Set 3 (10/8) Flashcards
Antibiotic associated with cholestasis
ceftriaxone (Rocephin)
What reverses effects of heparin?
Protamine IV
When to d/c heparin before surgery
4-6 hours before surgery (90min half-life)
Causes of hypotension
- hypovolemia
- sepsis
- MI/ cardiac dysrhythmia
- hypoxia
- pneumothorax
- PE
- cardiac tamponade
- meds (eg: morphine)
Causes of Mental Status Changes
- hypoxia (assume its hypoxia until ruled out)
- hypotension
- hypovolemia
- drug reaction/ drug or EtOH withdrawal
- seizure
- ICU psychosis
- CVA
- sepsis
- urinary retention in elderly
SIRS Criteria
2+ of these = sepsis:
- temp <36C or >38C
- Tachypnea >20 bpm
- Tachycardia >90bpm
- Leukocytes <4k or >12k
Septic shock
sepsis + hypotension
Most common bacteria in post-op wound infections
Staph aureus, E coli, Enterococcus
Clostridium if bronze-brown and weeping
When do you get CT looking for PO abscess
after post-op day 7
Meds that protect from post-op bleeding
H2 blockers & PPIs
Protection against wound infection
do not use razor for hair removal (electric shavers only), adequate skin prep in OR, do not close skin on contaminated case, pre-op Abx before incision
Types of Shock
hypovolemic, spetic, cardiogenic, neurogenic, anaphylactic
First vital sign to change in hypovolemic shock
tachycardia
Indications for dialysis
AEIOU: Acidosis, Electrolytes, Intoxication, volume Overload, Uremic complication
CCK
- Source: duodenum mucosal cells
- stimulated by fat, protein, amino acids
- Inhibited by trypsin and chymotrypsin
- Actions: empties gallbladder, opens ampulla of Vater, slows gastric emptying, release of exocrine pancreas products
Secretin
- Source: duodenal cells
- Stimulated by pH <4.5, fat in duodenum
- Inhibited by high pH in duodenum
- Actions: releases bicarb, enzymes, & H2O; releases bile; ↓LES tone; ↓release of gastric acid
Somatostatin
- Source: pancreatic D cells
- Stimulated by food
- Actions: globally inhibits GI function
RUQ Pain Differential
Cholecystitis, hepatitis, PUD, perforated ulcer, pancreatitis, choledocholithiasis, cholangitis, pyelonephritis, nephrolithiasis, appendicitis (esp w/ pregnancy), pneumonia, PE, MI, pericarditis
LUQ
PUD, perforated ulcer, gastritis, splenic injury, abscess, reflux, dissecting aortic aneurys,, thoracic causes, pyelonephritis, nephrolithiasis, hiatal hernia, Boerhaave’s, Mallory-Weiss tear, splenic artery aneurysm
LLQ Pain Differential
Diverticulitis, sigmoid volvus, perforated colon, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, referred hip pain, gynecologic problems
RLQ Differential
appenidicitis, diverticulitis, perforated colon, Meckel’s diverticulum, intussusception, colon cancer, UTI, SBO, IBD, nephrolithiasis, pyelonephritis, referred hip pain, gynecologic problems
CO2 gas embolus findings
hypotension, ↓end tidal CO2, mill-wheel murmur
When to operate w/ duodenal ulcers
Intractability, Hemorrhage, Obstruction, Perforation
Artery involved in bleeding duodenal ulcers
gastroduodenal artery
Risks for gstric cancer
smoked meats, high nitrates, low fruits & veggies, EtOH, tobacco, poor SES, atrophic gastritis, male, blood type A, pernicious anemia, H pylori
Virchow’s Node
metastatic gastric cancer to nodes in left supraclavicular fossa
Work-up for gastric cancer
EGD w/ Bx, endoscopic US, CT of abd/ pelvis for mets, CXR, labs
Linitis plastica
“leather bottle” gastric cancer involving the entire stomach
Genetic alteration in most gastric cancers
p53 mutation
GIST
Gastrointestinal Stromal Tumor
originates from interstitial cells of Cajal; found anywhere in GI tract
Sx: GI bleed, occult GI bleed, abd pain, abd mass, nausea, distention
Marker: C-KIT
Most common sign of anastomtoci leak after gastric bypass
tachycardia
