Abdominal incisions & Post Fever

Question 1

What are the advantages of vertical/midline incisions?

Answer 1

Best exposure
Quick entry
Decreased blood loss
Decreased nerve damage
Easily extended

Question 2

What is a disadvantage to vertical/midline incisions?

Answer 2

Wound dehiscence more common

Question 3

What are the advantages to transverse incision?

Answer 3

Good Strength
Good cosmesis
Hernia uncommon

Question 4

What is the disadvantage to transverse incision?

Answer 4

Decreased ability to extend

Question 5

What is the Cherney incision?

Answer 5

Excise rectus tendon from pubis. Excellent exposure to retropubic space

Question 6

What is the maylard incision?

Answer 6

Transection of rectus muscle with ligation of inferior epigastric vessels

Question 7

Should a drain be placed in sub Q tissue during closure?

Answer 7

No

Question 8

Tell me about Plain catgut suture?

Answer 8

Natural
Absorbs in 7 days
Breakdown via inflammation

Question 9

Tell me about Chromic catgut?

Answer 9

Natural
Absorbs in 14 days
Breakdown via inflammation

Question 10

Tell me about Vicryl suture?

Answer 10

Synthetic
Loses 50% of strength in 21 days
Breakdown via hydrolysis

Question 11

Tell me about Dexon suture?

Answer 11

Synthetic
Loses 50% of strength in 25-30 days
Breakdown via hydrolysis

Question 12

Tell me about PDS suture?

Answer 12

Monofilament
Delayed absorbable
Loses 50% of strength in 60 days

Question 13

Tell me about Maxon suture?

Answer 13

Monofilament
Delayed absorbale
Loses 50% of strength in 60 days

Question 14

Tell me about silk suture?

Answer 14

Natural braided
Non-absorable

Question 15

Tell me about Nylon suture?

Answer 15

Synthetic
Nonabsorable

Question 15

Tell me about Nylon suture?

Answer 15

Synthetic
Nonabsorable

Question 16

What is the differential diagnosis for postoperative fever?

Answer 16

Wind= Pneumonia, ileus, bowel obs
Water= UTI
Wound= Infection (vag cuff/uterus/ab
Walking= DVT
Wonder drugs= Drug allergies
Wonder breast= Mastitis

Question 17

What is the workup for post-op fever?

Answer 17

Examination!!!
1. Vitals (BP, pulse, temp)
2. Lung exam
3. Abdominal exam
4. Abdominal incision exam
5. Vaginal incision exam
6. Extremities exam
7. CVA tenderness exam

Question 18

What lab test are warranted for post op fever evaluation?

Answer 18

1. CBC
2. Urine culture
3. Blood cultures
4. CXR- if indicated
5. Doppler US- if indicated
   Pelvic US- if indicated

Question 19

When should you consider a drug fever?

Answer 19

eosinophilia is present
Clinically better then temp suggest

Question 20

How do you treat septic pelvic thrombophlebitis?

Answer 20

Antibiotics and heparin

Question 21

If you have a post-op fever 1- 3 days post op what is most likely diagnosis?

Answer 21

Pneumonia/GI

Question 22

If you have a post-op fever 3-7 days post op what is most likely diagnosis?

Answer 22

DVT, Wound infection, UTI, pnueomina, phlebitis

Question 23

If you have a post-op fever >7 days post op what is most likely diagnosis?

Answer 23

Ureter/bladder injury

Question 24

Most common cause of post op fever?

Answer 24

Physiologic fever due to inflammatory response to tissue damage and exposure to foreign material

Question 25

Most common cause of immediate post op fever within hours after surgery?

Answer 25

1. Inflammation from surgery 2. Immune mediated response to medications or blood products 3. Malignant hyperthermia 4. Infections predating the operation

Question 26

Common causes of early post op fever within 3 days of surgery?

Answer 26

UTI Pneumonia Surgical site infection

Question 27

What are the 5Ws?

Answer 27

Wind- pulmonary causes; PE, pneumonia, aspiration Water- UTI Wound- surgical site infection Walking- VTE Wonder drugs- drug related fever