkland formula
(Crystalloid only e.g. Hartman’s solution/Ringers’ lactate) Total fluid requirement in 24 hours =
4 ml x (total burn surface area (%)) x (body weight (kg))
* 50% given in first 8 hours
* 50% given in next 16 hours
Resuscitation endpoint:Urine output of 0.5-1.0 ml/kg/hour in adults (increase rate of fluid to achieve this) Points to note:
* Starting point of resuscitation is time of injury
* Deduct fluids already given
Why do we do fluid resuscitation in burns?
To prevent would deepening
- there is protein loss in burns
- fluid shifts from intravascular to interstitial compartment -> therefore circulatory volume may be compromised
Suxamethonium apnoea
- what happens
- causes
- management
Suxamethonium is a muscle relaxant (neuromuscular blocker) used in anaesthetics
What happens: Suxamethonium apnoea happens when there is little/ no respiratory effort after extubation following the surgery (+all other obs are normal)
Cause: a small proportion of the population has a mutation that causes defects in specific acetylcholinesterase enzymes that degrade suxamethonium -> therefore it takes longer for the effects to wear off
Management: ICU + mechanical ventilation