Surgery (1-6) Flashcards by Natalie Bubenheim

4 overarching reasons to do surgery

diagnostic, prophylactic, therapeutic, palliative

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-lysis means…

breakdown

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-itis means…

inflammation

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-megaly means…

enlargement

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-rrhage means…

bursting forth

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-rrhea means…

flow

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-sclerosis means…

hardening

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-stenosis means…

narrowing

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-malacia

softening

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-algia means…

pain

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-dynia means…

pain

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-coele means…

cavity/space

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-ectasia means…

dilation

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-plegia means…

paralysis

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-ptosis means…

displacement

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-ptysis means…

spitting

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-centesis means…

puncture to remove

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-desis means…

fusion

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-ectomy means…

excision

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-stasis means…

stopping or controlling

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-stomy means…

new opening

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-otomy means…

process of cutting into

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-plasty means…

reshaping or reconstructing

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-pexy means…

surgical fixation in one place

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-rrhaphy means...

join by suture

-plication means...

folding of a structure onto itself

cystocentesis means...

drain bladder with a needle

enterotomy means...

cut into intestine

name Halstead's 6 principles of surgery

1. aseptic technique 2. sharp anatomic dissection 3. gentle tissue handling 4. careful hemostasis 5. avoid tension 6. obliteration of dead space

what are the 3 reasons for Halstead's principles of surgery

1. reduced dehiscence 2. rapid wound healing 3. prevention of infection

name the 5 features/steps of aseptic technique

1. theater preparation 2. instrument prep 3. surgeon prep 4. patient prep 5. maintain asepsis

what can excessive tension lead to

dehiscence (wound bursting open)

why is the obliteration of dead space important?

minimize serum and hematoma formation; maximize healing

why is careful hemostasis important in surgery

minimize hematoma and contusion

these are the primary cutting instruments used to incise tissues

scalpels

this scalpel blade is the most commonly used in small animal surgery for incision and excision of tissues

no. 10 blade

this scalpel blade is ideal for stab incisions into fluid-filled structures or organs

no.11 blade

this scalpel blade is small and used for precise incisions in smaller tissues

no.15 blade

this grip of a scalpel allows shorter, finer, and more precise incisions; scape is help at 30 degrees to tissue

pencil grip

this grip of a scalpel offers the best accuracy and stability for long incisions

fingertip grip

these needle holders are ratchet, used for medium to coarse needles

Mayo-Hegar

these needle holders are ratchet with scissor blades that allows suture to be tied and cut with the same instrument

Olsen-Hegar

these needle holders have a ratchet lock at the proximal end

Mathieu

these needle holders have a spring and lock mechanism

Castroviejo

# name the needle holder grip no fingers are placed in the rings, and the upper ring rests against the ball of the thumb

palmed grip

# name the needle holder grip the upper ring rests on the ball of the thumb and the 4th finger is inserted through the lower ring

thenar grip

# name the needle holder grip held with the tips of the thumb placed through the upper ring and the 4th finger through the lower ring. the 2nd finger rests on the shanks near the fulcrum. rings should be kept near the distal finger joint

tripod grip

# name the needle holder grip thumb and 2nd finger rest on the shafts of the needl holder

pencil grip

# name the surgical instrument variety of shapes, sizes and weights classified according to type of point, blade shape, or cutting edge

scissors

# name the type of scissor designed for sharp and blunt dissection or incision of finer tissues

Metzenbaum

# name the type of scissor for cutting dense, heavy tissue, such as fascia

Mayo

# name the type of scissor used to cut sutures but these are separate instruments from those used to cut tissue

Heavy scissors

# name the type of scissor have a concavity on one blade to gently hook the suture away from the skin and facilitate easy removal

Skin suture scissors

# name the type of scissor fine, precise cuts, opthalmic procedures and otehr meticulous surgeries, such as perineal urethrostomy

Tenotomy scissors or Iris scissors

what grip should you use with scissors

tripod grip

# name the surgical instrument tweezer-like, non-locking instruments used to grasp tissue; tips may be pointed, flat, round, smooth, or serrated

tissue (thumb) forceps

which hand should tissue (thumb) forceps be held in?

non-dominant hand

what grip should be used for tissue (thumb) forceps

pencil grip

# name the type of hemostat forcep has transverse serrations that extend the entire length of the jaws

crile forceps

# name the type of hemostat forcep transverse serrations extend only over the diatal portion of the jaws

Kelly forceps

# name the type of hemostat forcep larger, crushing forceps often used to control large tissue bundles, such as during an ovariohysterectomy

Rochester-Carmalt forceps

# name the term surgical excision of part of the stomach

gastrectomy

# define the term nephrotomy

incision into a kidney

# define the procedure paracentesis

perforation or tapping of a body cavity with a needle

this is the exclusion of all pathogenic microorganisms before they can enter an open surgical wound or contaminate a sterile field during surgery

surgical asepsis

the destruction of all micro-organisms on all inanimate objects

sterilization

this is the destruction of pathogenic organisms on inanimate objects

disinfection

this is the destruction or inhibition of growth of most pathogenic micro-organisms on animate organisms

antisepsis

name 3 sources of contamination that threaten surgical field

1. animal 2. inanimate 3. airborne

name the 3 hand scrubbing technique options for surgery

1. timed anatomic brush stroke method 2. counted brush stroke method 3. sterilium

what parts of the surgical gown is considered sterile

front of gown from chest level to sterile field, sleeves from 2" below elbow to cuff

what skin antiseptic has the most rapid kill rates

alcohols

this option for wrapping surgical packs is soft, reusable, inexpensive and absorbent BUT penetrative to bacteria

woven

this option for wrapping surgical packs is an effective barrier and water resistant

non-woven

# name the method of sterilization for heat-tolerant medical supplies, instruments and packaging; temp, pressure and exposure time is critical; rapid destruction of all known microorgansisms

steam sterilization (autoclave)

# name the method of sterilization for disposable items as cannot re-sterilize after use; cobalt-60 gamma rays, electron accelerators, expensive

ionizing radiation

list some characteristics of the 'ideal' suture material | (total of 9)

1. good handling 2. low tissue reactivity 3. non-capillary 4. not support bacterial growth 5. knot securely 6. absorb predictably 7. easy to sterilize 8. non-carcinogenic/non-allergenic 9. affordable

this category of suture gradually loses tensile strength and disappears

absorbable

what are the 2 ways absorbable suture is removed

hydrolysis or phagocytosis

# name the category of suture single strand, little drag, high memory, non-capillary

monofilament

# name the category of suture several braided strands, rough/increased drag, capillary, soft/easy to handle, good knot security

multifilament

# name the category of suture material found in nature, not predictable absorption, enzymatic degradation and phagocytosis

natural

# name the category of suture man made material, predictable absorption by hydrolysis

synthetic

name 4 ways a coating can modify surface characteristics of a suture

1. reduce tissue drag 2. fill internal space 3. reduced friction/less secure knots 4. anti-bacterial

# name the type of knot even knot, secure and stable, routine go to knot

square knot

# name the type of knot uneven knot, potential to damage monofilament materials, used if some tension in tissues

surgeons knot

how many throws for knots in interrupted patterns

4 throws

how many throws for knots in continuous patterns

5 throws to start, 6-7 throws to end

what shape of needle for skin?

straight

what shape of needle for deeper tissues

curved

# name the type of needle used for difficult to penetrate tissue, spex of edges on inside curvature

cutting

# name the type of needle used for difficult to penetrate tissue, apex of edges on outside curvature

reverse cutting

# name the type of needle separates tissues, pierces without cutting, for easily penetrated tissue

round bodied

# name the type of needle combination of reverse cutting and round bodied, used for dense, tough fibrous tissue

tapercut

# name the type of needle has a rounded, blunt point that can dissext through friable tissue without cutting, used for soft, parenchymal organs

bluntpoint

# name the type of suture natural, absorbed by phagocytosis and enzymatic degradation, loses tensile strength rapidly and unpredictably, prepared from sheep/cattle intestinal mucosa/serosa

catgut

# name the type of suture synthetic monofilament, rapidly absorbabed by hydrolysis, memory-free, highest initial tensile strength

Monocryl (poliglecaprone 25)

# name the type of suture multifilament, braided synthetic absorbable, coated to reduce tissue drag and improve knotting, absorbed by hydrolysis

Vicryl (Polyglactin 910)

# name the type of suture synthetic, monofilament, degraded by hydrolysis but at slow rate to provide extended wound support, low tissue drag

PDS, PDSii (Polydioxanone)

# name the type of suture non-absorbable, monofilament, high tensile strength, high memory (poor knotting and handling), main use for skin sutures

nylon

# name the type of suture monofilament, strands flatten at knot to enhance holding, virtually inert in tissues, used to repair large tissue defects

polypropylene (prolene, premilene, flurofil)

# name the type of suture natural, braided multifilament, good handling characteristics, cardiovascular procedures, non-absorbable but do not retain tensile strength after 6 months

silk

what are the 4 possible sources of hemorrhage

1. arterial 2. venous 3. capillary 4. mixed

what are the 3 time scales for hemorrhage

1. primary 2. delayed 3. secondary

# name the type of hemorrhage (time scale) immediately after vessel disruption due to: surgery, trauma, or disorders of primary hemostasis

primary

# name the type of hemorrhage (time scale) occurs within 24h of vessel disruption due to: ligature slip, inappropriate electrocautery, dislodgment of blood clot, disorders of secondary hemostasis

delayed

# name the type of hemorrhage (time scale) uncommon, occurs 7-14 days post surgery due to: erosion of vessel by drain, implant, etc

secondary

name 4 ways to try to avoid primary hemorrhage

1. anatomical knowledge 2. accurate dissection 3. avoid vessel 4. ligate vessel

how much blood can a pre-moistened swab hold

5-10 mL

how much blood can a pre-moistened laparotomy pad hold

50 mL blood

this is the spontaneous physiological response to hemorrhage designed to control the loss of blood - platelet activation and circulating clotting factors to produce clot

hemostasis

name 4 ways that hemostasis reduces surgical morbidity

1. reduces infection 2. improves wound healing 3. reduces hematoma formation 4. prevents life threatening hemorrhage

name 8 mechanical methods of hemostasis

1. tourniquets 2. digital pressure 3. packing 4. dressings 5. hemostatic clamps 6. ligatures 7. ligating clips 8. bone wax

name 6 thermal methods of hemostasis

1. electrocautery 2. electrocoagulation 3. hypothermia 4. harmonic scalpel 5. laser 6. argon beam coagulation

name 6 chemical methods of hemostasis

1. vasoconstrictors 2. absorbable gelatin 3. collagen 4. cellulose 5. MPH 6. thrombin fibrin sealants and glues

# name the mechanical method of hemostasis for distal extremeties; hemorrhage will start again once removed; do NOT use if vascular compromise

tourniquet

# name the mechanical method of hemostasis provides temporary hemostasis with finger or saline soaked wipes (dab)

digital pressure

# name the mechanical method of hemostasis pressure applied to bleeding area; absorbs blood and creates pressure

dressings

# name the mechanical method of hemostasis definitive hemostasis for smaller vessels; temporary occlude larger vessels for subsequent ligation

hemostatic forceps/clamps

name 5 factors that influence knot security of ligatures

1. type of material 2. length of cut ends 3. knot configuration 4. number of throws 5. experience

# name the type of ligature square knot with 4 throws tied around the vessel

simple (circumferential)

# name the type of ligature bite of suture through the vessel; one knot placed on opposite side of vessel from bite

Halsted transfixing

# name the type of ligature first bite through the wall of vessel, single throw, then tie on opposite side with 4 throws

modified transfixation ligature

# name the type of ligature tie vessel including some of the surrounding tissue

tissue ligature

# name the type of ligature suture fixed to the wall of the structure; for serosal surface of intestine; rarely used

stick tie

# name the mechanical method of hemostasis prevents bleeding from cancellous bone; soft and kneadable but non-absorbable

bone wax

# name the thermal method of hemostasis heat is generated by direct current in a metal wire/probe and used to cut tissue or coagulate small blood vessels - current does not pass through the patient

electrocautery (diathermy)

# name the thermal method of hemostasis heat is generated within tissues using alternating current that passes through the tissue itself; converts to heat energy on contact with vessel so vessel shrinks and lumen occludes

electrocoagulation (monopolar or bipolar)

# name the type of electrocoagulation current flows from handpiece through patient to a ground plate placed under animal may be used to cut tissue or coagulate vessels

monopolar electrocoagulation

# name the type of electrocoagulation forceps handpiece; current flows from 1 tip of forceps to the other, passing through tissue being held between the tips used to coagulate vessels ground plate not needed

bipolar electrocoagulation

# name the thermal method of hemostasis cold saline; lot of capillary ooze (nasal surgery)

hypothermia

# name the thermal method of hemostasis ultrasound energy induced coagulation

harmonic scalpel

# name the thermal method of hemostasis light energy, CO2

laser

# name the chemical method of hemostasis used for vessels too small to ligate; ex: epinephrine and silver nitrate crystals

topical vasoconstrictors | (styptics)

# name the chemical method of hemostasis substrate for clot formation (Surgicel)

cellulose

# name the chemical method of hemostasis thrombocyte adhesion and activation of clotting factors (Lyostypt)

collagen

# name the chemical method of hemostasis swella and has a direct pressure effect

absorbable gelatin | (Gelfoam)

# name the chemical method of hemostasis biocompatible, absorbed within 24-48h, expand to 5x their original volume

Microporous Polysaccharide Hemospheres (MPH)

3 ways to manage intra-operate hemorrhage of minor subcutaneous tissue, fat, and muscle

1. dab with saline soaked swab, digital pressure 2. electrocoagulation 3. hemostatic clamps +/- ligature

2 ways to manage intra-operative hemorrhage of a bleeding bitch spay

1. triple clamp technique 2. ligate pedicle (circumferential closest to heart; transfixing more towards ovary)

this is the presence of microbes on a wound surface

contamination

this is when surface microbes are replicating

colonization

this is defined as >10^5 organisms / gram of tissue

bacterial infection

this is an infection occurring anywhere in the operative field following a surgical procedure

surgical site infection (SSI)

name the 4 classic signs of inflammation

1. rubor (redness) 2. calor (heat) 3. dolor (pain) 4. tumor (swelling/oedema)

what are the 4 classifications of wunds (NRC)

1. clean 2. clean-contaminated 3. contaminted 4. dirty

what is the SSI rate for clean wounds

2-4.8%

what is the SSI rate for clean-contaminated wounds

3.5-5%

what is the SSI rate for contaminated wounds

4.6-12%

what is the SSI rate for dirty wounds

6.7-18.1%

# name the wound classification non-traumatic elective surgery; no inflammation; no break in aseptic technique; resp, urogenital, & GI tracts not entered

clean

# name the wound classification non-traumatic elective incision; GI, urogenital or resp tracts opened under controlled conditions to prevent contamination; minor break in asepsis during clean procedure; clean surgery in which drain is placed

clean-contaminated

# name the wound classification fresh traumatic wound; major break in asepsis; spillage from GIT; infected urogenital or biliary tract entered

contaminated

# name the wound classification perforated viscus or fecal contamination; traumatic wound with devitalized tissue; purulent discharge; wounds with a foreign body

dirty

name 5 reasons prophylactic antibiosis should be considered with clean and clean-contaminated wounds

1. prolonged procedure (>90min) 2. endocrinopathy or debilitating disease 3. remote infections 4. implants placed 5. drain placed

this is when an antibiotic is administered to protect a patient against an anticipated bacterial infection

prophylactic antibiotics

this is the use of antibiotics to treat an already established infection

therapeutic antibiotics

# name the likely GI pathogens oesophageal, gastroduodenal

enteric gram negative bacilli & gram positive cocci

# name the likely GI pathogens biliary tract

enteric gram negative bacilli; Enterococci; Clostridia

# name the likely GI pathogens colorectal

Enteric gram negative bacilli; Anaerobes; Enterococci

# name the commonly encountered surgical pathogen(s) genitourinary

enteric gram negative bacilli; Enterococci

# name the commonly encountered surgical pathogen(s) neurosurgery

Staphylococcus

# name the commonly encountered surgical pathogen(s) Oropharyngeal

enteric gram negative bacilli; Staphylococcus

# name the commonly encountered surgical pathogen(s) orthopedic

Staphylococcus

name 4 ways to minimize risk of surgical infections

1. good surgical technique 2. wound lavage 3. closure of dead space 4. prophylactic antibiosis

name 2 features of infection to distinguish it from inflammation

1. purulent exudate 2. positive culture

this is the progressive loss of lean body mass and adipose tissue caused by an inadequate intake OR an increased demand for protein and calories

malnutrition

# 3 or more of the following may lead to the diagnosis of what? - weight loss >10% normal body weight - anorexia/hyporexia >5 days - increased nutrient loss - increased nutrient needs - chronic illness - serum albumin <2.5 g/dl

protein-calorie malnutrition

this is the administration of adequate nutrients to malnourished patients or patients at risk of malnutrition

hyperalimentation

# name the type of hyperalimentation nutrients provided intravenously through central or peripheral veins - when you can't use GIT

parenteral

# name the type of hyperalimentation nutrients provided to a functional GIT via a tube

enteral

# name the type of hyperalimentation given through a central vein - 100% of nutrition, protein, fat calorie needs

total parenteral nutrition (TPN)

# name the type of hyperalimentation given through a peripheral vein - part of nutritional needs

partial parenteral nutrition (PPN)

name the 5 types of feeding tubes for enteral hyperalimentation

1. naso-oesophageal 2. pharyngostomy 3. oesophagostomy 4. gastrostomy 5. enterostomy

name 5 ways to check that a naso-oesophageal tube is placed in the oesophagus NOT the trachea

1. suck back on syringe (negative pressure) 2. flush with small volume saline (no cough) 3. inject 10 mL air (borborugmus at xiphoid) 4. radiograph 5. visualize tube going into oesophagus with laryngoscope

describe how to place a naso-oesophageal feeding tube

- light sedation/topical local anaesthetic OR general anesthesia - measure length from nasal plank to 7/8 intercostal space - lubricate tip of tube (normal head position) - direct tube from ventrolateral aspect of external nares to caudoventral/medial aspect of nasal cavity - when you have advanced tube 2-3cm into nostril, elevate external nares dorsally to open ventral meatus - advance tube → swallowing reflex at oropharynx will allow tube to enter the oesophagus

describe how to place an oesophagostomy feeding tube

- R lateral recumbency under general anaesthesia with an endotracheal tube in place - approach to left side of neck (oesophagus is to the left of midline) - aseptic preparation of mid-cervical region - pre-measure tube from cervical insertion point to 7/8 intercostal space - mark length on tube with pen - place curved forceps (Rochester-Carmalt) in oral cavity into the oesophagus and advance tips to mid-cervical region - palpate tips on left lateral neck - push skin up with tips and incise through the skin into oesophagus using a blade - push forceps through incision - grasp tube and pull through neck incision out of oral cavity - redirect tube down the oesophagus using fingers and pull the spare tube back out of the neck - change in tube direction will be seen - suture the tube in place (Chinese finger trap), bandage, cap tube, leave column of water in tube - radiograph to ensure correct placement

name 2 indications for oesophagostomy and naso-pharyngeal feeding tubes

1. disorders/traumas of oral cavity/pharynx 2. anorexic patients | must be a functional distal GIT

name 4 contraindications for oesophagostomy and naso-pharyngeal feeding tubes

1. oesophageal disorder 2. oesophagitis 3. megaoesophagus 4. vomiting or regurgitation

name an indication for gastrostomy feeding tube

surgery/disease of oral cavity, larynx, pharynx, oesophagus w/ functional distal GIT

name a contraindication for gastrostomy feeding tube

primary gastric disease | (gastritis, ulceration, neoplasia)

# name the type of gastrostomy tube stomach tube

Blind Percutaneous Gastrostomy

# name the type of gastrostomy tube placed using endoscope

Percutaneous Endoscopic Gastrostomy (PEG)

# name the type of gastrostomy tube placement via flank, minimally invasive approach secure surgical gastropexy

laparotomy placement

# name the type of gastrostomy tube placement ventral midline coeliotomy: direct visualization of placement, secure gastropexy, more invasive procedure

surgical placement

describe how to surgically place a ventral midline coeliotomy gastrostomy tube

- ventral midline coeliotomy incision - stab incision into left abdominal wall - pull feeding tube through incision into the abdomen - purse-string suture in ventrolateral wall of body of the stomach - stab incision in center of purse-string suture - insert feeding tube tip into the stomach, inflate bulb of feeding tube, tighten purse-string - traction on tube to appose stomach and body wall, sexy stomach to body wall using 4 sutures - synthetic absorbable material (PDS) - secure tube to skin surface (Chinese finger trap) and close abdomen

nme 4 possible complications of gastrostomy tubes

1. peritonitis 2. vomiting 3. peri-stomal infection 4. migration of feeding tube tip into pylorus

name 2 metabolic complications of enteral hyperalimentation

1. hyperglycemia due to rapid glucose absorption 2. refeeding syndrome

name 5 advantages of gastrostomy tubes

1. ease of placement 2. well tolerated 3. large bore tubes 4. ease of feeding 5. oral feeding can still occur

name 5 disadvantages of gastrostomy tubes

1. GA required 2. specialist equipment 3. enter peritoneal cavity 4. needs 7-14 days before removal 5. sever complications if premature removal

name 5 advantages of oesophagostomy tubes

1. easy to place 2. well tolerated 3. large bore tube 4. ability to eat and drink around 5. removal at any time

name 1 disadvantage of oesophagostomy tubes

requires GA for placement

name 4 advantages of naso-oesophageal tubes

1. easy to place 2. ease of care and feeding 3. ability to eat and drink around the tube 4. removal at any time

name 4 disadvantages of naso-oesophageal tubes

1. small tube size 2. risk of tracheal placement 3. risk of premature removal 4. short term