Surgery Tips 1 Flashcards
The COC (microgynon) should be stopped
4 weeks before any major surgery (which includes operations lasting more than 30 minute), all surgery to the legs, or surgery that involves prolonged immobilization of a lower limb
If emergency surgery or immobilization is necessary
Cause of postoperative fever by days after operation
Day 1-2: ‘Wind’ - pneumonia, aspiration, pulmonary embolism
Day 3-5: ‘Water’ - urinary tract infection (especially if the patient was catheterised)
Day 5-7: ‘Wound’ - infection at the surgical site or abscess formation
Day 5+: ‘Walking’ - deep vein thrombosis or pulmonary embolism
Any time: drugs, transfusion reactions, sepsis, line contamination
Wound dehiscence
Wound ruptures along the surgical incision site - emergency -> call for senior help
Which anatomical landmark will be most important in categorising the origin of the bleed?
The ligament of Treitz (the suspensory muscle of the duodenum) is found at the duodenojejunal flexure.
It defines the boundary between an upper GI bleed (proximal) and a lower GI bleed (distal).
Dumping syndrome
May occur following gastric surgery
Due to as a hyperosmolar load rapidly entering the proximal jejunum -> osmosis drags water into the lumen -> lumen distension (pain) -> diarrhoea
Excessive insulin release also occurs and results in hypoglycaemic symptoms
Post gastrectomy syndromes
Small capacity (early satiety), dumping syndrome, bile gastritis, afferent loop syndrome, efferent loop syndrome, anaemia (B12 deficiency), metabolic bone disease
Abdominal wall haematoma
Haematoma in the rectus sheath Following trauma (either directly to the abdominal wall or iatrogenic trauma from surgery) Can be spontaneous following excessive straining of the rectus muscle, prolonged valsalva manoeuvres experienced with strenuous excesses or coughing
Indications for splenectomy
Uncontrollable splenic bleeding, hilar vascular injuries, devascularised spleen
Osteogenesis imperfecta
Defective osteoid formation due to congenital inability to produce adequate osteoid, collagen and dentine
Failure of maturation of collagen in all the connective tissues
Radiology show translucent bones, multiple fractures, particularly of the long bones, wormian bones (irregular patches of ossification) and a trefoil pelvis
4 types - type 1 is the most common
Osteopetrosis
Bones become harder and more dense
Autosomal recessive condition
Commonest in young adults
Radiology shows a lack of differentiation between the cortex and the medulla described as marble bone
Adhesive capsulitis
AKA frozen shoulder
Most common in middle aged females
Associated with diabetes mellitus
Features develop over days - external rotation is affected more than internal rotation or abduction, active and passive movement are affected, have a painful freezing phase, an adhesive phase and a recovery phase
Bilateral in up to 20% of patients - lasts between 6 months and 2 years
Mx - NSAIDs, physio, oral steroids, intra-articular steroids
Red flags in lower back pain
<20 years or >50 years Hx of previous malignancy or HIV Night pain Hx of trauma Systemically unwell (FLAWS) Thoracic pain Non-mechanical pain Pain worse when supine Presence of neurological signs Immunosuppression or steroid use IVDU Structural deformity
Compartment syndrome
Complication that occurs following fractures
Raised pressure within a closed anatomical space -> reduced tissue perfusion -> necrosis
Pain (especially on movement, even passive), parasthesiae, pallor, paralysis of the muscle group
Death of muscle groups within 4-6 groups
Ix - intracompartmental pressure measurements (20-40mmHg is abnormal and >40mmHg is diagnostic)
Mx - fasciotomy, aggressive IV fluids
Ewings sarcoma
M>F 10-20 years old Femoral diaphysis is commonest site Small round tumour Blood borne metastasis is common Mx - chemotherapy combined with surgery
Osteosarcoma
Mesenchymal cells with osteoblastic differentiation
M>F
15-30 years old
Mx - limb preserving surgery may be possible, chemotherapy
