Surgery. Flashcards
Which Surgerys are high, medium, and low risk for perioperative cardiac complications?
What percentage of perioperative deaths are due to cardiac events?
⅓-½
DMs have a 50% increased risk of perioperative morbidity and mortality
Pulmonary = second most common cause of morbidity and mortality
ASA classifications
Types of Anesthesia
Epidural vs Spinal Anesthesia
Electrolyte composition of different body fluids and electrolyte abnormalities of surgery
Nutritional Status of the Surgical Patient: Ebb & Flow
Ebb Phase of Starvation & Stress
- Immediate
- Tissue hypoperfusion
- decreased metabolism
- catecholamine release
- norepi
Flow Phase of Starvation/Physiologic Stress
- Catabolic & Anabolic
- increased cardiac output
- Peaks 3-5 days
- hypermetabolic
- hyperglycemia
-
Anabolic
- corticoid withdrawal
- repletion
Lab Indicators of Illness and Perioperative Morbidity
Nutritional Support for Surgery Pts
Phases of Wound Healing & Care
Factors that Affect Wound Healing
Types of Wounds
Classifications of Surgical Wounds and infx risk
Primary Intention vs Secondary Intention Wound Healing
Postoperative Complications
Outpt Surgery vs Short Stay Inpatient
Inpatient Surgeries & Pediatric Surgerys
Acute Abd Pain Red Flags
Peritonitis (Overview)
- Pt looks sick
- lie still → minimizes discomfort
- rebound tenderness & tenderness to percussion
- pain with light palpation and bumps
- diminished bowel sounds
Causes of Abd Pain by Location
What is an acute Abdomen?
requires a stat surgical consult/ to OR
sxs of obstruction or peritonitis
Initial Diagnostics in Abd pain
- CBC with diff
- BMP/CMP
- AST/ALT, Alk phos, total bili
- Lipase
- UA
- Urine hcG in women
- abd imaging
- plain film
- CT U/S
How do you rule in/out peritonitis?
US or CT
but be careful with use of CT in children (1 CT may increase a child’s risk of CA, 1/1000)
Acute Abd Pain Tx while you wait for surgical intervention
- IV, give fluids → this is a top priority!
- Pain control
- NPO (until they have been ruled out for surgery)
- Abx when indication
- Monitor for sxs of sepsis & shock
Abx prophylaxis before GI surgery
Acute Cholecystitis Tx
Steps of the Laparoscopic Cholecystectomy
Choledocholithiasis
Management of Pancreatitis
Best abx for pancreatic abscess?
Imipenem
Gastric Cancer Overview
Dx and Tx of Splenic Abscess vs Infarct
Acute Abd Pain Helpful Hints
Meckel’s Diverticulum
Mesenteric Ischemia Management
Appendicitis Management
- Perioperative Abx
- Lower infectious complications
- Recommend 3-5 days in pts with confirmed perforated appendicitis
- (ceftriaxone + metronidazole)
- Appendectomy
- Open
- Laparoscopically
Steps of an Appendectomy
Complications Associated with Appendicitis
Diverticulitis Tx
Terminology of bowel Surgery
-
Ostomy:
- new passageway for stool or urine → create an opening in abd wall
-
Stoma:
- portion o fthe intestine outside the abdomen
-
Ileostomy:
- small bowel divided
-
Colostomy:
- colon divided → proximal end brought through the abd wall
-
Hartmann’s Procedure:
- colostomy with distal end oversewn and placed in peritoneal cavity as blind limb
Colostomy vs Loop Colostomy
Ileostomy
Stoma
Types of Colon Resections