Surgery 1 Flashcards
Varicocele vs. Hydrocele
Dilation of pampiniform plexus - left side (rt angle)
- bag of worms, worse standing, better supine
Accumulation of fluid btwn parietal & visceral layers of tunica vaginalis
- transillumination
Appendicitis > 5 days after onset…
Perforation w/ abscess formation
- may be contained abscess…
- IV hydration, abx, bowel rest + interval appendectomy
Blunt Abdomen Trauma
- hemodynamically stable
Alert?
- No = serial abd exams +/- CT
- Yes = FAST
Fast + CT of abdomen
Fast - serial abd exams +/- CTHighly specific and sensitive test for PAD in symptomatic patients?
Ankle-brachial index
Blunt abdominal trauma…interval…ULQ pain + left shoulder pain + hypotensive + tachycardia
Splenic injury w/ delayed symptoms
- if stable, get abd CT w/ contrast
Hypotension after surgery…bloody diarrhea…where injury?
Splenic flexure
- watershed areas damaged (splenic + rectosigmoid)
Do colonoscopy to confirm
Symptomatic epidural hematoma patients?
Emergent neurosurgical hematoma evacuation
Multiple rib fractures + respiratory distress
Flail chest
- retracts during inspiration
- bulges out during expiration
Blunt abdominal trauma
How know if splenic laceration?
Free intraperitoneal fluid
- hypotension after BAT suggests solid organ or vascular injury
Rapid deceleration trauma to chest?
Aortic injury
- widened mediastinum
- left-sided hemothorax
Pain and changes in lung compliance after surgery…
Atelectasis
- impaired cough and shallow breathing
- get low O2 due to mucus plug + lung bases not getting O2 due to shallow breathing
- then get compensatory increase in RR and then decreased PCO2
Significant body area burns get…
Hypovolemic shock
- give adequate fluid resuscitation
- worry about bacterial infection
Sudden-onset, severe, poorly localized mid abdominal pain (periumbilical) w/ N/V
Heart Stuff
Mesenteric Ischemia
- cardiac embolic events (a-fib, valve disease)
- pain out of proportion to exam findings
- elevated lactate = metabolic acidosis
Left sided bowel in lung field
Diaphragmatic rupture
- do CT scan of chest & abdomen
- Shift of mediastinum to other side
Abrasion wound; pain + red
No sensation to light touch
CT scan shows ?
Necrotizing fasciitis
- gas in subQ tissue
- pain out of proportion to exam + swell + erythema
- tissue necrosis + crepitus + purulent drainage
- radiographic evidence of gas in deep tissues
RAPID progression
GSW, obtunded mental state + hypotension
- if peritonitis, evisceration of organ or unstable
FAST
- if equivocal = get immediate laparotomy
Hyperextension injury to hand
- mild tenderness in snuffbox
- pain w/ radial deviation
X-ray does NOT reveal a fracture
Place thumb spica cast and repeat XRAY in 7-10 days
- scaphoid fracture - blood supply
- CT/MRI would give immediate diagnosis
4 Steps to pt w/ hemodynamically unstable victim of motor vehicle accident w/ suspected blunt abdominal trauma
- Cervical spine immobilization
- IV hydration
- FAST
- If blood in peritoneal cavity = urgent laparotomy
Septic Shock, metabolic acidosis, treat?
Correct underlying cause + restore tissue perfusion
- IV normal saline (0.9%) - NOT D5
- dopamine/pressors only after IV fluids fail
Pain radiate to groin + extension of hip increases pain flexion decreases pain
Psoas sign + psoas abscess
CT of and/pelvis to confirm
Treat w/ drainage + broad-spectrum abx
Femoral vs. Common peroneal vs. Tibial nerve?
Femoral - medial thigh & lower leg
Common Peroneal - anterior & lateral leg
Tibial - posterior thigh & leg + plantar flexion of foot
AAA rupture can cause…
Profound hypotension
Abd/back pain + syncope
Injure bladder = hematuria
Suspected tension pneumothorax?
Subclavian catheter
Treat w/ needle thoracotomy in hemodynamically unstable patients
Cardiac cath can cause?
Retroperitoneal hematoma - get CT of abd/pelvis without contrast…surgical repair almost NEVER needed
Diaphragm injury
Surgical repair + exploration of abdomen look for other traumatic injuries
Diverticulitis w/ abscess
Do CT-guided percutaneous drainage
- rim-enhancing perisigmoid fluid collection
Pulmonary contusion vs. ARDS
Pulm contusion = w/in 24 hours of injury
ARDS: 24-48 hours after trauma + BILATERAL lung involvement
Surgical repair AAA w/ postop bloody diarrhea + pain
Thickening of colon (at rectosigmoid junct)
Ulcerations seen via colonoscopy
Colon above and below lesions is normal
Management?
Ischemic colitis: pt > 60yo w/ Renal/Heart dx
- supportive care: IV, bowel rest + IV abx
- possible colon resection
- bowel infarct / perforation / gangrene
- clinical deterioration
Older b/c often have extensive CV disease
Pneumatosis in bowel wall!
Gallbladder wall thickening
Pericholecystic fluid
Dx + treatment?
Acalculous cholecystitis
Abs followed by percutaneous cholecystostomy
Tenderness medial knee at joint line
Internal rotation = locking sensation + pain
Normal Xray
Medial meniscus tear
- do valgus stress test: stabilize thigh, push on medial leg…laxity = MCL injury
Internally & externally rotate knee
Pain, clicking, catching
Meniscal tear
Hemorrhagic Shock
Signs of Class I: pt loses
Early vs. Late Wound Prosthetic Joint Infection
3 mos) (3-12 mos
Staph aureus & Pseudomonas – early
Staph epidermis + enterococci – late
Neisseria g. in septic arthritis
Occupations requiring kneeling
- concrete
- carpet laying
- plumbing
Housemaid’s knee = Prepatellar bursitis
- infection common w/ Staph aureus
No infection? Modify activity + NSAIDs
Infection = drainage + abx
Unilateral LE edema worse when leg is dependent
- better when leg elevated
Venous valvular incompetence
- blood pools
- get increased capillary hydrostatic pressure
- fluid leaves capillaries into interstitial tissue
- get increased capillary hydrostatic pressure
Thyroidectomy – leads to what lab value?
Hypocalcemia
- can get tetany, muscle cramps, poor sleep
- get QT prolongation
Gas in gallbladder wall
Emphysematous cholecystitis
- life-threatening form of acute cholecystitis
- infection by gas-forming bacteria
- Clostridium
- E. coli strains
- infection by gas-forming bacteria
Rust-colored discharge in Bra of 42yo F
No family hx breast CA, no fever
No fluid expressed from nipples
Intraductal papilloma
