Surgery Flashcards
Intraabdominal pathology causing pain in one or both shoulders suggests what?
subdiagphragmatic peritonitis
Among the possible blunt traumatic bladder injuries, only an intraperitoneal rupture of the bladder dome could by itself, cause a chemical peritonitis.
where is the most common site of extraperitoneal bladder rupture?
bladder neck
Pancreatic cancer presentation
-combo of constant and gnawing epigastric pain that is frequently worse at night, anorexia w/ weight loss, and jaundice due to extrahepatic biliary obstruction (cholestatic picture of elevated alk phos. and direct bilirubin)
Distended neck veins
either pneumothorax or cardiac tamponade
tracheal deviation to the right
- LEFT sided pneumothorax/hemothorax
- RIGHT sided lung collapse
hypotension, tachypnea, tachycardia
tension pneumothorax
untreated tension pneumothorax
can lead to pulseless electrical activity and/or asystole
Patients who continue to remain hemodynamically unstable after needle decompression of pneumothorax?
have a FAST (focused assessment w/ Sonography for Trauma) exam to look for pericardial tamponade
what do the neck veins look like in a hemothorax?
collapsed
Tension pneumothorax
- presence of tachypnea, tachycardia, and distended neck veins, and tracheal deviation in pts w/ blunt or penetrating chest trauma
- pts w/ hemodynamic instability and suspected TP should have immediate needle thoracostomy prior to intubation, as positive ventilation following intubation usually exacerbates an existing pneumothorax
Clinical features of compartment syndrome
- pain out of proportion to injury
- pain increased on passive stretch
- rapidly increasing and tense swelling
- paresthesia (early)
- decreased sensation
- motor weakness (within hours)
- paralysis (late)
- decreased distal pulses (uncommon finding)
Ischemia-reperfusion syndrome
a form of compartment syndrome
- reperfusion of a limb following arterio-occlusive ischemia for longer than 4-6 hours can lead to intracellular and interstitial edema
- compartment syndrome may occur when edema causes the pressure within a muscular fascial compartment to rise above 30mmHg, leading to further ischemic injury
compartment syndrome pressures
- compartment pressure >30 mmHg or delta pressure (diastolic BP - compartment pressure) < 20-30 mmHg indicates significant CS.
- if compartment pressures are improving, pts may be closely observed. However, pts who have elevated compartment pressures and do not show rapid improvement require FASCIOTOMY
how can embolic occlusion be differentiated from compartment syndrome?
embolic occlusion will have absent pulses, pallor of affected limb, and lack of local swelling
Acute cholecystitis
- pain is predominantly in the upper abdomen and radiates to the tip of the right scapula or right shoulder
- Radioisotope (HIDA) scan is indicated in patients w/ acute cholecystitis when ultrasonography cannot definitively demonstrate obstruction at the neck of the gall bladder
when is exploratory laparotomy indicated?
when there is evidence of PERITONITIS (perforated viscus (free air under diaphragm), ruptured AAA, abdominal trauma, etc.)
-signs of guarding, rigidity, or rebound tenderness
Urinalysis in patients w/ urinary stones
-will show microscopic or gross hematuria in over 90% of cases
Ureteral calculi
- may cause flank or abdominal pain radiating to the perineum, often w/ nausea and vomiting
- a noncontrast spiral CT scan of the abdomen and pelvis is the imaging modality of choice to confirm the diagnosis
- Ultrasonography can be used if CT is unavailable or if the patient is pregnant to reduce radiation exposure
Intraductal papilloma
- intermittent bloody discharge from one nipple
- benign
- masses generally not appreciable because they are small, soft, and directly beneath the nipple
Paralytic (adynamic) ileus
- absent bowel sounds w/ gasseous distention of both the small and large bowels.
- classically follows abdominal surgery but can also occur in cases of retroperitoneal hemorrhage associated w/ vertebral fracture
Atelectasis
- one of the most common postoperative pulmonary complications and is usually due to airway obstruction from retained airway secretions, decreased lung compliance, postoperative pain, and meds that interfere w/ deep breathing
- ABG levels typically show hypoxemia, hypocapnia, and respiratory alkalosis
when does post-op atelectasis typically begin symptomatically?
2nd post-op day
what is the minimum duration of smoking cessation necessary prior to surgery to show a significant effect?
8 weeks
tracheobronchial tear
-dyspnea, hemoptysis, subcutaneous emphysema, Hamman sign (audible crepitus on cardiac auscultation) and sternal tenderness