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General Surgery > Surgery > Flashcards

Surgery Flashcards

1
Q

Complications of post op wound infection ?

A
  • haemorrhage
  • sepsis
  • wound dehiscence
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2
Q

What antibiotics should be added to pre op prophylaxis in high risk MRSA patients ?

A

Teicoplanin or vancomycin

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3
Q

When should IV prophylactic antibiotics be administered before surgery ?

A

30 mins

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4
Q

What is the role of post op surgical drains ?

A
  • vacuum to protect against collection, haematoma and seroma formation
  • protect sites where leakage may occur e.g. Bowel anastomoses
  • collect RBCs which can be auto transfused (protects against the risks of allotransfusion)
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5
Q

What is a seroma ?

A
  • Pocket of clear serous fluid that sometimes develops in the body after surgery
  • occurs when small blood vessels rupture and blood plasma seeps out
  • inflammation caused by dying injured cells also contributes to the fluid

*in breast can cause necrosis of overlying tissue

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6
Q

What in particular should be checked for in Afro Caribbean patients before surgery if not already documented ?

A

Sickle cell trait

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7
Q

What is post operative ileus ?

A

Severe or absolute constipation and intolerance of oral intake (vomiting) due to non mechanical factors that disrupt the normal coordination of propulsive motor activity of GI tract
* certain degree is normal physiological response to surgery

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8
Q

How long after surgery should gut motility reappear ?

A

2-3 days

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9
Q

Presentation of post operative paralytic ileus

A
  • vague, mild abdo pain and bloating
  • nausea, vomiting, anorexia
  • constipation
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10
Q

Difference between ileus and intestinal obstruction

A
  • obstruction: pain more severe + cramping (not seen in ileus)
  • obstruction = tinkling bowel sounds, ileus = absent
  • obstipation more likely in obstruction
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11
Q

When does secondary post operative haemorrhage start ?

A

1-2 weeks post op

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12
Q

Warning sign of wound dehiscence

A

Serous pink discharge from wound

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13
Q

What general post op complications may present immediately ? (4)

A
  • primary haemorrhage (starting during surgery or on Post opincreased BP - reactive bleeding)
  • acetelectasis (minor lung collapse)
  • shock: blood loss, acute MI, PE, septicaemia
  • low urine output: inadequate fluid replacement intra or post operative lay
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14
Q

What is usually the cause of secondary post op bleeding ?

A

Infection

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15
Q

What complications may occur a within days post op ? (Early complications)

A
  • acute confusion: dehydration, sepsis
  • nausea and vomiting: analgesia/anaesthetic related or ileus
  • fever
  • secondary haemorrhage
  • pneumonia
  • wound dehiscence
  • DVT
  • acute urinary retention
  • UTI
  • infection
  • bowel obstruction
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16
Q

Late complications of surgery

A
  • bowel obstruction due to fibrous adhesions
  • incisional hernia
  • keloid formation
17
Q

What complications are likely to present 3-5 days post op?

A
  • sepsis, wound infection, abscess
  • DVT
  • bronchopneumonia
18
Q

Factors affecting healing rate of surgical wounds ?

A
  • poor blood supply
  • excess suture tension
  • long term steroids
  • immunosuppressive therapy
  • radiotherapy
  • severe rheumatoid disease
  • malnutrition
19
Q

Risk factors for incision hernia ?

A
  • obesity
  • poor muscle tone
  • wound infection
  • multiple use of same incision site
20
Q

Signs of post op acetelectasis

A
  • usually mild and asymptomatic
  • slow recovery from op, poor colour, mild tachypnoea, tachycardia
  • may be associate with early post op fever
21
Q

Signs of acute respiratory distress ?

A
  • Rapid, shallow breathing, severe hypoxaemia with scattered crepitations
  • usually 24-48 hrs after surgery
  • no cough, chest pain or haemoptysis
22
Q

When is sepsis, wound infection or abscess formation post surgery likely to present post op?

A

Day 3-5

23
Q

What type of surgery do cellulitis and abscesses usually form after ?

A

Bowel-related surgery

24
Q

How does acetelectasis occur post surgery ?

A

Alveolar collapse usually due to bronchial secretions obstructing airway

25
Q

Management of aspiration pneumonitis

A
  • urgent bronchial suction
  • positive pressure ventilation
  • prophylactic antibiotics
  • IV steroids
26
Q

Pain on passive dorsiflexion of the foot post op is suggestive of what ?

A

DVT

27
Q

Describe the causes of post-op fever + 5Ws

A 
From time of onset: 
Inflammatory reaction to trauma of surgery
Reaction to blood products 
Malignant hyperthermia 
Atelectasis 
Early wound infection 
Aspiration pneumonitis 
Infection or abscess if over 4 hours 
5 Ws of post op fever 
Wind (pulmonary causes) 
Water (UTI) 
Wound (infection) 
Walk (thrombosis) 
Wonder drugs
28
Q

Classification of surgical procedures with reference to surgical site infection

A

Clean = incision under sterile conditions, no entrance of hollow organ
Clean-contaminated = incision under sterile conditions, entrance of hollow viscus
Contaminated = incision under sterile conditions, major contamination of wound during procedure
Dirty/ infected = infection present before incision is made

29
Q

Management of seroma

A

Pressure dressing + needle drainage

30
Q

Management of respiratory atelectasia post op

A

Spirometry, deep breathing, chest physio
CPAP
NGT decompression
Neuromuscular blocking agents

31
Q

Causes of pulmonary edema post op

A 
Circulatory overload (LV failure, shift of fluids, negative airway pressure, alveolar injury)
Negative pressure pulmonary edema due to inspiratory efforts against closed glottis
32
Q

Management of pulmonary edema post op

A

LMNOP

33
Q

Common arrhythmias post op

A

SVT, AF (due to fluid overload, PE or MI)

General Surgery (2 decks)

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