Surgery Flashcards by Mia Richardson

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

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What do we use for oral prep ?

0.1% chlorhexidine in dogs can cause ulcers in cats

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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

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What do we use to prep for aural surgery ?

-flushed with saline then 0.2% chlorhexidine

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What do we use to prep for foot surgery ?

-wrap in bag with 2% chlorhexidine then clipped then done again for another 5 min

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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

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Name the 4 draping styles

-plain 4 corner draping
-draping a limb
-fenestrated drapes
-adhesive barrier drapes

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Different origins of suture material .

-natural e.g catgut, silk
-synthetic
-metal

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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

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Different structures of suture material

-monofilament - single filament
-multifilament - bundles of very fine filaments usually braided together

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Definition of tensile strength.

breaking strength per unit area

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TRUE/FALSE : Monofilament has a higher memory than multifilament

true - therefore monofilament isn’t as good to tie knots

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Definition of chatter/tissue drag

lack of smoothness or friction whilst passing through tissues

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TRUE/FALSE : monofilament have less tissue drag than multifilament

true

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Advantages and disadvantages of absorbable suture.

+disappear
+low risk of long-term foreign body reaction
-lose strength
-limited period of wound support

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Advantages and disadvantages of nonabsorbable suture.

+permanent
+provide indefinite wound support
-don’t disappear
-delayed reactions possible e.g foreign body reaction

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Advantages and disadvantages of multifilament.

+easy to handle
+good knotting - very secure
-greater friction/tissue drag/chatter
-more tissue trauma - thicker

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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

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why is monofilament better for lower risk of infection ?

multifilament has a lot more areas where bacteria can harbour and divide

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TRUE/FALSE hydrolysis of suture causes less of a tissue reaction than phagocytosis

true - cat gut absorbed via phagocytosis , many synthetics absorbed via hydrolysis

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What are the 2 kinds of grades for suture size ?

-USP - united states pharmacopia - 11-0 , 2-0
-metric

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What does swaged mean ?

needle is already attached to suture

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Disadvantages of eyed needles .

-double stranded suture - more trauma
-multiple use - blunt
-increased tissue trauma

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Benefits of swaged needle

-minimal trauma
-single use
-optimal penetration properties

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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

Surgery Flashcards

(77 cards)