surgery notes

Question 1

Arterial blood supply o Liver

Answer 1

Left and right hepatic

Question 2

Arterial blood supply of spleen

Answer 2

Splenic

Question 3

Arterial blood supply of gallbladder

Answer 3

Cystic (branch of the R hepatic)

Question 4

Arterial blood supply stomach

Answer 4

lesser curvature: Right and left gastric
Greater curvature: Right an left gastroepiploic
Fundus: short gastric

Question 5

Arterial blood supply of duodenum

Answer 5

Gastroduodenal

pacreatodiodenals

Question 6

Arterial blood supply pancreas

Answer 6

Pancreatic branches of splenic

Panreaticoduodenal

Question 7

Arterial blood supply small intestines

Answer 7

Superior mesenteric branches (jejunal, ileal, ileocolic)

Question 8

Arterial blood supply large intestines

Answer 8

superior mesenteric branches; Right colic, middle colic

Inferior mesenteric: left colic, sigmoid, superior rectal

Question 9

Types of peritonitis

Answer 9

Primary: spontaneous without clear etiology
Secondary: due to perforated viscus
Tertiary: recurrent secondary peritonitis more often with resistant organisms

Question 10

Upper GI bleeding

Answer 10

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

Question 11

LGIB

Answer 11

source distal to the ligament of Treitz

often presents with BRBPR unless proximal to transverse colon (may occasionally present with melena)

Question 12

Indications of Urgent Operation (GI)

Answer 12

IHOP

Ischemia
hemorrhage
Obstruction
Perforations

Question 13

Overt bleeding

Answer 13

obvious hematemesis, hematochezia or melena per rectum

Question 14

Occult bleeding

Answer 14

Bleeding per rectum is not obvious to naked eye

Question 15

Obscure bleeding

Answer 15

Bleeding with no identifiable source after colonoscopy and endoscopy

Question 16

Biochemical SIgns for Differentiating Jaundice

Answer 16

Hepatocellular: Elevated bilirubin + elevated AST/ALT
Cholestatic: Elevated bilirubin + elevated ALP/GGT +/- duct dilatation upon biliary U/S
Hemolysis: dec. haptoglobin inc. LDH

Question 17

5 Ws of post-Op fever

Answer 17

WIND - pulmonary-atelectasis, pneumonia
WATER - urine-UTI
WOUND= wound infecction ( if earlier think streptococcal or clostridial)
WALK- Thrombosis -DVT/PE
WONDER DRUGS

Question 18

Types of wound

Answer 18

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

Question 19

Wound Hemorrhage/Hematoma

Answer 19

secondary to inadequate surgical control of hemostasis

RF: anticoagulation therapy, thrombocytopenia, DIC, liver disease.

More common with transverse incisions through muscle

Question 20

Seroma

Answer 20

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

Question 21

Wound dehisence

Answer 21

disruption of FASCIAL layer contents contained by skin only

95% caused by intact suture tearing through fascia

Question 22

Sliding Hiatus hernia (type I)

Answer 22

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

Question 23

Paraesophageal hernia (type II)

Answer 23

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

Question 24

Mixed hiatus hernia

Answer 24

combination of type I and Type 2

Question 25

Type IV hernia

Answer 25

herniation of stomach and other abdominal organs into the thorax: colon, spleen, small bowel

Iron deficiency anemia is common

Question 26

Esophageal perforation

Answer 26

Most common (iatrogenic)

neck or chest pain
fever, tachycardia, hypotension, dyspnea
subcitaneous emphysema, pneumothorax, pleural eff, hematemesis

Question 27

Boerhaave’s syndrome

Answer 27

transmural esophageal perforation

Question 28

Mallory Weiss tear

Answer 28

non-transmural esophageal tear (partial thickness tear)

Question 29

Kissing ulcer

Answer 29

combination of perforation and bleeding

Question 30

Virchow’s node

Answer 30

left supraclavicular node

Question 31

Blumer’s shelf

Answer 31

mass in puch of douglas

Question 32

krukenburg tumor

Answer 32

metastases to ovary

Question 33

Sister Mary Joseph

Answer 33

Umbilical Metastases

Question 34

Irish’s node

Answer 34

Left axillary node