Surg - Dr Oaks

Question 1

acute phase of post surg recovery

Answer 1

first 24 hr
peripheral vasoconstriction
hypothermia
blood shunts to vital organs

Question 2

subsequent reparative phases

Answer 2

days 2-14

multitude mechanisms = healing

Question 3

cortisol role in healing

Answer 3

promotes PRO breakdown and gluconeogenesis in liver = high blood glucose
promotes lipolysis and has anti-inflammatory properties

Question 4

catecholamine role in healing

Answer 4

adrenal gland releases

glycogenolysis, pro breakdown and lipolysis

Question 5

GH role in healing

Answer 5

promotes pro synthesis, stops pro breakdown, promote lipolysis and inhibits glucose uptake by cells

Question 6

adh levels post surg are..

Answer 6

elevated

Question 7

insulin secretion post surge is

Answer 7

blunted while glucagon secretion slightly elevates

Question 8

net effect that leads to healing

Answer 8

1. salt and water retention = keeps CV stable

2. increased catabolism = energy sources

Question 9

what 3 main cytokines play major role in surg

Answer 9

IL 1 TNF alpha and IL6

fever, leukocytosis

Question 10

how do cytokines affect liver?

Answer 10

increase acute phase proteins such as CRP, fibrinogen and alpha 2 macroglobulin

Question 11

primary extracellular ion

Answer 11

sodium

Question 12

primary intracellular ion

Answer 12

potassium

Question 13

adults generally need ___ fluids per day

Answer 13

30 ml per kg

first 10 kg = 100ml/kg/d
10-20 kg = + 50 ml/kg/d
over 20 kg = + 20 ml/kg/day

Question 14

t/f sepsis causes third spacing

Answer 14

true

Question 15

for surgical pts they need ___ for nutrition per day

Answer 15

30 kcal/kg/day

Question 16

for renal pts want nutrition with

Answer 16

less fuild and less protein

Question 17

for hepatic pt want __ in nutrition

Answer 17

less nitrogen

avoid encephalopathy

Question 18

for pulm pts want nutrition with

Answer 18

less CO2

Question 19

t/f parenteral feeding is far superior to enteral feeding

Answer 19

FALSE

enteral is WAY better

Question 20

enteral feeding

Answer 20

is through GI tract

Question 21

parenteral feeding is via

Answer 21

an IV

Question 22

if see higher rates of nitrogen excreted post op..

Answer 22

sign they are in very catabolic stage need higher caloric post op!

Question 23

3 phases of wound healing

Answer 23

hemostasis with inflammation
proliferation
maturation

Question 24

what occurs during proliferation phase of wound healing

Answer 24

after first few days last several weeks and
type III collage laid down and replaced by type I
growth of new BV and epithelial cells

Question 25

maturation starts when?

Answer 25

after 2-3 wks injury lasts couple mo | MMPS break down collagen, scar remodeling, myofibroblasts - secondary intention

Question 26

what vitamins and minerals are needed for collagen synthesis?

Answer 26

zin, copper and MN, vit a and c

Question 27

why obese pts at risk for wound infection?

Answer 27

fat is not well vascularized - slows down healing process and ability to fight off infection

Question 28

why do DM struggle with wound healing?

Answer 28

hyperglycemia impairs neutrophil function and fibroblast function

Question 29

CT diseases and wound healing..whats problem?

Answer 29

can be associated with vasculitis and slower healing and impaired blood flow also may be IC or on meds that make IC

Question 30

smoking induces vasoconstriction and reduces skin blood flow up to about ___ for ___

Answer 30

reduces blood flow to 40% for 90 min! reduces possibility to heal quickly!

Question 31

smokers have what 6 factors that impair healing

Answer 31

``` decreased tissue oxygen low levels of vit c (needed for collagen synthesis) low levels of collagen synthesis impaired neutrophil phagocytic activity endothelial cell dysfunction enhanced thrombus formation ```

Question 32

a fever over ___ is common and is ___

Answer 32

over 38 degrees celcius | not always indicator of a wound infection

Question 33

6 W of fever post op

Answer 33

``` wind - atelectasis water - UTI/ anastomotic leak wound - site infxn walking - DVT/ PE Wonder - drugs ``` days: 1, 3, 5, 7, over 9 .. then ask why else did we do?

Question 34

clip don't ____ for prvt site infections

Answer 34

clip don't shave off hair

Question 35

abx before surgery?

Answer 35

yes to prvt infxn but stop within 48 hours to avoid resistance

Question 36

examples of bacteria that can cause necrotizing fascitis

Answer 36

GAS, S. aureus, clostridium perfringens, bacteroides fragilis and aeromonas hydrophila, often combo of bacteria!!

Question 37

what suture type has higher infection risk?

Answer 37

multifilament - more surface area

Question 38

soft tissue expansion is most often used in..

Answer 38

breast reconstruction surgery

Question 39

ftsg vs stsg

Answer 39

full thickness: includes entire epidermis and dermis leaving behind a wound, appear more normal, undergo minimal contraction

Question 40

split thickness graft

Answer 40

whole epidermis but part of dermis behind often not that appealing contracts with time more fragile but lower failure rate because thinner covers larger surface area because of meshing option

Question 41

NPWT is what?

Answer 41

wound vac or negative pressure wound therapy