Surgery

Question 1

Leriche Syndrome

1. What is it?
2. Triad

Answer 1

1. Arterial occlusion at the bifurcation of the aorta into the common iliac arteries (aortoiliac occlusion); pts will have BL decrease in pulses of LE
2. Bilateral hip, thigh and buttock claudication; impotence; symmetric atrophy of the bilateral LEs dt chronic ischemia

Question 2

Rupture of the dome of the bladder

1. causes
2. results

Answer 2

1. Blunt trauma to the lower abdomen commonly with the bladder is full and distended
2. results in urine to spill into the peritoneum –> peritonitis

Question 3

What is Kehr Sign:

Answer 3

• Irritation of the peritoneal lining of the right or left hemidiaphragm may cause referred pain to the ipsilateral shoulder (kehr sign) as sensory innervation to the shoulder originates from the C3-C5 spinal roots
• these roots are also the origin of the phrenic nerve innervating the diaphragm

Question 4

Acute chemical peritonitis

1. Causes
2. Signs

Answer 4

1. in the setting of blunt abdominal trauma, spillage of blood, bowel contents, bile, pancreatic secretions or urine into the peritoneal cavity can cause acute chemical peritonitis
2. signs include diffuse abdominal pain, abdominal guarding and possible kehr sign

Question 5

PO Pulmonary Complication risk factors?

Prevention?

Answer 5

• smoking, pre-existing pulmonary disease, age >50, thoracic or abdominal surgery, surgery lasting >3 hours, poor general health
• prevention = incentive spirometry and deep breathing exercises (promote lung expansion)

Question 6

ABGs for PO atelectasis

Answer 6

hypoxemia, hypocapnia, and respiratory alkalosis

Question 7

Acute Bacterial Parotitis

1. Risk Groups
2. Agent
3. Symptoms/PE
4. Prevention

Answer 7

1. Risk: Dehydrated PO patients and the elderly
2. Agent: Staph Aureus
3. Sx: Fever, leukocytosis, Parotid inflammation; painful swelling of parotid gland that is aggravated by chewing;
   PE: tender, swollen, erythematous gland with purulent saliva from the parotid duct
4. prevention: adequate fluid hydration and oral hygiene pre- and post- operatively

Question 8

Ischemic Colitis (4)

Answer 8

• Characterized by acute abdominal pain and Lower GI bleeding
• Typically follows episodes of hypotension and most commonly effects arterial watershed areas at the splenic flexure and the rectosigmoid junction
• CT shows thickened bowel wall
• Colonoscopy can confirm the dx