Surgery Flashcards
After an epidural, how should urinary retention be managed?
Perform a bladder scan (USG) and reinsert the catheter if:
- Post void residual volumes (PVRVs) between 300-500ml and patient is unable to void or is uncomfortable;
- PVRVs > 500ml.
What is the most common absolute complication after any surgery?
Post-op infection.
How to manage diabetes treatment in a patient undergoing major surgery?
Put patient on a sliding scale (VRIII) pre-operatively to maintain optimal glucose control. This is done by administering insulin, dextrose and saline, according to the patient’s needs measured by hourly monitoring of capillary glucose
Start VRIII (variable rate intravenous insulin infusion) when
- more than one meal is going to be missed in major surgery
- patient has not received any background insulin the day before
- patient is in continuous subcutaneous insulin infusion pump
Which anatomical structure is pierced during a midline port insertion during a laparoscopic cholecystectomy?
Linea alba
What are the features, causes, diagnostic test and treatment for paralytic ileus?
Causes
- prolonged surgery, exposure and handling of the bowel
- peritonitus and abdominal trauma
- electrolyte disturbances (hypokalaemia, hypercalcaemia)
- anticholinergics or opiates
- immobilization
Clinical features: nausea, vomiting, abdominal distension, absent bowel sounds
Diagnosis: abdominal x-ray (shows air/fluid filled loops of small and/or large bowel)
Treatment
- NG tube if nausea ou vomit
- IV hydration
- correct electrolytes
- reduce opiate analgesia
- encourage mobilization
- lactulose or erythromycin to stimulate bowel movements
Management of suspected intestinal obstruction?
- Resuscitate with IV fluids
- Analgesia
- X-rays
- Insert NG tube
- Refer to surgical team for further management
How to differentiate indirect and direct inguinal hernias?
Differences
- Indirect:
• protrusion through the deep inguinal ring, lateral to the inferior epigastric vessels - Direct:
•enters through the posterior wall of the inguinal canal medial to the inferior epigastric vessels.
Similarities
- protrudes through the superficial inguinal ring
Indirect is the most common type of inguinal hernia
How to differentiate inguinal and femoral hernias?
They have different locations in relation to the inguinal ligament and the pubic tubercle of the symphysis pubis.
Inguinal hernia
- above the inguinal ligament
- medial to the symphysis pubis
Femoral hernia
- below the inguinal ligament
- lateral to the symphysis pubis
Which test should be ordered to diagnose a patient with bad breath and regurgitation of undigested food?
What is the suspected diagnosis and which test should be avoided?
Diagnosis: pharyngeal pouch (Zenker’s diverticulum)
First step to investigation is barium swallow
An endoscopy should not be ordered as it could lead to a perforation
Which tumour markers are associated with ovarian, pancreatic, breast, prostatic, colorectal and hepatocellular cancers?
Ovarian cancer - CA 125
Pancreatic cancer - CA 19-9
Breast cancer - CA 15-3
Prostatic cancer - PSA
Colorectal cancer - CEA
Hepatocellular cancer - AFP
What are the 3 cancer screening programmes available in the UK?
Bowel, breast and cervical screening.
Bowel screening
- men and women 60-74 yo are sent a self-administered test kit every 2 years
- over 74 yo can request a kit
- faecal immunochemical test received in the post (replaced the faecal occult blood test)
- one-off bowel scope test at 55 yo
Breast screening
- women 50-70 yo, invited every 3 years
- over 70 can request screening
- mammograms
Cervical screening
- women 25-49 yo, invited every 3 years
- women 50-64 yo, invited every 5 years
- cytology and HPV
- screening likely to change in the future in view of HPV vaccines
What should be suspected in a patient with abdominal pain 10 days after bowel surgery?
Anastomotic leak
