Surgery Flashcards
What 3 surgical scrub solutions could we use and what are there benefits /disadvantages, percentage and contact time .
-chlorhexidine - 2% for 5 minutes , in open wounds kills cells and slow healing
-povidone iodine - good if have a sensitivity to chlorhexidine , 7.5% for 3 minutes , not good with gross contaminates
-isopropyl alcohol
What do we use for oral prep ?
0.1% chlorhexidine in dogs can cause ulcers in cats
What do use to prep for ocular surgery ?
0.2%-2% or 1:50 dilution of povidone iodine - as chlorhexidine shown to irritate mucous membrane
What do we use to prep for aural surgery ?
-flushed with saline then 0.2% chlorhexidine
What do we use to prep for foot surgery ?
-wrap in bag with 2% chlorhexidine then clipped then done again for another 5 min
What to remember when prepping the skin ?
- don’t make the skin too wet
can make the patient cold during surgery
can cause burns due to heat generated by heat mat
strike through
Name the 4 draping styles
-plain 4 corner draping
-draping a limb
-fenestrated drapes
-adhesive barrier drapes
Different origins of suture material .
-natural e.g catgut, silk
-synthetic
-metal
Different behaviours of suture material and def
-absorbable - will be fully degraded and absorbed by body once placed
-nonabsorbable -stay in place for indefinite period e.g 60 days without changing or breaking down
Different structures of suture material
-monofilament - single filament
-multifilament - bundles of very fine filaments usually braided together
Definition of tensile strength.
breaking strength per unit area
TRUE/FALSE : Monofilament has a higher memory than multifilament
true - therefore monofilament isn’t as good to tie knots
Definition of chatter/tissue drag
lack of smoothness or friction whilst passing through tissues
TRUE/FALSE : monofilament have less tissue drag than multifilament
true
Advantages and disadvantages of absorbable suture.
+disappear
+low risk of long-term foreign body reaction
-lose strength
-limited period of wound support
Advantages and disadvantages of nonabsorbable suture.
+permanent
+provide indefinite wound support
-don’t disappear
-delayed reactions possible e.g foreign body reaction
Advantages and disadvantages of multifilament.
+easy to handle
+good knotting - very secure
-greater friction/tissue drag/chatter
-more tissue trauma - thicker
Advantages and disadvantages of monofilament.
+minimal tissue trauma
+passes through tissues easily
+no capillary action
-harder to handle
-harder to knot
-need different knotting techniques for more security
why is monofilament better for lower risk of infection ?
multifilament has a lot more areas where bacteria can harbour and divide
TRUE/FALSE hydrolysis of suture causes less of a tissue reaction than phagocytosis
true - cat gut absorbed via phagocytosis , many synthetics absorbed via hydrolysis
What are the 2 kinds of grades for suture size ?
-USP - united states pharmacopia - 11-0 , 2-0
-metric
What does swaged mean ?
needle is already attached to suture
Disadvantages of eyed needles .
-double stranded suture - more trauma
-multiple use - blunt
-increased tissue trauma
Benefits of swaged needle
-minimal trauma
-single use
-optimal penetration properties
TRUE/FALSE : the deeper the wound the more curved the needle
true
What different needle curvatures are there ?
1/4
3/8
1/2
5/8
Different shapes of needle
-blunt - circular,elliptic
-sharp - polygonal
-compound -tapercut,short cutting point
What is ductility in relation to needles ?
will bend before they break - warns surgeon too much force on needle
What are mayo scissors used for ?
tough tissues e.g linea alba
what are Metzenbaum used for ?
delicate for subcut tissue and viscera
What are iris scissors used for ?
for fine cuts
Which forceps are the least traumatic ?
debakey - serrations less tissue damage
What are haemostatic forceps used for ?
occlude bv and prevent haemorrhage
Halsteds principles
gentle tissue handling
strict asepsis
haemostasis - minimise blood loss
TRUE/FALSE = an ectopic island of pancreas is normal not pathological
true
How quick does stomach heal ?
7 days
How long does fracture take to heal ?
2 months
How long do tendons take to heal ?
very slowly - always going to need suture support
How long does intestine take to heal ?
1-2 weeks
What 5 regions can the abdominal cavity be seperated into ?
-cranial abdomen
-GI tract
-right paravertebral region
-left paravertebral region
-caudal abdomen
What is the duodenal manoeuvre?
when you use the mesoduodenum on right to push the above onto the opposite site so you can see underneath ( exposes the paravertebral region )
What is the coelic manoeuvre?
use colon to move mesenteric root struc to the animals right hand side so you can see underneath ( left kidney )
What’s the difference between grading and staging ?
grading = how aggressive - malignant or benign ( cytology -FNA , histology -biopsy)
staging = spread - radiograph chest
What is cytoreduction ?
using chemotherapy/radiotherapy to reduce tumour
Define the term metastasis
when cancer cells spread to other part of the body
What is debulking/intralesional/cytoreduction excision?
leave macroscopic volumes of tumour that you’ll treat with cytoreduction
What is a marginal excision ?
known as local
go just around the tumour pseudocapsule
try not to get any other tissue outside tumour
What is a wide incision ?
remove tumour with complete margins of normal tissue
What is radical excision ?
removing an entire anatomical struc containing the tumour e.g limb amputation
Name the layers of bowel/bladder ( both the same )
serosa
muscular layer - longitudinal then circular
submucosa
mucosa
TRUE/FALSE = the sub mucosal layer is the most important layer when closing ( in the case of the bladder/bowel )
true
(very )briefly explain how would you conduct a gastrotomy
incision
find stomach
exteriorise and pack off so don’t contaminate the peritoneal cavity
then put in stay sutures
and make incision into stomach
omentalise at end
How would you close in a gastrotomy
-use absorbable monofilament 0-3 or 0-2
-1 layer ( full thickness simple interrupted/continuous or continuous inverting )or 2 layer ( sub mucosa /mucosa and serosa/muscular )
What is intussusception
when a portion of the bowel invaginates into adjacent segment next to it
-causes bowel obstruction
What clamps would you use for a enterotomy ?
-non crushing - fingers best
Best pattern for enterotomy suture
simple continuous or interrupted
What suture material would you use for enterotomy ?
monofilament absorbable
0-3, 0-4
Define enterectomy
remove portion of bowel
TRUE/FALSE = its good to starve after GI surgery
false - can be very harmful - vilous atrophy , ulceration
How might you conduct a cystotomy ?
-incision
-locate bladder
-drain it
-put in stay sutures
-exteriorise
-insicison into bladder abd take out what need to
-close
How would you close for a cystotomy ? pattern, material
-absorbable monofilament
-0-3,0-4,0-2
-pattern - either 1 or 2 layer like the bowel
How long does urinary bladder take to heal
month
Define dehiscence .
breakdown
Name some postoperative complications
-woudn infection
-peritonitis
-uroabdomen
-dehiscence
How would you close the linea alba ?
-continuous suture patterns
-absorbable monofilament - but that will last a logn time as linea alba takes 60-80 days to heal - 0( small dog ) 0-2 , 0-3 ( cat , dog )
TRUE/FALSE = primary problems are usually structural
true
DAMNIT-V
Degenerative - gets worse over time
Anomalus - genetic
Metabolic
Neoplasia
Inflammation
Trauma , TOXINS
Vascular
What’s important in shared decision making ?
informed consent
When would you use an IM pin and what is it ?
-nomograde -place pin proximally along long axis of the bone into medullary cavity
-retrograde - enter the proxixmal fragment distally -go in opposite direction
-stops bending and poor axial compression
What’s an IM interlocking nail ? when would you use ?
-nail going through bone and screws to hold in place
-stops rotation and compression
What is an external fixator ?
-series of pins placed through skin through the bone and connected to connecting bar on the outside of the body
-all forces - can be combined with an IM pin
What forces are plates good and bad at preventing ?
-good stopping compression *not as good as IM pin
-good against torsion
How can you combat distractive forces ? ( e.g tension/avulsion fractures )
-place screw and compress using lagging technique
-or can convert the distractive forces into compressing using a tension band
What is a lag screw and when do you use it ?
-make hole you put in one side of the fracture bigger then screw in the screw - so it goes into the other side ( this pulls the far side against the near side )
-use to compress fractures
What is a tension band and how is it used ?
pull fracture together and fixed in place by two pins then apply a wire in figure of 8 opposite to distractive forces
-creates compressive force
Where do triceps insert ?
olecranon
Wolfs law
bone will adapt to the force it is placed under
