Surgery Flashcards
What are the causes of post-op fever
Wind
water
walking
wound
wonder drugs
Wind Post-op Fever
timing and Disease
Malignant Hyperthermia, During Surgery
Bacteremia, Right after Surgery
Atlectasis, POD 1
Pneumonia POD 2
Water Post-Op Fever
Disease, Timing
Dx, Tx, PPX
UTI, POD 3
U/a, UCx (WBC casts=Pyelonephritis)
Tx: Abx
PPx=take foley out
Walking Post-op Fever
Disease, Timing
Dx, Tx, PPx
DVT/PE, POD 5
U/S Bilatleral Lower Extremity
Tx: Heparin to warfarin bridge
PPX: LMWH, Out of bed as soon as possible
Wound Post Op Fever
Disease, Timing
Dx, Tx, PPX
Cellulitis, POD 7
- U/S (-)
- Tx: Abx
- PPx: keep it sterile and clean
Abscess, POD 10-14
- U/S (+) for abscess
- Tx: Abx and I&D
Malignant Hyperthermia
Timing
Tx, PPx
During Surgery
O2, Dantrolene, Cool IVF
Family Hx
Bacteremia
timing
Dx, Tx, PPx
Right after Surgery
Dx: Blood Cx
Tx: Broad Spectrum Abx
maintain the sterile Field
Atlectasis
Timing
Dx, Tx, PPx
POD 1
Dx: CXR
PPx: spirometry breathing, Out of bed
Pneumonia
Timing
Dx, Tx, PPx
POD 2
Dx: CXR
Tx: Broad Spec Abx
PPx: Breathing Spirometry, Out of bed
What is sun downing?
AMS in elderly patients after surgery, treat with Atypical antipsychotics
decreased urinary output algorithm after surgery
- Decreased urinary output
- Urge to void
* Yes
Obstruction, perform Bladder scan or in and out cath
- No=Renal Failure
3. Renal failure
4. Any output? - None
Mechanical cause, unkink or irrigate
- decreased output=Renal Disease
5. Renal Disease, perform 500cc Bolus - increase output
- volume down status, give IVF
- no increase=medical disease
Gallstones
Obstructive Jaundice
Presentation
Dx, Tx
Presentation
- Obstructive jaundice
- increased temp, WBCs
- positive Murphy
- painful
Dx
- RUQ U/S
- MRCP
Tx
- ERCP
- Cholecystectomy
Gallbladder Cancer/Stricture
Obstructive Jaundice
Presentation
Dx, Tx
Presentation
- Painless, No temp or increase in WBCs, negative murphy sign
Dx
- RUQ U/S
- MRCP
- (Massively dilated ducts)
Tx
- Endoscopic U/S with biopsy
- ERCP with Biopsy
- Stenting/Resection
Boorheaves
Presentation
Dx, Tx
Presentation
- “Career Vomiter” ie Bulimia or alcoholic
- Air in the mediastinum
- Possible Mediastinitis
Dx
- Gastrograffin
- Barium Swallow
- EGD
Tx
- Surgery
Small Bowel Obstruction
Presentation
Dx, Tx
Presentation
- Colicky Abdominal pain
- Abdominal Distention
Dx
- KUB shows air fluid levels
- Perform CT scan to determine complete or incomplete
Tx
- Complete=surgery
- Incomplete=Watch and wait, NG tube, K+, IVF; No change after three days go to surgery
Pancreatic workup and presentation
Presentation
- Epigastric pain, boring to the back
- peritoneal
- nausea/vomiting
Dx Workup
- Lipase
- CT Scan will show either necortizing Pacreatitis, An Abscess, or Pseudocyst
Psuedocyst
Findings and treatment
<6wks old, <6 cm in size
- Uncomplicated, watch and wait
- follow up U/S
>6 wks old, > 6 cm in size
- Complicated
- Drain
Cholelithiasis
Presentation
Dx, Tx
Presentation
- Fat, Forty, Female
- RUQ colicky abdominal pain
- Pain radiates to the shoulder
- Worse with fatty foods
Dx
- RUQ US=Gallstones
Tx=Cholecystectomy
Cholecystits
Presentation
Dx, Tx
Presentation
- Pericholecystic fluid
- thickened wall
- gallstones in CBD
- Constant RUQ pain
- (+) murphy
- Signs of inflammation
Dx
- RUQ US=inflammation, no stones
- HIDA Scan
Tx
- NPO, IVF, IV Abx
- Urgent Cholecystectomy
Choledocolithiasis
Presentation
Dx, Tx
Presentation
- Painful Jaundice
- +/- murphy sign
- inflammation
- Possible increase in AST, ALT and Amylase and lipase
Dx
- RUQ US= Dialted ducts
- MRCP
Tx
- NPO, IVF, IV Abx
- ERCP
- Cholecystectomy
Cholangitis
Presentation
Dx, Tx
Ascending infection
Presentation
- RUQ pain
- Jaundice
- fever
- Hypotension
- AMS
Dx
- RUQ US=Obstruction
Tx
- NPO, IVF, IV Abx
- Emergent ERCP
- Cholecystectomy
What antibiotics do you use for the gallbladder
Ciprofloxacin + MTZ
Ampicillin/Gentamicin + MTZ
Ulcerative Colitis
Presentation
Dx, Tx
Presentation
- Affects the superficial mucosa
- bloody BM and weight loss
Dx
- Colonoscopy shows continuous inflammation
Tx
- 8 years after diagnosis screen yearly
- prophylactic colectomy
Hemorrhoids
Presentation
Dx, Tx
Presentation
- Internal-painless bleeding
- External-Painful no bleeding
Dx
- Visual Inspection
- Anoscopy
Tx
- Internal-banding
- External-Resection
- PrepH or a sitz bath
Presentation of Obstructive Abdominal pain
Colicky in nature
No fever, no leukocytosis ie-cholelithiasis, nephrolithiasis
No Comfortable position
Inflammatory abdominal pain presentation
Constant pain
Positive fever and leukocytosis
no comfortable position ie- cholecystitis, pyelonephritis
Perforated abdominal pain
Super sick, constant pain, patient will be motionless
x-ray will show free air
PUD, Cancer, Penetrating trauma
Ischemic abdominal pain
bloody BM, Sepsis, CAD, A-Fib, Mesenteric ischemia
Arterial Insufficiency
Presentation
Dx, Tx
Presentation
- Peripheral vascular disease
- hairless legs, shiny scaly skin, absent pulses, tips of toes
Dx
- arterial brachial index
- US doppler
- Angiogram
Tx
- Stent or bypassing
Closed Angle Glaucoma
Presentation
Dx, Tx
“Pressure with pupil dilation”
Presentation
- in low light pressure will increase causing pain, headache, rigid eyeball
- pupil non-reactive
Dx
- Clinical, ocular pressure
Tx
- Constrict the pupil
- alpha-2-agonists
- beta blockers
Retinal Artery Occlusion
Presentation
Dx, Tx
Presentation
- Painless unilateral vision loss
- no focal neurological deficits
- Cherry red spot fovea
Tx
- tPA
- Hypoventilation
- Global pressure
Basal Cell Ca
Presentation
Dx, Tx
Presentation
- Pearly lesion
- sun exposed areas
- Fails to heal, and bleeds
Dx
- Excisional Biopsy
Tx
- Face=mohs
- Limb (Mild)=excision
- Limb (Large)=Amputate
Squamous Cell Ca
Presentation
Dx, Tx
Presentation
- Well defined red papule
- ulcer heals and breaks
- Can metastasize
Dx
- Excisional Bx
Tx
- The same as BCC
Anterior Brain Tumors
Anterior lesions most often affect adults
Meningioma-affects the dura, resection is curative
Glioblastoma-affects the parenchyma, ring-enhancing lesion, bats wing appearance-crosses the midline
Posterior brain tumors
posterior lesions most often affect kids
Medulloblastoma-seeds arachnoid space, distal lesion, resection and radiation
Ependymoma-4th ventricle lesion, obstructive hydrocephalus, fetal position, resection
Testicular Torsion
Presentation
Dx, Tx
Presentation
- Spontaneous scrotal pain
- Horizontal lie and pain on elevation
Dx
- US Doppler
Tx
- Untwist
- bilateral orchiectomy
Epididymitis
Presentation
Dx, Tx
Presentation
- Spontaneous pain
- Vertical lie
- relief of pain on elevation
Dx
- US Doppler
Tx
- Abx
- <35 ceftriaxone and azithromycin
- >55 ciprofloxacin
Bone Tumors
Presentation
Dx, Tx
Presentation
- focal Atraumatic bone pain
Dx
- X- Ray
- MRI
- Bx
Tx
- Resection
Ewings - t11,12, midshaft, onion skin appearance
Osteosarcoma- Rb Gene, sunburst pattern
Hard signs of penetrating neck injury
Airway: Gurgling, stridor, loss of airway
Vascular: Expanding hematoma, pulsatile bleeding, stroke, shock
Soft signs of penetrating neck injury
Dysphonia
dysphagia
subcutaneous air
