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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
Q

Which suture is good to use in tendons, ligaments, joint capsule, and fasica? Why?

A

Prolene (non-absorbable monofilament) b/c min. tissue reactivity + LEAST thrombogenic

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26
Q

Mono vs Multifilament

A

Mono:
- Pros: lower tissue drag, decreased capillarity
- Cons: decreased knot security, increased memory

Multi: opposite of mono

27
Q

When to use taper point vs reverse-cutting suture needle

A

Taper Point: soft tissue, luminal organs

Reverse-Cutting: tough, thick, fibrous tissue or long/large incision

28
Q

Suture choice for tie-over bandage for a necrotic wound

A

Prolene or Nylon (non-absorbable monofilaments) b/c tie-over bandages require stay sutures that need to maintain tensile strength for 5 weeks

29
Q

Suture choice for entropion sx

A

Vicryl w/ long tags, 3-0 to 5-0
- absorbable multi; soft, min. tissue reactivity

30
Q

Suture choice for PU surgery (urethra gets sutured!)

A

Taper point w/ absorbable monofilament (monocryl is softer than PDS II)

31
Q

Suture choice for SCC removal on the pinna of an outdoor cat

A

Absorbable suture that does NOT stick around for long (vicryl; monocryl)

32
Q

Suture choice in fast-healing tissue like oral mucosa

A

Monocryl, Vicryl

33
Q

Suture choices for toe amputation (internal tissue + dermis)

A
  1. PDS II (tissue)
  2. Prolene or Nylon (dermis)

Long healing time b/c on extremtiy

34
Q

What are the phases of wound healing

A
  1. Inflammatory/debridement
  2. Proliferative
  3. Maturation
Remember that the phases are a SPECTRUM; phases can overlap!!
35
Q

What cells are key in inflammatory phase

A

Clotting factors (send 1st molecular signals), neutrophils (early- kill bacteria +debride necrotic tissue), and macrophages (days 3-5; phagocytosis)

36
Q

Key characteristics of Proliferative Phase

A
  • Granulation tissue (collagen, fibroblasts)
  • Epithelialization (epithelial migration)
  • Contraction (myofibroblasts)
37
Q

Contraction v Contracture

A

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
Q

Purpose of Maturation phase

A

Remodeling//Strengthening
- skin will only regain ~80% of original strength

39
Q

Why is proper oxygenation of healing tissue important?

A
  • neutrophils need O2 to kill bacteria (free- oxygen radicals)
  • needed for collagen production
40
Q

What phase is inherently resistant to infection?

A

Granualtion tissue (proliferative phase)

41
Q

What can delay and/or reverse the proliferative phase?

A

Presence of inflammation – infection or necrotic tissue

42
Q

What is the goal of tissue debridement

A

To remove necrotic/devitalized/severely contaminated tissue, any foreign material in order to decrease risk of infection (which delays/prevents proliferative phase)

43
Q

Surigcal debridement: layered vs. En Bloc

A

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
Q

What is the most effective way to reduce bacterial numbers on wound surface?

A

LAVAGE!!
- large syringe + 18g needle
- fluids (tap water, 0.9% saline, LRS, NormR)
- saline bottle w/ puncture holes

goal is 7-8 psi
45
Q

When are topical ABX indicated?

A

Inflammatory/debridement phase

contraindicated during prolif phase

46
Q

When are systemic ABX indicated and contraindicated?

A

Presence of infected tissue OR NRC Dirty classification
- NOT indicated for contaminated wound during inflammatory phase OR healthy wound during proliferative phase

47
Q
  1. Primary closure (1st intension)
  2. Delayed primary closure
  3. Second intention
  4. Third intention
A

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 1ºclosure
4. Secondary Closure (3rd intention)
- wound closed > 5 days post injury
- granulation tissue present
- seeverly infected wounds/massive tissue destruction

48
Q

Layers of a bandage

A
  1. Primary layer: dressing/contact layer
  2. Secondary layer: absorption, stabilization, and pressure (+/- splint)
  3. Tertiary layer: additional protection, pressure
49
Q

Inflammatory vs proliferative phase Dressing goals

A

Inflammatory: debridgement + decontamination (ABX)

Proliferative: hold cytokines/cells in w/out disrupting fragile tissue

50
Q

Dressings for inflammatory phase

A
  1. Wet-to-dry bandage
  2. Honey/sugar (hyperosmotic properties. non-selectively draws out fluid//bacteria)
51
Q

Dressings for proliferatie phase

A
  1. tefla pad + triple ABX ointment
  2. petroelum-infused gauze
  3. hydrogel/hydrocolloids
  4. calcium alginate
  5. polyurathane foam
52
Q

Does epithelial migration occur quicker in dry or moist wound environments? Why?

A

Moist
- physiologically favors cell migration/ECM formation
- promotes autolytic debridement

53
Q

Do bandage changes occur more frequently in inflammatory or proliferative phase?

A

Inflammatory (q1-2 days)

proliferative = q3-7 days

54
Q

3 most important considerations in fracture repair

A

Stress, strain, bending moment

55
Q

How can the stress on a fracture be reduced?

A

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
Q

Severity of bone fracture is directly correlated to what?

A

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)

  • 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
Q

What are the 4 principle forces causing fractures?

A
  1. Bending
  2. Torsional
  3. Compressional (axial load)
  4. Distraction
58
Q

Biomechanics of Fractures

Stress and strain are scalar quantities. What does this mean (what do they measure)?

A

They measure the quantity and/or magnitude of something

other examples: temp, energy, speed, distance

Tensors are Scalars and Vectors. Vectors measure magnitude AND direction (force, acceleration velocity).

59
Q

Blood supply to bone is sourced how?

A

Extraosseously -> important consideration for internal/external fixation!!

60
Q

Main difference b/w non-locking and locking plates

A

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.

Top: non-locking Bottom: locking
61
Q

What are the only bones interlocking nails can be used on?

A

Femurl, tibia, humerus

62
Q

Interlocking nails

A

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
Q
A

AAA Fall 2024 (15 decks)

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