Surgery Flashcards
Diabetic medications and surgery
Sulfonylureas need to be stopped until patients can eat and drink again - hypoglycaemia
Metformin be aware of lactic acidosis
SGLT2 inhibitors - DKA
Continue long acting insulin and stop short acting when fasting
Which patients cannot have NSAIDs?
Asthma
Renal impairment
Heart disease
Stomach ulcers
How do you measure maintenance fluid?
25 – 30 ml / kg / day of water
1 mmol / kg / day of sodium, potassium and chloride
50 – 100 g / day of glucose (this is to prevent ketosis, not to meet their nutritional needs)
What are the main causes of bowel obstruction
Adhesions (small bowel)
Hernias (small bowel)
Malignancy (large bowel)
What are the signs seen in cholecystitis?
Murphy’s
Boas sign - Below scapula
What are the signs seen in Appendicitis?
Rovsing’s sign
Rebound tenderness
Psoas stretch
McBurney’s point tenderness
What are the signs seen in pancreatitis?
Cullens - bruising in peri-umbilicial region
Grey-turners sign - bruised flank
What are the side effects of gentamycin?
Ototoxicity and nephrotoxicity
What is the traid of Meneiere’s?
Vertigo
Tinitus
Hearing loss
What do you have to look out for in gallbladder removal?
The Calot’s triangle:
Cystic duct laterally
Hepatic duct medially
Inferior edge of liver superiorly
The cystic artery lies within the triangle and have to be careful not to cut it.
What is the blood supply to the abdominal organs?
3 main branches of the abdominal aorta:
- coeliac artery
- superior mesenteric artery
- inferior mesenteric artery
Foregut: stomach, part of the duodenum, biliary system, liver, pancreas and spleen = coeliac artery
Midgut: distal part of duodenum to first half of the transverse colon = superior mesenteric
Hindgut: second half of transverse colon to the rectum = inferior mesenteric
Give the presentation of chronic mesenteric ischaemia
- central colicky abdominal pain after eating
- weight loss
- abdominal bruit
What is the diagnosis and management of chronic mesenteric ischaemia?
CT angiography
Management:
- reducing modifiable risk factors
- secondary prevention
- revascularisation (stenting/open)
Define cholecystitis
Inflammation of the gallbladder which is caused by a blockage of the cystic duct preventing the gallbladder draining
What is the presentation of acute cholecystitis?
RUQ pain (radiate to R shoulder) Fever N+V Tachycardia Tachypnoea Murphy's sign Raised inflammatory markers Boas sign
What is the investigation for acute cholecystitis?
- Abdominal USS
- thickened gallbladder wall
- stones or sludge in gallbladder
- fluid around gallbladder - MRCP
What is the management of acute cholecystitis?
ERCP
Cholecystectomy
What are the causes of small bowel obstruction?
ADHESIONS HERNIAS Diverticular disease Strictures Intussusception
What are the causes of large bowel obstruction?
MALIGNANCY
Volvulus
Strictures
Intussusception
What is the presentation of bowel obstruction?
Vomiting green bilious Abdominal distention Diffuse abdo pain Absolute constipation and lack of flatulence Tinkling bowel sounds
What are the findings in bowel obstruction?
X-ray: distended loops of bowel
Valvulae conniventes
Haustra
What are the causes of ileus?
Injury to bowel
Handling of bowel
Inflammation or infection
Electrolyte imbalance
What are the signs and symptoms of ileus?
Green bilious vomiting Abdo distention Diffuse abdo pain Absolute constipation and lack of flatulence ABSENT bowel sounds
What is the management of ileus?
Supportive care: Nil by mouth NG tube IV fluids Mobilisation TPN