Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

AC- Simon > wk6 Thoracic surgery > Flashcards

wk6 Thoracic surgery Flashcards

1
Q

Conditions presenting for lung resection

A

Lung Caner - small cells (20%), Non small Cells (mostly), Metastatic tumor, Pleural tumours
Carcinoma
Significant pulmonary disorder - bronchiectasis, emphysematous bullae
Oesophageal problems - cancer, hiatus herniation
Trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Causes of lung cancer

A 
Smoking/ passive smoking
Cannabis consumption (Marijuana)
occupational hazards or materials e.g. toxic chem
Atmospheric pollutants
Genetic predisposition
Metastatic disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Prevalence of lung cancer in NZ

A

NZ Maori - 3 times higher than non-Maori
Mortality rate is also 2times higher than non-Maori (Euro)
5 year survival rate (poor compared to other developed)
5th leading cause of death world wide

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Signs and symptoms of lung cancer

A 
persistent cough
sputum
haemoptysis (blood clot expectoration) 
Dyspnoea
chest pain
Stridor - monophonic wheeze
Wheeze
Lymph node involvement
Collapse/consolidation/effusion
Hoarseness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Franky Haemoptysis

A

blood without sputum when cough

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Stridor - monophonic wheeze

A

unchanging pitch sound due to obstruction in the airways
can involve in trachea or main bronchi
If trachea is affected, then can’t do surgery but can do surgery if bronchi is affected –> pneumonectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Hoarseness

A

weak vocal sound such as husky, breathy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Investigative Procedure

A

*currently no routine screening
*confirmation clinical diagnosis includes…
-sputum cytology & bronchial washings
-bronchoscopty & biopsy
-thoracoscopy
- PET scanning (positive emission) - uptake glucose –>show as bright
CT/MRI/CXR
Blood profiles
Evidence of metastatic spread –> BAD prognosis –> no point of having surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LUNG cancer staging - NMT

A

N: represents the lymph NODES involved by metastasis from the lung tumour
M: describes whether spread to other organs has occured - METASTASIS
T: represents the size of the TUMOR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Lung cancer staging - Stage 1 - 4

A

1- No metastasis / no node involvement / local tumor -75% survival rate post surgery

  1. Hilia lymph node involvement/ no distal metastasis/ 3cm or lager tumor - 10-20% survival
  2. mediastinal node on same side. Advanced node involvement - operable depending on site and spread
  3. Distal metastasis. Can’t do surgery
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Treatment for lung cancer

A

surgery - lobectomy or pneumonectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Incision Types

A
  • Key hole/scopic (VATS-video assisted thoraco surgery)
  • minimal access
  • open thoracotomy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Advantage of key hole/ VATS thoracotomy

A

Px can up and moving very quickly post op compared to ‘open thoracotomy’
Better function & less pain

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What type of incision need for Lobectomy and Pneumonectomy

A

Small incision is enough for Lobectomy

Have to do big Open incision for Pneumonectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Muscles transected include…

A 
Latissimus Dorsi
Serratus Ant
Trapezius
Intercostals
Pec Major and Minor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Data suggests PPC development occurs irrespective of preop physio education - Name the author and intervention they made

A

Reid et al, 2010. Face to Face VS written info only
No significant difference
Thus providing written information to patients is sufficient.

17
Q

Feeney at al, 2011

A

“patients who developed a PPC engaged in less physical activity than those who did not- hence targeting physcial activity preoperatively may result in less PPCs”

18
Q

Briefly describe Pneumonectomy

  • type of Incision required
  • Indications
  • inclusion criteria
  • number and type of drain used
A
  • Type: Thoracotomy
  • Indication: Carcinoma
  • Inclusion criteria: FEV > 2L or 25% of VC
    FEV1/FVC >50%
    Vo2PEAK HIGH risk
  • No. Drain: 1 chest drain
19
Q

Briefly describe Lobectomy

  • type of Incision required
  • Indications
  • number and type of drain used
A 
-type of Incision: Thoracotomy. Some surgeons now performing video assisted
thoracoscopic lobectomy (VATS) 
-Indications: Usually Carcinoma, Bronchiectasis , Lung abscess
  • Drain: Two - Apical chest (To remove air)
    - Basal chest (To remove fluid)
20
Q

Briefly describe Pleurectomy

  • type of Incision required
  • Indications
  • Procedure
  • number and type of drain used
A

type of incision: Thoracotomy and VATS
Indication: Treatment of recurrent or persistent pneumothoraxes
Procedure: Strip the parietal pleura off the chest wall. Pneumothorax is prevented as adhesion forms between Viceral pleura and chest wall as lung expands
Drain: one or two chest drains. removed when air leak stops.

21
Q

Physiotherapy management following thoracic surgery

A

Post op care

  • respiratory care (lung is quite small, deflated, after surgery so, Increase lung expansion to fill the space in the hemi-thorax, Also chest drain to increase lung function)
  • Shoulder and Thoracic cage function
  • Early mobilisation

Post operative pulmonary rehabilitation - lacking evidence
Post thoracotomy pain management - pain team tend to take over our role

22
Q

Rationale for Early mobilisation

A

Decrease risk of PPC,
Decrease other sequela e.g. DVT, pulmonary emboli
Increase Vo2Max cardiovascular fitness
Increase respiratory Fitness

23
Q

postoperative complications specific to thoracic surgery

A 
Pneumonia, chest infection
persistent air leaks
Empyema - build up of pus in the pleural cavity due to bacterial infection
recurrent laryngeal nerve damage
Broncho pleural fistula
Wound infection
Post thoracotomy pain
Surgical emphysema
24
Q

Treatment of post thoracotomy pain

A

TENS is effective in px with mild pain. but not in severe pain. useful in moderate pain if used with other medications. (Freynet & Falcos, 2010)

25
Q

Post operative management of Pneumonectomy

A

Patients MUST NOT lie on good side - this is to ensure the bronchial stump remains intact.
Chest drain clamped -released one minute every hour to control mediastinal shift.
No suction applied.
Chest drain removed after about 24 hours and mediatstinal space allowed to slowly fibrose.

26
Q

Post operative management of Lobectomy

A

Postoperative care: O2, Chest drains on low grade suction. Basal chest drain removed
1-2 days post-op, apical chest drain removed when air leak ceases usually 4-5 days
post-op. May lie on either side, but should not lie on thoracotomy side unless necessary
for chest purposes

AC- Simon (12 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions