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Surgery > Surg - Dr Oaks > Flashcards

Surg - Dr Oaks Flashcards

1
Q

acute phase of post surg recovery

A

first 24 hr
peripheral vasoconstriction
hypothermia
blood shunts to vital organs

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2
Q

subsequent reparative phases

A

days 2-14

multitude mechanisms = healing

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3
Q

cortisol role in healing

A

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

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4
Q

catecholamine role in healing

A

adrenal gland releases

glycogenolysis, pro breakdown and lipolysis

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5
Q

GH role in healing

A

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

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6
Q

adh levels post surg are..

A

elevated

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7
Q

insulin secretion post surge is

A

blunted while glucagon secretion slightly elevates

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8
Q

net effect that leads to healing

A
  1. salt and water retention = keeps CV stable

2. increased catabolism = energy sources

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9
Q

what 3 main cytokines play major role in surg

A

IL 1 TNF alpha and IL6

fever, leukocytosis

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10
Q

how do cytokines affect liver?

A

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

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11
Q

primary extracellular ion

A

sodium

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12
Q

primary intracellular ion

A

potassium

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13
Q

adults generally need ___ fluids per day

A

30 ml per kg

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

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14
Q

t/f sepsis causes third spacing

A

true

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15
Q

for surgical pts they need ___ for nutrition per day

A

30 kcal/kg/day

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16
Q

for renal pts want nutrition with

A

less fuild and less protein

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17
Q

for hepatic pt want __ in nutrition

A

less nitrogen

avoid encephalopathy

18
Q

for pulm pts want nutrition with

A

less CO2

19
Q

t/f parenteral feeding is far superior to enteral feeding

A

FALSE

enteral is WAY better

20
Q

enteral feeding

A

is through GI tract

21
Q

parenteral feeding is via

A

an IV

22
Q

if see higher rates of nitrogen excreted post op..

A

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

23
Q

3 phases of wound healing

A

hemostasis with inflammation
proliferation
maturation

24
Q

what occurs during proliferation phase of wound healing

A

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

25
Q

maturation starts when?

A

after 2-3 wks injury lasts couple mo

MMPS break down collagen, scar remodeling, myofibroblasts - secondary intention

26
Q

what vitamins and minerals are needed for collagen synthesis?

A

zin, copper and MN, vit a and c

27
Q

why obese pts at risk for wound infection?

A

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

28
Q

why do DM struggle with wound healing?

A

hyperglycemia impairs neutrophil function and fibroblast function

29
Q

CT diseases and wound healing..whats problem?

A

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

30
Q

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

A

reduces blood flow to 40% for 90 min!

reduces possibility to heal quickly!

31
Q

smokers have what 6 factors that impair healing

A 
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
32
Q

a fever over ___ is common and is ___

A

over 38 degrees celcius

not always indicator of a wound infection

33
Q

6 W of fever post op

A 
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?

34
Q

clip don’t ____ for prvt site infections

A

clip don’t shave off hair

35
Q

abx before surgery?

A

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

36
Q

examples of bacteria that can cause necrotizing fascitis

A

GAS, S. aureus, clostridium perfringens, bacteroides fragilis and aeromonas hydrophila,

often combo of bacteria!!

37
Q

what suture type has higher infection risk?

A

multifilament - more surface area

38
Q

soft tissue expansion is most often used in..

A

breast reconstruction surgery

39
Q

ftsg vs stsg

A

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

40
Q

split thickness graft

A

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

41
Q

NPWT is what?

A

wound vac or negative pressure wound therapy

Surgery (3 decks)

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