Surgical complications in pregnacny

Question 1

what trimester is the safest to have a surgery like appendectomy

Answer 1

second trimester (so like 13 to 27wks)

Question 2

If surgery must be done. what should they be premedicated with

Answer 2

bicitrate and H2 blockers

-all pregnant women need to be treated like they have a full stomach

Question 3

approach the pregnant patient w/ a surgical emergency as you would a non-pregnant patient

Answer 3

she stressed this

Question 4

what is the most common surgical emergency in pregnancy

Answer 4

appendicitis

-note that appendicitis signs can be confusing with regular pregnant symptoms

Question 5

where is McBurney’s point in pregnant women

Answer 5

the growing uterus progressively displaces the appendix in a counterclockwise rotation out of the pelvis into the RUQ
-so RUQ pain

Question 6

Radiation greater then 5 rads is serious shit. What will happen if exposed before second to third wk after conception

Answer 6

severe abnormalities will not exist if pregnancy continues

Question 7

Exposure of radiation greater then 5 rads btw the fourth and eleventh weeks after conception

Answer 7

severe abnormalities of many organs

Question 8

Exposure of radiation greater then 5 rads btw eleventh and sixteenth weeks after conception

Answer 8

stunted growth, microcephaly, or mental retardation

Question 9

Exposure of radiation greater then 5 rads btw sixteenth and twentieth weeks after conception

Answer 9

mild degrees of mental retardation and stunted growth

Question 10

Exposure of radiation greater then 5 rads after twentieth week of conception

Answer 10

abnormalities not likely to be produced

Question 11

what is the tetragonic period according to wooton

Answer 11

btw fourth and twentieth. most severe in the beginning

Question 12

how many rads is a CT scan to the abdomen

Answer 12

3. 5 rads

- if you suspect appenditis, and she is after the twentieth week since conception the baby will be fine

Question 13

Laparoscope or Laparotomy for acute appendicitis. which poses concern that CO2 used for insufflation will be absorbed through peritoneum into maternal bloodstream and across the placenta resulting in fetal respiratory acidosis

Answer 13

Laparoscope

Question 14

why do women have such high cholesterol levels

Answer 14

estrogen increase the saturation of cholesterol in bile

Question 15

almost all gall stones in pregnant women are almost always made of what

Answer 15

cholesterol

Question 16

increase WBC count, elevated bilirubin levels, jaundice, increased thickness of gallbladder wall on U/S

Answer 16

acute cholecystitis and cholelithiasis

Question 17

how do you manage acute cholecystitis and cholelithiasis in a prego woman

Answer 17

IV fluids, gastric decompression, and diet
-note if patient has cholangitis or pancreatitis caused by common bile duct stone than you can do endoscopic retrograde cholangiopancreatography

Question 18

If patient has acute cholecystitis and cholelithiasis and develops signs of peritonitis then how would you manage

Answer 18

Laprascopic cholecystectomy

Question 19

Symptoms: severe, non-colicy epigastric pain radiating to the back. Nausea and vomiting. Elevated serum amylase (>200 U/dL)

Answer 19

Acute pancreatitis

-usually as a result of cholecystitis, cholelithiasis or alcoholism

Question 20

what diagnosis has tx plans such as 1 to 10 days bed rest, IV fluids, pain management, and nasogastric suction

Answer 20

acute pancreatitis

Question 21

upright x-ray reveals dilated loops of bowel and air fluid levels

Answer 21

bowel obstruction

Question 22

sudden onset of severe intermittent abdominal pain. Pain after sex also. what can cause this

Answer 22

adnexal torsion

-may radiate to flank or down anterior thigh

Question 23

what is confirmed by presence of mass on U/S and LACK of flow by doppler study

Answer 23

adnexal torsion

-tx is surgical removal

Question 24

what types of ovarian tumors have a risk of ~5% of malignancy

Answer 24

germ cell tumors and epithelial tumors