Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Revision > Surgery > Flashcards

Surgery Flashcards

1
Q

List the pre-op considerations

A
  • history including SHx and whether patient fit for GA
  • examine patient
  • organise investigations
  • ASA score (1-6)
  • gain consent - give patient the benefits, risks, alternative options (ensure they are competent)
  • prophylaxis - VTE and abx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is ASA grading?

A

shorthand to communicate the broad level of systemic function for a patient

grading can help to decide which pre-op investigations are useful

ASA grading between 1-6

1 = healthy patient, 6 = declared brain dead and the organs are being removed for donor purposes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

If you smoke, but are otherwise completely healthy, what is your ASA grade?

A

smoking automatically puts the ASA grade up by 1 so ASA 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the 2-level DVT Wells score?

A

If patient is suspected to have a DVT we use his scoring system to assess

If score >= 2 DVT is likely therefore organise proximal leg US within 4 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the clinical features listed in the Wells score?

A
  • active cancer
  • Paralysis, paresis or recent plaster immobilisation of the lower extremities
  • bedridden for 3 days or major surgery within 12 weeks
  • entire leg swollen
  • calf swelling >= 3cm larger than symptomatic side
  • pitting oedema in symptomatic leg only
  • collateral superficial veins
  • previous DVT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the risk factors for DVT?

A
  • active cancer/chemotherapy
  • aged over 60
  • known blood clotting disorder (e.g. thrombophilia)
  • BMI over 35
  • dehydration
  • one or more significant medical comorbidities (e.g. heart disease; metabolic/endocrine pathologies; respiratory disease; acute infectious disease and inflammatory conditions)
  • critical care admission
  • use of hormone replacement therapy (HRT)
  • use of the combined oral contraceptive pill
  • varicose veins
  • pregnant or less than 6 weeks post-partum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What happens in a VTE risk assessment?

A

All patients admitted to hospital are assesssed for individual risk factors for VTE development and bleeding risk

Decision can be made whether to start VTE prophylaxis or not - start ASAP

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the mechanical VTE prophylaxis types?

A
  • compression stockings

- flowtron boots (intermittent pneumatic compression device)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the pharmacological VTE prophylaxis types?

A
  • LMWH (enoxaparin) - caution in renal patients
  • fondaparinux sodium (SC)
  • patients with CKD are offered unfractionated heparin (rather than LMWH)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What surgical procedures require VTE prophylaxis for all patients?

A

hip and knee replacement post surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Virchow’s triad (factors that contribute to thrombosis)?

A

endothelial injury
hypercoaguable state
blood stasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How much of the human body is made of fluids?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

When we administer fluids, which compartment are we influencing?

A

intravascular fluid (plasma) of the extracellular compartment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How much K+ and Na+ do we need everyday?

A

K+ 0.5 mmol/kg/day

Na+ 1-2 mmol/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What factors affect fluid prescription?

A
  • pre-existing = renal failure, BP, congestive CF (pulmonary oedema), liver failure, age and fragility
  • post-op = NBM, blood loss, V&D, obstruction, ileus
  • end organ damage = AKI, pulmonary oedema, sepsis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How can fluid status be assessed?

A
  • OBS - pulse, BP, RR, O2 sats, stool chart
  • daily weights
  • exam = JVP, cap refill, skin turgor, tongue, mucus membranes
  • investigations - blood tests (renal function - U&Es)
  • imaging
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the normal urine output?

A

0.5 ml/kg/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a fluid challenge?

A

bolus of 500ml crystalloid (0.9% saline) over less than 15 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are the different types of fluids?

A

-5% dextrose
-crystalloids - 0.9% NaCl + Hartmann’s solution
(Can add K+ into bags)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

If someone is acutely bleeding what fluids do we give them?

A

blood products - packed red cells, FFP (clotting factors), platelets, factor concentrates

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

On admission, what routine bloods are required?

A

G&S and clotting screen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Why is nutrition so important in surgical patients?

A

these patients are metabolically stressed and have increased energy requirements

malnutrition leads to infections, decreased healing, wound breakdown, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the difference between enteral and paraenteral feeding?

A

enteral = refers to delivery of food via the GIT

paraenteral = refers to the delivery of calories and nutrients into a vein (bypasses GIT)/venous system via PIC or central line

24
Q

What are the different types of enteral nutrition tubes?

A
  • nasogastric
  • nasoduodenal
  • gastrostomy
  • jujunostomy
  • nasojejunal
25
Q

Describe the WHO pain ladder

A

Step 1 = mild pain - non-opioids (paracetamol +/- NSAIDs)

Step 2 = moderate pain - weak opioids (codeine, tramadol)

Step 3 = severe pain - strong opioids (morphine, oxycodone, fentanyl)

26
Q

What local anaesthetic can be given to patients?

A

lignocaine or lidocaine (1% = 10mg/ml)

safe dose = 3mg/kg

(with adrenaline for vascularised areas like scalp) = 7mg/kg

27
Q

List some post-op complications

A

Immediate (hrs)

  • bleeding, pain, ischaemia, infection
  • aspiration

Early (days)

  • infection
  • VTE/PE
  • MI
  • ileus
  • pressure sores
  • electrolyte abnormalities

Late (weeks)

  • scar related
  • wound dehiscence
  • MI/HF
  • nutrition related
28
Q

Colorectal cancer 2 week referral criteria

A
  • significant change in bowel habit
  • rectal bleeding
  • palpable rectal masses
  • unintentional weight loss
29
Q

What are the red flag sx for gastro hx?

A
  • unintentional weight loss
  • Fe deficiency anaemia
  • haematemesis
  • malaena
  • significant change in bowel habit
30
Q

If someone has suspected colorectal cancer what happens?

A
  • they have a colonoscopy
  • if any masses, need to take biopsies (6-8-biopsy is sent to the histopathologist
  • cancer nurse specialist counsels the patient
  • radiologist stages the cancer by CT thorax, abdomen, pelvis (TNM)
  • MDT meeting is organised
31
Q

Who are the core members of the MDT for colorectal cancer?

A
  • suregon
  • oncologist
  • cancer nurse specialist
  • radiologist
  • histopathologist
32
Q

How long is the rectum and how many sections is it made up of?

A

15cm, split into 1/3s

33
Q

What is a right sided hemicolectomy?

A

Resection of the bowel if there is a cancer in the caecal, ascending or proximal transverse colon

Ileo-colic anastamosis

34
Q

What is a left sided hemi-colectomy?

A

Resection of the bowel if there is a cancer in the distal transverse or descending colon

Colo-colon anastamosis

35
Q

What is an anterior resection?

A

removal of the upper rectum

colo-rectal anastomosis

36
Q

What is an APER (abdomino-perineal excision of rectum)?

A

if a cancer is present in the anal canal, the whole rectum is removed

patient will have a permanent stoma/colostomy

37
Q

What LFTs do the liver cells reflect?

A

ALT, AST

38
Q

What LFTs do the common bile duct cells reflect?

A

ALP, GGT (if obstruction = increased bilirubin)

39
Q

What are the 3 types of abdominal pain?

A

somatic

visceral

referred

40
Q

Characteristics of somatic pain?

A
  • due to irritated fibres in parietal peritoneum
  • easy to localise
  • intense constant pain
  • aggravated by activity, relived by rest
  • occurs late
41
Q

Characteristics of visceral pain

A
  • dull, achy, cramping pain
  • patient cannot stay still
  • occurs early
  • only pathological organ involved
42
Q

Characteristics of referred pain

A
  • occurs at site distant from site of stimulation
  • mechanism unclear
  • does not cross the midline
43
Q

what is colorectal cancer?

A

malignancies that arise from beginning of colon, caecum through to the end of the rectum

does not include anus or small bowel

44
Q

what are the mutations involved in the adenoma-carcinoma sequence?

A

1st - mutation in APC (tumour suppressor)

2nd - mutation in KRAS (protooncogene)

3rd - mutation in p53

4th - mutation in SMAD4

45
Q

where does rectal cancer usually spread?

A

lungs

46
Q

where do other colorectal cancers usually spread to?

A

liver

47
Q

what is the NHS screening test of choice for colorectal cancer?

A

FIT test (from the age of 56)

done every 2 years

48
Q

what is the gold standard for colorectal cancer diagnosis?

A

colonoscopy with biopsy

49
Q

what investigation for diagnosing colorectal cancer is used in those declining endosocopy?

A

CT pneumocolon - CT scan of colon, non invasive

requires bowel prep - laxative

inflation of the bowel and then CT scan

50
Q

tests for suspected clolorectal cancer

A 
bloods 
FBC
serum ion, transferrin, TIBC
U&Es
LFTs
clotting 
CEA
51
Q

what are the 3 stoma types?

A

colostomy
ileostomy
urostomy

52
Q

what are the features of a colostomy ?

A

LIF

solid stool in bag

flushed

53
Q

what are the features of ileostomy?

A

located in RIF

liquid faeces

spouted - doesnt touch skin

54
Q

what are the features of urostomy

A

RIF - typically after cystectomy

urine in the stoma bag

55
Q

what are the 2 main herediatry syndromes that causes colorectal cancer?

A

Lynch syndrome

FAP

both autosomal dominant

56
Q

what other cancers is lynch syndrome associated with?

A 
endometrial
ovarian 
small bowel 
stomach 
gallbladder
liver 
brain 
renal tract
57
Q

what management is required in a child known to have FAP?

A

screening from the age of 12 (colonoscopies)

prophylactic ileostomy (before the age of 25)

Revision (20 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions