surgery notes Flashcards
Arterial blood supply o Liver
Left and right hepatic
Arterial blood supply of spleen
Splenic
Arterial blood supply of gallbladder
Cystic (branch of the R hepatic)
Arterial blood supply stomach
lesser curvature: Right and left gastric
Greater curvature: Right an left gastroepiploic
Fundus: short gastric
Arterial blood supply of duodenum
Gastroduodenal
pacreatodiodenals
Arterial blood supply pancreas
Pancreatic branches of splenic
Panreaticoduodenal
Arterial blood supply small intestines
Superior mesenteric branches (jejunal, ileal, ileocolic)
Arterial blood supply large intestines
superior mesenteric branches; Right colic, middle colic
Inferior mesenteric: left colic, sigmoid, superior rectal
Types of peritonitis
Primary: spontaneous without clear etiology
Secondary: due to perforated viscus
Tertiary: recurrent secondary peritonitis more often with resistant organisms
Upper GI bleeding
bleeding source proximal to the ligament if Treitz
presents with hematemesis and melena
PUD accounts for approximately 55% of severe UGIB
Initial TX: with endoscopy then cosider surgical mangement appropriate to etiologuy
LGIB
source distal to the ligament of Treitz
often presents with BRBPR unless proximal to transverse colon (may occasionally present with melena)
Indications of Urgent Operation (GI)
IHOP
Ischemia
hemorrhage
Obstruction
Perforations
Overt bleeding
obvious hematemesis, hematochezia or melena per rectum
Occult bleeding
Bleeding per rectum is not obvious to naked eye
Obscure bleeding
Bleeding with no identifiable source after colonoscopy and endoscopy
Biochemical SIgns for Differentiating Jaundice
Hepatocellular: Elevated bilirubin + elevated AST/ALT
Cholestatic: Elevated bilirubin + elevated ALP/GGT +/- duct dilatation upon biliary U/S
Hemolysis: dec. haptoglobin inc. LDH
5 Ws of post-Op fever
WIND - pulmonary-atelectasis, pneumonia WATER - urine-UTI WOUND= wound infecction ( if earlier think streptococcal or clostridial) WALK- Thrombosis -DVT/PE WONDER DRUGS
Types of wound
Clean - incision under sterile conditions; non traumatic; no entrance of hollow organ (i.e hernia repair)
Clean contaminated - ENTRANCE to hollow viscus; no evidence of active infection; minimal contamination (i.e cholecystectomy; colon resection)
Contaminated - MAJOR contamination of wound during procedure (i.e gross spillage of stool, infection in biliary, respiratory, or GU systems)
Dirty/Infected: Established infection present before wound is made in skin
Wound Hemorrhage/Hematoma
secondary to inadequate surgical control of hemostasis
RF: anticoagulation therapy, thrombocytopenia, DIC, liver disease.
More common with transverse incisions through muscle
Seroma
fluid collection other than pus or blood. Secondary to transection of lymph vessels
Delays healing
increased infection risk
TX: consider pressure dressing +/- needle drainage. If significant, may need to re-operate
Wound dehisence
disruption of FASCIAL layer contents contained by skin only
95% caused by intact suture tearing through fascia
Sliding Hiatus hernia (type I)
herniation of both the stomach and GE junction into the thorax.
90% of esophageal hernias
Majority are asymptomatic
hernias frequently associated with GERD due to dec competence of LES
Most common complication is GERD.
Esophagitis (peptic stricture, Barrett’s esophagus, and esophageal carcinoma)
Aspiration pneumonitis, pneumonia, asthma type bronchospasm, cough, laryngitis
DX: Barium swallow, endoscopy, or esophageal manometry, 24 h esophageal pH monitoring
TX: lifestyle modification, antacid, H2-antagonist, PPI, prokinetic agent
Surgical; if failure of medical therapy
Paraesophageal hernia (type II)
herniation of all or part of the stomach through the esophageal hiatus into the thorax with an undisplaced GE junction.
usually asymptomatic
pressure sensation in lower chest, dysphagia
Cx: hemorrhage, incarceration, strangulation, obstruction
CAMERON’s lesion - gastric stasis ulcer -causes iron deficiency anemia
Mixed hiatus hernia
combination of type I and Type 2
Type IV hernia
herniation of stomach and other abdominal organs into the thorax: colon, spleen, small bowel
Iron deficiency anemia is common
Esophageal perforation
Most common (iatrogenic)
neck or chest pain
fever, tachycardia, hypotension, dyspnea
subcitaneous emphysema, pneumothorax, pleural eff, hematemesis
Boerhaave’s syndrome
transmural esophageal perforation
Mallory Weiss tear
non-transmural esophageal tear (partial thickness tear)
Kissing ulcer
combination of perforation and bleeding
Virchow’s node
left supraclavicular node
Blumer’s shelf
mass in puch of douglas
krukenburg tumor
metastases to ovary
Sister Mary Joseph
Umbilical Metastases
Irish’s node
Left axillary node
