surgery Flashcards
what lab measuring renal function should be done for preop patients over 40?
creatinine
who should have their blood glucose tested preop?
family hx, personal hx of DM and patient undergoing grafting for peripheral vascular disease
do routine prep labs show a reduction in mortality and morbidy?
no, do not do for otherwise healthy individuals
warfarin and dig are known for causing what electrolyte abnormality?
K
ECHO are recommended in all patients older than?
40
silent MI is most common in what population?
elderly and DM
spirometry is recommend to who?
thoracic and upper abdominal surgery, smokers and dyspnea
pregnancy test?
for all women of child bearing years
H&P identify previous?
MI, heart failure, chronic pulmonary dz, dm, peripheral vascular disorders, hepatic or renal impairment
index used to measure cardiac risk?
detsky’s modified cardiac risk index or Lee’s
what does Lee’s index look at
high risk surgery, coronary artery dz, congestive heart failure, cerebrovascular dz, insulin dependent DM, and elevated serum creatinine >2
what is the best prophylactic blood thinner to use?
unfractionated heparin 5,000 units subcutaneouly every 8-12 hours, stop once pt is ambulatory
Enoxaparin is also used what is it?
low molecular weight heparin
can warfarin be used
yes, once the initial use of heparin has been completed, but dosing is measured via INR (therapeutic dose ranging between 2-3)
what is fondaparinux
anticoagulant, good for hip surgery
Greenfield filter prevents clots formed in the lower extremities to migrate, patient who are candidates include?
allergic to anticoagulants, trauma (risk of further bleeding), central nervous system procedures
malnourished criteria is
lost more than 10% of lean body mass, or has not has adequate intake in 7 days
malnourishment effects many systems including
GI atrophy, slow cardiac output, decreased vital capacity, immune system and skin healing
what labs may be abnormal of malnourishment
increased creatinine, high lymphocyte count, albumin, transferrin
what is refeeding syndrome?
abnormal glucose, lipid metabolism, thiamine deficiency, hypophosphatemia, hypomag, hypo k
how do you avoid refeeding syndrome?
limit initial feedings to no more than 20kcal/kg during the first week of feedings
basal energy expenditure
harris benedict equation
what is the preferred route of nurtrient replacement
enteral route (tube feeding)
are naso or gastro tube better at preventing aspiration
gastro
best tube to avoid aspiration and great for pancreatits
jejunostomy
what is hyperalimentation
Intravenous nutrition
what are the complications of hyperalimentation
catheter related problems, hyperglycemia, electrolyte abnormalities
leading cause of death between the age of 1-44
unintentional and violence related injuries
leading cause of accidental death
MVA (Etoh is involved in over 1/2)
what does the FAST exam look at
abdominal cavity for fluid or air, perihepatic, perisplenic, pelvic and pericardial regions
most common reason to intubate in trauma
altered mental status
why should open chest wounds never be occluded?
can develop a tension pneumo
what does beck’s triad evaluate for
cardiac tampondade
what is beck’s triad
JVD, hypotension, muffled heart sounds
penetrating trauma and unstable (shock, peritoneal irruption, evisceration, __________is used for dx and tx
laparotomy
workup of penetrating flank trauma
CT with oral and IV contrast
basilar fracture is associated with what PE findings
battle sign, raccoon eyes, rhinorrhea, otorrhea
lucid period with head trauma
epidural hematomas
epidural hematomas are usually result from injuring what artery
middle meningeal artery
coma, fixed or dilated pupil, and decerebrate posturing +
brain herniation
subdural hematomas are injuries to
the bridging veins
subdural hematomas are common in
eldery, alcoholics and axonal injuries
most common cause of burns
scald burns
fluid recommended for burn victims
LR
sulfadiazine
is the most common used topical burn ointment
white phosphous burn are tx with
copper sulfate
hydrofluoric acid burns are tx with
30 minutes of lavage, apply calcium gluconate
most post op fever is a result of
cytokines and will resolve on own
five w’s of a post op fever
wind, water, wound, walking and wonder drug/whopper
the most common W of a post op fever, timeframe and tx
wind: complete of parial collapse of lung (atelectasis) usually occurs in the first 24-48 hours. TX: Incentive spirometry, mucolytics, expectorants
water (what does it stand for and timeframe) and tx
UTI 48-72 hours, most common nosocomial infix, culture and sensitivity and tx with targeted antibiotics
wound infection what does it stand for and timeframe) and tx
72 hours, most common bug is staph aureus, culture and antibiotics
walking ;what does it stand for and timeframe)
after 72 hours thrombophlebitis (superficial and deep) DVT
tx: superficial stop IV line use warm compresses. Systemic start staph A and strep antibiotics. Septic thrombophlebitis requires vein stripping (b/c if will behave like an abscess and a make antibiotic penetration difficult
wonder drug; what does it stand for and timeframe)
drug fever
whopper; what does it stand for and timeframe)
fever after 1 week. Abscess. Tx is percutaneous drainage or surgical debridement
what is still the gold standard for DVT dx
venography
most effective approach to pressure ulcers
prevention
necrotizing fasciitis is caused by
group A strep, clostridia or salt water is vibrio sp.
triad for necrotizing fasciitis
elevated WBC, elevated BUN >15 and hyponatremia renal impairment is an hallmark of the dz)
most common complication in cholecystecomy?
misidentification of hepatic duct system and injury to common bile duct due to heat
Lap surgery complications fall into two categories: access complications and pneumoperitoneum including
bowel perf with introduction of trochar and cardiac output decrease due to increased systemic circulation
most common complication for antireflux surgeries
perf of stomach or esophagus
complication for inguinal hernia
injury to bladder, epigastic vessels and spermatic cord
most important post op complication for hernia ingunial
recurrence and urinary retention
stages of wound healing
coagulation and inflammation (platelet activation and migration of WBC) neovasularization and finally proliferation which is the production of collagen
define a clean contaminated case?
operation of the Respiratory, GI or GU tracts
is an inguinal heria case clean, clean contaminated or contaminated
clean
antibiotic used as a prophases for the majority of clean surgical cases?
Cefazolin
what does a FEV1 values less than 1 are indicative of?
post of pulmonary complications and ventilator dependence
75% of gallstones are of what variety is the US
mixed stones (cholesterol and calcium) most common in the US
difference between cholecystitis and choledocholithiasis
choledocholithiasis-is blockage of the common bile duct, thus jaundice will be a symptom.
cholangitis is described as
common bile duct obstruction, with fever, jaundice, RUQ pain, and leukocytosis
describe acute cholecystitis
RUQ pain (murphy’s sign), fever, and leukocytosis
weight loss, jaundice, midepigastric pain and courvoisier sign, you are thinking?
pancreatic carcinoma
weight loss, mid-epigastric pain, no jaundice
gastric carcinoma
US shows thickened gallbladder wall and pericholecystic fluid, these findings point to?
acute cholecystitis
US shows dilated intrahepatic and extra hepatic ducts
dilated ducts = obstruction = choledocholithiasis
US shows air in the lumen of the gallbladder
acute emphysematous cholecystitis
what imaging helps with the location of a gallstone obstruction and the type of pathology?
CT
what is charcots triad
fever, chills, right upper quad pain, and jaundice
what is charcots’s triad used for
ascending cholangitis
if you add hypotension and mental status change you get__________which helps to diagnosis ______
Reynolds pentad and ascending cholangitis
recurrent biliary colic and confirmed gallstones and tx with ________
elective lap surgery
what is ranson’s criteria used for?
grade the severity of pancreatitis
pt has recently recovered from pancreatitis, but continues to have abdominal pain, a mass is found mid epigastric region and his labs continue to show elevated amylase and lipase
pancreatic pseudocyst
grey turnersand cullen’s sign are associated with
acute pancreatitis hemorrhage
what is murphy’s sign
pain the RUQ associated with inspiratory arrest
what is courvoisier sign?
palpable contender gallbladder in patient’s with jaundice, (pancreatitis carcinoma)
out of the 5 P’s what is the first to present with an acute artery occlusion
PAIN, then pins and needles, then pallor
3cm firm breast nodule, ovoid in shape and freely moveable —- most likely
fibroadenoma (most common benign breast mass)
rating of ankle/brachial pulses 1.0 to .3
1.0 is normal, 0.7 is consistent with claudication, and 0.3 is associated with pain at rest.
what is the most common symptom associated with abdominal pain secondary to chronic intestinal ischemia?
fear of eating
when staging breast cancer tumors what does T1, T2, T3 mean?
T1 5cm
what is the most common EMBOLIC source of acute arterial occlusion in the lower extremities
atrial fib
what are the most common symptoms of Crohn’s disease
abdominal pain, weight loss, and diarrhea
is bleeding more commonly associated with UC or Crohn’s
UC
obstipation and failure to pass gas occur with both small bowel obstruction and paralytic ileus how do the bowel sounds differ?
ileus-hypo and SBO is high-pitched
what is the surgical treatment for achalasia
myotomy and pneumatic dilatations
what is the medical tx for achalasia
CCB and botulinum injection
is a lobectomy used more frequently in early or late stage lung cancer?
early
most common lung cancer
adenocarcinoma
name 2 absolute contraindications of surgical resection of lung cancer
malignant pleural effusion and MI within 3 months
relative contraindication of surgical resection
FEV1
hemorrhoid staging
- prolapse only with straining
- prolapse through anus but reduce spontaneously
- must be manually reduced
- cannot be reduced
cecal distention to 12cm, bowel obstruction: what it the treatment
surgical exploration
most common cause of small bowel obstruction
adhesions
most common cause of larger bowel obstruction
adenocarcinoma
how do you tx acute execration of Crohn’s disease
steroids
patient has UC and low grade dysplasia
do a proctocolectomy with oleo-anal pull through
pathologic findings associated with ulcerative colitis
95% has rectal involvement
skipped lesions and transmural
Crohns
how are small bowel obstructions managed
correct fluid and electrolyte abnormalities, then surgery
most common cause of massive lower GI bleeding
diverticular dz
dukes aster coller is staging system for what type of CA
colon
staging to colon cancer
A. only mucosal penetration B1. penetrate into muscular B2. penetrate through muscular C. into the muscular with nodes C2 through the muscular with nodes D. metastasis
