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Surgery > Common Abdominal and Chest Sx - Exam 1 > Flashcards

Common Abdominal and Chest Sx - Exam 1 Flashcards

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1
Q

What pt factors would help decide open vs laparoscopic surgery?

A

overall health

BMI

prior sx

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1
Q

What are some major differences between Laparotomy vs Laparoscopic Surgery? Which type requires longer recovery time?

A

laparotomy is when they use a blade and cut the pt open

Laparoscopic Surgery when they use probs/cannulas and insuflate the belly using CO2

major difference is the size of the incision

laparotomy (open) requires a longer recovery time

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2
Q

What is the screening tool called for appendicitis? What score is a high index of suspicion?

A

alvarado score

7-10 is high

1-4 low
5-6 moderate
7-10 high

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3
Q

What is the MC cause of appendicitis? What is the imaging of choice in kids? Adults?

A

Fecalith/appendiceal obstruction

US in kids

abdominopelvic CT scan +/- oral contrast if concerned for perforation

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4
Q

_____ is standard of care for acute appendicitis diagnosis. What is the conservative option?

A

Appendectomy

abx if it is uncomplicated and non-perforated

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5
Q

What is the approperiate abx regimen for non-complicated appendicitis? What is the reoccurrence rate?

A

IV abx for 1-3 days then oral for total of 7-10 days

ceftriaxone with metro

30% will have recurrent appendicitis within 1y

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6
Q

**What artery needs to be identified and tied off first before an appendectomy can be preformed?

A

mesoappendix artery

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7
Q

It is important for patients to ______ before doing a laparoscopic appendectomy. Why?

A

void

to reduce the chances of puncturing the bladder

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8
Q

What is pneumoperitoneum? Where are the ports placed in a laparoscopic appendectomy? What position is the pt in?

A

insufflating the belly

laparoscope is inserted into the abdomen
One port is placed in the left lower quadrant.
One port is placed in the lower midline/suprapubic region.

The patient is then positioned in Trendelenburg with the left side of the table down

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9
Q

Why is the pt put into the Trendelenburg position in a lap appy?

A

This maneuver utilizes gravity to help pull the small bowel away from the cecum.

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10
Q

What is the discharge criteria for uncomplicated lap appy? Open or perforated?

A

d/c home same day for uncomplicated lab appy

admit for perforation or open technique

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11
Q

What are the abx requirements for non-perforated/uncomplicated Lap appy? with perforation?

A

single preop dose

Ceftriaxone AND Metronidazole x 5-7 days

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12
Q

What are the indications for cholecystectomy?

A

symptomatic Cholelithiasis

Asymptomatic Cholelithiasis in pts with increased risk of GB cancer or gallstone complications

Acalculous Cholecystitis

Gallbladder polyps >0.5cm

Porcelain Gallbladder

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13
Q

What are the 3 MC indication for an open chole?

A

s the inability to safely/effectively perform a lap chole

highly suspect cancer

Have hemodynamic compromise and will not tolerate intraop pneumoperitoneum

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14
Q

What anatomicaly structures need to be isolated during a cholecystectomy?

A

common cystic artery and duct

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15
Q

**What 3 components make up charcots triad?

A

fever (or chills),

right upper quadrant abdominal pain

jaundice (yellowing of the skin and eyes)

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16
Q

What are complications of cholecystectomy? What are the 2 common signs? When do symptoms appear?

A

Common Bile Duct (CBD) injury/ CBD leaks/Obstruction

suspect with fever, abdominal pain

usually start 2-10 days postop

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17
Q

What is the tx for common bile duct injury/leak/obstruction due to a complication of cholecysteomy?

A

Treat with U/S guided percutaneous drainage with ERCP to stent or repair OR re-operation

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18
Q

What is the post-op care for an uncomplicated lap chole? When do you follow up?

A

d/c home same day

PO pain meds

NO abx needed

f/u in office 5-7 days later

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19
Q

What is the post-op care involved in an open/compicated lab chole?

A

Admit for 1-3 days

Pain meds.

Typically no abx needed - unless surgery contaminated.

Monitor for complications

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20
Q

Which types of colectomy also involves removing the anus?

A

abdomino-perineal resection

total proctocolectomy

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21
Q

What tumor markers would you want to get in colon sx?

A

CEA

CA19-9

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22
Q

_______ is the MC cause of toxic megacolon

A

C diff

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23
Q

lap colectomy take more or less time than an open procedure?

A

lap colectomy take MORE time and are MORE expensive to perform but have decreased post-op pain requirements, faster return of bowel function and shorter hospital stays when compared to open colectomy

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24
What are 4 complications of colectomy?
Anastomotic leak Intra-abdominal abscess Bleeding Bowel obstruction
25
What is happening in a colostomy?
piece of the colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon.
26
What are the indications for a colostomy?
Gangrenous/perforated bowel Colorectal cancer Inflammatory bowel disease Trauma-> GSW/penetrating wounds Fecal diversion -> think quad/para pts who have decubitus ulcers
27
What is the post-op care for colostomy? When do you need to f/u?
admit anywhere between 4-12 days NPO for first 24 hours, the clear liquids then regular diet abx if needed pain management ambulation!! F/U in office 10 days PO (5-7 days after discharge)
28
What are the risk factors for developing hernias?
straining fascial weakness or defect obesity MC in males
29
What imaging should you use to confirm hernias?
Confirm with CT
30
**What is an indirect hernia? Where does it pass in relation to the inferior epigastric vessels?
Indirect - passes thru inguinal canal and into scrotum passes LATERALLY to the inferior epigastric vessels
31
**What is a direct hernia? Where does it pass in relation to the inferior epigastric vessels?
Direct - originates in Hesselbach’s triangle - bulge above inguinal ligament passes MEDIAL to the inferior epigastric vessels
32
**What is a femoral hernia?
Femoral - bulge below inguinal ligament in area of the femoral canal
33
What type of hernia is each? A B C
A: indirect inguinal hernia B: direct inguinal hernia C: femoral hernia
34
What is the tx for ALL inguinal and femoral hernias? ______ can be considered for MEN without symptoms.
Surgery Watchful waiting
35
What is the treatment in WOMEN who have an inguinal or femoral hernia? Why? Which type is MC in elderly women?
All women should have surgery higher risk for complications and strangulation/incarceration femoral hernias = elderly women
36
Consider looking at this slide again
maybe do it??
37
What is the MC complication of a herniorrhaphy? How long does the pain usually last?
Hematoma/Seroma - most common Pain lasts > 3 months postop
38
What are the 3 indications for a lumpectomy?
Lump -> Fibroadenoma Ductal Carcinoma in situ Invasive breast cancer
39
What are the indications for mastectomy?
Prior radiation to breast/chest wall Radiation therapy is contraindicated 2/2 pregnancy Inflammatory breast cancer Diffuse suspicious or malignant appearing microcalcifications Widespread disease in multiple quadrants Positive pathologic margin after repeat excision
40
What tumor markers are associated with the breast?
CA 15-3, CEA, CA 27/29
41
What is the post-op care after a breast surgery? When do you want to f/u?
admitted for 1-2 days pain control wound/drain care F/U within week for drain removal
42
**______ is a complication of breast surgery that may occur as a result of exposing the ________ during the axillary lymphadenectomy
winged scapula long thoracic nerve
43
_______ is an indication for lung surgery that is most commonly due to the underlying pneumonia
empyema
44
______ is an air space within the lung measuring >1cm in diameter and is an indication for lung surgery
bullous lung
45
What tumor markers are associated with lung surgery?
CEA, SCC, NSE
46
What does VATS stand for? How is the patient positioned for lung surgery?
VATS - Video-assisted thoracoscopic surgery lying on their side
47
What is the post-op care after lung sx?
Admitted to ICU -Close cardiopulmonary monitoring -Likely to remain intubated post operatively, wean as able Chest tube management Pain control Wound Car
48
What is the not obvious complication of lung sx?
atrial fibrillation
49
What are the indications for CABG?
congenital defect repair 3 vessel blockage or left main stem artery stenosis heart valve dysfunction infection: constrictive pericarditis pericardial tamponade/ventricular rupture
50
What is the detailed description for CABG with regards to the % of stenosis and location?
>70% stenosis of the LAD or proximal left circumflex
51
Which vein is used the most in CABG?
saphenous vein
52
What is the post-op care after CABG?
ICU: intubated with close cardiopulm monitoring chest tube management pain control and wound care
53
What are the indications for peripheral venous lines?
Short-term access for medication administration, hydration, or blood product transfusions. Suitable for patients who require frequent blood draws or intermittent intravenous therapy.
54
What are the CI for peripheral venous lines?
Severe peripheral vascular disease or damage Presence of thrombosis in the vein intended for cannulation. Cellulitis or infection at the intended insertion site. Inadequate peripheral venous access due to collapsed or sclerosed veins.
55
What are the complications of peripheral venous lines?
Phlebitis (inflammation of the vein). Infiltration/extravasation (leakage of fluid into surrounding tissues). Thrombophlebitis (blood clot formation within the vein). Infection at the insertion site.
56
What are the indications for central venous lines?
Long-term venous access for chemotherapy, prolonged antibiotic therapy, parenteral nutrition, hemodynamic monitoring, etc. Administration of irritant medications that may cause peripheral vein damage.
57
What are the CI for central venous lines?
Coagulopathy or bleeding disorders. Infection at the insertion site. Presence of severe hypotension or shock. Severe thrombocytopenia.
58
**Where are the 3 possible sites for central venous line placement?
internal jugular femoral subclavian
59
**Which one is the most direct path to the right atrium ?
The right internal jugular and subclavian valves are the most direct paths to the right atrium via the superior vena cava.
60
**The _____ are compressible sites and, as such, may be more appropriate for patients who are at _______
femoral veins better choice for patients with a high risk of bleeding
61
What are the central venous line complication?
infection thrombosis pneumothorax hemorrhage catheter malposition air embolism -> can lead to stroke or MI nerve injury skin irritation and breakdown
62
Is a central line placement a sterile procedure? What is used in the flushing solution? What should you do next after placing a central line?
YES!! need to maintain a sterile field during procedure these are sutured into place and usually done the RIGHT side, usually US guided Heparin NaCl chest xray to confirm the correct placement of the central line
63
What are the indications for cut-down venous access?
emergencies!!! Inability to access veins using traditional methods: Pediatric patients -> very commonly used in peds
64
What is the MC vein used in cut-down venous access?
Most common vein used = Saphenous Vein
65
What are the indications for intraosseous lines?
Emergency situations where vascular access cannot be achieved by traditional methods. Patients in cardiac arrest or shock. Pediatric patients with difficult peripheral venous access. aka you need to give meds RIGHT NOW
66
**Where is the MC site for intraosseous line to be placed? 2nd?
Proximal tibia (most commonly used in adults and children) 2nd: distal femur
67
What is the vNOTES procedure?
Vaginal Natural Orifice Transluminal Endoscopic Surgery Instruments are placed through the vagina into the pelvic cavity, giving access to the uterus, fallopian tubes and ovaries without the need for abdominal skin incisions.
68

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