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AAA Fall 2024 > Surgical Diseases 1 > Flashcards

Surgical Diseases 1 Flashcards

1
Q

What are the 4 NRC Sx Classifications

A
  1. Clean (Non-traumatic, uninfected, no break in aseptic technique, non-inflamed; elective with 1º closure & no drain)
  2. Clean-Contaminated (Controlled entering into luminal organ, minor break in aseptic technique)
  3. Contaminated (Open, fresh traumatic wound; acute, non-purulent inflammation present; major break in aseptic technique e.g. spillage of abdominal contents)
  4. Dirty (Purulent inflammation; perforated organs; traumatic wound w/ devitalized tissue; foreign material or fecal contamination; procedure > 4 hours long)
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2
Q

NRC Surgical Classification

Routine spay or castration

A

Clean

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3
Q

NRC Surgical Classification

Exploratory laparotomy, no entering of luminal organs

A

Clean

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4
Q

NRC Surgical Classification

Exploratory laparotomy for FB removal

A

Clean-contaminated

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5
Q

NRC Surgical Classification

Cystotomy

A

Clean-contaminated

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6
Q

NRC Surgical Classification

Cystotomy/laparotomy with significant abdominal contamination

A

Contaminated

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7
Q

NRC Surgical Classification

Pyometra

A

Contaminated

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8
Q

NRC Surgical Classification

Peritonitis

A

Dirty

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9
Q

NRC Surgical Classification

Necrotic traumatic tissue > 4-hour duration with 1º closure

A

Dirty

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10
Q

Contamination vs Infection

A

Contamination: presence of any abnormal bacterial organisms in any field, WITHOUT inflamamtion

Infection: presence of inflammation AND 10^5 abnormal bacterial per gram

difference = presence of bacterial invasion/colonization

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11
Q

The 5 cardinal signs of inflammation:

A
  1. Redness
  2. Heat
  3. Swelling
  4. Pain
  5. Loss of function
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12
Q

The 6 Halsted’s Principles:

A
  1. Aseptic technique
  2. Gentle tissue handling
  3. Control hemorrhage
  4. Eliminate dead space
  5. Accurate apposition of tissue w/ minimal dead space
  6. Preservation of blood supply
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13
Q

How often should prophylactic ABX be administered and when should they be d/c

A

Start 30-60 mins prior to sx (ensures peak tissue concentration @ time of incision + throughout period of contamination) + re-dose every 2 half lives while incision is still actively open. D/c within 24h of closure.

E.g., cefazolin 1/2 life = 45mins -> re-dose q90mins

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14
Q

When are post-op ABX indicated?

A
  1. All Dirty procedures
  2. Pt is exhibiting clinical signs of illness (sepsis)
  3. When consequences of infection are catastrophic (permanent implants)
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15
Q

Absorbable suture definition
- Name the multifilaments (4)
- Name the monofilaments (2)

A

Loses tensile strength @ 60-90 days in living mammalian tissue
- Multi: Catgut, Chromic gut, Vicryl, Vicryl Rapide
- Mono: Monocryl, PDS II

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16
Q

Non-absorbable suture definition
- Name the multifilament
- Name the monofilaments (2)

A

Retains almost all tensile strength for > 60 days
- Multi: Silk
- Mono: Nylon, Prolene

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17
Q

Polyglactin 910

A

Vicryl

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18
Q

Poliglecaprone 25

A

Monocryl

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19
Q

Polydioxanone

A

PDS II

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20
Q

Polypropylene

A

Prolene

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21
Q

Which suture types can be used in contaminated wounds? (3)

A

Monocryl, PDS II, Prolene

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22
Q

How long does it take for monocryl to lose 50% of tensile strength? 100%?

A

50% lost @ 7 days
100% lost in 4 months

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23
Q

How long does it take Vicryl to lose 50% of tensile strength? 100%?

A

50% = 2-3 weeks
100% = 56-70 days

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24
Q

How long does it take PDS II to lose 50% of tensile strength? 100%?

A

50% = 4-6 weeks
100% = 6 months (have seen longer)

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25
Which suture is good to use in tendons, ligaments, joint capsule, and fasica? Why?
Prolene (non-absorbable monofilament) b/c min. tissue reactivity + LEAST thrombogenic
26
Mono vs Multifilament
**Mono**: - **Pros**: lower tissue drag, decreased capillarity - **Cons**: decreased knot security, increased memory **Multi**: opposite of mono
27
When to use taper point vs reverse-cutting suture needle
**Taper Point**: soft tissue, luminal organs **Reverse-Cutting**: tough, thick, fibrous tissue or long/large incision
28
Suture choice for tie-over bandage for a necrotic wound
Prolene or Nylon (non-absorbable monofilaments) b/c tie-over bandages require stay sutures that need to maintain tensile strength for 5 weeks
29
Suture choice for entropion sx
Vicryl w/ long tags, 3-0 to 5-0 - absorbable multi; **soft**, min. tissue reactivity
30
Suture choice for PU surgery (urethra gets sutured!)
Taper point w/ absorbable monofilament (monocryl is softer than PDS II)
31
Suture choice for SCC removal on the pinna of an outdoor cat
Absorbable suture that does NOT stick around for long (vicryl; monocryl)
32
Suture choice in fast-healing tissue like oral mucosa
Monocryl, Vicryl
33
Suture choices for toe amputation (internal tissue + dermis)
1. PDS II (tissue) 2. Prolene or Nylon (dermis) | **Long healing time b/c on extremtiy**
34
What are the phases of wound healing
1. Inflammatory/debridement 2. Proliferative 3. Maturation
35
What cells are key in **inflammatory phase**
**Clotting factors** (send 1st molecular signals), **neutrophils** (early- kill bacteria +debride necrotic tissue), and **macrophages** (days 3-5; phagocytosis)
36
Key characteristics of **Proliferative Phase**
- Granulation tissue (collagen, fibroblasts) - Epithelialization (epithelial migration) - Contraction (myofibroblasts)
37
Contraction v Contracture
**Contraction**: healthy migration of epithelial cells during proliferative phase (normal muscle shortening) **Contracture**: abnormal shortening of muscles that leads to stiffness/shortening of joints or natural orifices, preventing normal movement/function
38
Purpose of Maturation phase
Remodeling//Strengthening - skin will only regain ~80% of original strength
39
Why is proper oxygenation of healing tissue important?
- neutrophils need O2 to kill bacteria (free- oxygen radicals) - needed for collagen production
40
What phase is inherently resistant to infection?
Granualtion tissue (proliferative phase)
41
What can delay and/or reverse the proliferative phase?
Presence of **inflammation** -- infection or necrotic tissue
42
What is the goal of tissue debridement
To **remove** necrotic/devitalized/severely contaminated tissue, any foreign material in order **to decrease risk of infection** (which delays/prevents proliferative phase)
43
Surigcal debridement: **layered** vs. **En Bloc**
Surgical debridement = **selective removal** **Layered**: begin at wound surface, then progress to depths **En bloc**: excise entire wound + margin of normal tissue | "when in doubt, cut it out"
44
What is the most effective way to **reduce bacterial numbers** on wound surface?
LAVAGE!! - large syringe + 18g needle - fluids (tap water, 0.9% saline, LRS, NormR) - saline bottle w/ puncture holes
45
When are **topical** ABX indicated?
Inflammatory/debridement phase | contraindicated during prolif phase
46
When are **systemic** ABX indicated and contraindicated?
Presence of **infected** tissue OR NRC **Dirty** classification - NOT indicated for contaminated wound during inflammatory phase OR healthy wound during proliferative phase
47
1. Primary closure (1st intension) 2. Delayed primary closure 3. Second intention 4. Third intention
**1. Primary closure (1st intension)** - surgical incision, clean/fresh wounds (< 6 hours old) **2. Delayed primary closure** - 3-5 days after injury, BEFORE granulation tissue appears - used for heavilty contaminated/infected wounds, wounds > 6 hours old, mass removal **3. Second intention** - allow for contraction & epithelialization to occur - small or large wounds; failure of 1º closure **4. Secondary Closure (3rd intention)** - wound closed > 5 days post injury - granulation tissue present - seeverly infected wounds/massive tissue destruction
48
Layers of a bandage
1. Primary layer: dressing/contact layer 2. Secondary layer: absorption, stabilization, and pressure (+/- splint) 3. Tertiary layer: additional protection, pressure
49
Inflammatory vs proliferative phase **Dressing** goals
Inflammatory: debridgement + decontamination (ABX) Proliferative: hold cytokines/cells in w/out disrupting fragile tissue
50
Dressings for inflammatory phase
1. Wet-to-dry bandage 2. Honey/sugar (hyperosmotic properties. non-selectively draws out fluid//bacteria)
51
Dressings for proliferatie phase
1. tefla pad + triple ABX ointment 2. petroelum-infused gauze 3. hydrogel/hydrocolloids 4. calcium alginate 5. polyurathane foam
52
Does epithelial migration occur quicker in dry or moist wound environments? Why?
Moist - physiologically favors cell migration/ECM formation - promotes autolytic debridement
53
Do bandage changes occur more frequently in inflammatory or proliferative phase?
Inflammatory (q1-2 days) | proliferative = q3-7 days
54
3 most important considerations in fracture repair
Stress, strain, bending moment
55
How can the stress on a fracture be reduced?
**Stress = force/unit area** - area is indirectly proportional to stress -> **increase plate area (plate thickness) on fracture** - e.g., addition of **plate rod** increases unit area
56
Severity of bone fracture is directly correlated to what?
**1. Rate of loading** (viscoelastic property) - *Bone is stronger when loaded rapidly* **2. Loading direction** (anisotrophic nature) - **Bone is stronger/most resistant to axial/compressive loads** - bone is much less resistant to loads along its sides (radial), surface (tangential), **and especially 90º to its long axis (transverse)** ## Footnote - Rapidly loaded bones release more energy when they reach failure point -> more complex fractures + greater soft tissue damage - However, these bones are stronger and experience fewer fractures when impacted with rapidly loaded forces. will eventually fracture when failure point is reached.
57
What are the 4 principle forces causing fractures?
1. Bending 2. Torsional 3. Compressional (axial load) 4. Distraction
58
# *Biomechanics of Fractures* **Stress and strain** are scalar quantities. What does this mean (what do they measure)?
They measure the quantity and/or **magnitude** of something | other examples: temp, energy, speed, distance ## Footnote Tensors are Scalars and Vectors. Vectors measure magnitude AND direction (force, acceleration velocity).
59
Blood supply to bone is sourced how?
Extraosseously -> important consideration for internal/external fixation!!
60
Main difference b/w non-locking and locking plates
Locking plates' screws are locked into the plate itself, creating a fixed angle construct and b/w plate and bone and eliminating the need to rely on bone-plate friction for stability.
61
What are the only bones interlocking nails can be used on?
Femurl, tibia, humerus
62
Interlocking nails
Metallic implants used for the repair of traumatic long bone fractures - large diameter rod inserted into medullary cavity -> secured w/ locking bolts going from one cortex to another, capturing the nail inside the medullary cavity
63

AAA Fall 2024 (17 decks)

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