Surgery LE 1 - Boxes Flashcards
Locations and Causes of Referred Pain
Right Shoulder
Liver
Gallbladder
Right hemidiaphragm
Locations and Causes of Referred Pain
Left Shoulder
Heart
Tail of pancreas Spleen
Left hemidiaphragm
Locations and Causes of Referred Pain
Scrotum and Testicles
Ureter
Nonsurgical Causes of the Acute Abdomen - 3
Endocrine and Metabolic Causes
Hematologic Causes
Toxins and Drugs
Surgical Acute Abdominal Conditions - 5
Hemorrhage
Infection
Perforation
Blockage
Ischemia
Associated symptoms can be important diagnostic clues.
What are they?
Nausea, vomiting, constipation, diarrhea, pruritis, melena, hematochezia, and/or hematuria can all be helpful symptoms if present and recognized.
Murphy’s sign
Pain caused by inspiration while applying pressure to right upper abdomen
Acute cholecystitis
Rovsing’s Sign
Pain at McBurney’s point when compressing the left lower abdomen
Acute appendicitis
Aaron’s Sign
Pain or pressure in epigastrium or anterior chest with persistent rm pressure applied to McBurney’s point
Acute appendicitis
Technique to test Peritonitis
– ask pt to take a deep breath → sudden sharp
pain (+ sign) do not shake the bed
Obturator sign
Flexion and external rotation of right thigh while supine creates hypogastric pain
Pelvic abscess or in ammatory mass in pelvis
Order-specific steps in physical examination:
- General Appearance
- Vital signs
- Inspection
- Auscultation
- Percussion
- Palpation
G VIA PerpP
Iliopsoas
Elevation and extension of leg against resistance creates pain
Apppendicitis with retrocecal abscess
Clean Wound
(5%)
o No infection is present
o Surgery of breast, thyroidectomy and simple hernia
o Cut under sterile conditions
o No prophylaxis
Clean Contaminated –
(10%)
o Respiratory, alimentary or genitourinary under
controlled circumstances without spillage of contents
o Give prophylactic antibiotics immediately prior to
surgery –
Immediately prior to surgery (30min/1hr)
1 dose only unless the procedure is longer than the half life
Contaminated
(15%)
o Contamination of sterile area of the body due to
spillage of contents (e.g. stab wounds)
o With antibiotic prophylaxis
o e.g. acute appendicitis
Dirty
– 3.1-12.8%
Necrotic tissue and purulent material is present (e.g. fecal material)
e.g. diabetic foot gangrene
UNDER AGE 50 consulting for
in order!!
Non-specific abdominal pain
Appendicitis
Cholecystitis
OVER AGE 50 consulting for
in order!!
Cholecystitis
Non-specific abdominal pain
Appendicitis
pain in EPIGASTRIC REGION:
stomach, duodenum, biliary tract
pain in PERIUMBILICAL:
small bowel, appendix, cecum
Referred Pain
Ureteral obstruction –
testicular pain.
Referred Pain
2) Subdiaphragmatic infection –
ipsilateral shoulder or supraclavicular pain.
Referred Pain
3) Biliary disease –
right infrascapular pain.
Referred Pain
4) MI –
epigastric, neck, jaw or UE pain.
Referred Pain
5) Gynecologic pathology –
back or proximal lower
extremity
5 Categories of Acute Abdomen
(BIOPI)
- Bleeding or rupture of vessel, or tumor
- Ischemia or Infarction
- Obstruction
- Perforation
- Inflammation
- Most common cause of ssi
A. Enteric microorganism
- not a host defense of skin:
A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage
D. macrophage
- organ in which presence of microorganism is important for host defense:
A. urogenital tract
b. Biliary tract
c. lungs
d. colon
d. colon
Infection rate of elective cholecystectomy
10%
CHARACTERISTICS OF PAIN
Precipitating or Alleviating Factors
• Quality – Bright, sharp, dull, achy
• Radiation – Scapula, inguinal, supraclavicular
• Severity – 1-10 scale (intensity is based on the frame
of reference of the patient. Be careful in suggesting a
scale)
• Timing – Sudden, insidious, crampy or continuous
The type of wound with multiple deep abrasions and lacerations secondary to vehicular accident
contaminated
- Multiple cutaneous abscesses that spread
through dermis into the subcutaneous region and are commonly seen in diabetic patients.
A. feruncle
B. carbuncle
C.hydradentis suppurativa
D. cellulitis
B. carbuncle
Handwashing using chlorine water
Ignaz Semmelweis
Stated that the patient dies due to inflammatory response to infection
William Osler
- Most common cause of ssi
A. Enteric microorganism
B. Anaerobic gram (+)
C. aerobic skin commensal
D. Aerobic gram (-)
A. Enteric microorganism
- not a host defense of skin:
A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage
D. macrophage
- organ in which presence of microorganism is important for host defense:
A. urogenital tract
b. Biliary tract
c. lungs
d. colon
d. colon
Infection rate of elective cholecystectomy
5%
10%
15%
10%
explanation:
5% = clean
10% = clean contaminated
15% = contaminated
Wound classification of penetrating abdominal trauma
Contaminated
peritonitis seen in patients with ascites and patients undergoing peritoneal dialysis
primary
- type of peritonitis which requires minimal surgical intervantion
Primary
Type of peritonitis seen in perforated acute appendicitis
Secondary
- Type of peritonitis seen after colon resection and anastomosis of perforated diverculitis
Secondary
- Type of peritonitis managed by surgery
a. primary
b. secondary
c. tertiary
d. peritonitis like syndrome
b.secondary (ans)
What is the most common cause of pyogenic liver abcess
cholecystitis
any infection in gut
This is frequently seen in acne and usually begins in hair follicles
Furuncle
Surgical removal of perforated sigmoid
dirty wound
contaminated
Thyroid gland surgery is a
- Clean wound
Most common cause of abdominal pain under 50 -
Non specific abdominal pain
Protein-energy malnutrition and dietary deficiencies = Marasmus
a. lack of protein and calories
b. lack of protein only
lack of protein and calories
Protein-energy malnutrition and dietary deficiencies = Kwashiorkor
a. lack of protein and calories
b. lack of protein only
b. lack of protein only
LOW RESIDUE ISOTONIC FORMULA
1st line formula for stable patient with intact GI tract
ISOTONIC FORMULAS WITH FIBER
Fiber stimulates pancreatic lipase activity and are
degraded by gut bacteria into short-chain fatty acids, an
important fuel for colonocytes
IMMUNE ENHANCING FORMULAS
Additives includes glutamine, arginine, branch-chain amino acids, omega-3 FA, nucleotides and beta-carotine
CALORIE-DENSE FORMULA
Greater caloric value for the same volume to 2 Kcal/mL
HIGH-PROTEIN FORMULAS
Isotonic and nonisotonic mixtures and are proposed for critically ill or trauma patients with high protein requirements
ELEMENTAL FORMULA
Predigested nutrients
