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Surgery > Common Abdominal and Chest Surgeries > Flashcards

Common Abdominal and Chest Surgeries Flashcards

1
Q

What is the main difference between open surgery (laparotomy) and laparoscopy?

A

Size of incision
Laparotomy: single incision multiple inches long
Laparoscopy: minimally invasive with several incisions one-quarter or less

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2
Q

What is the difference between laparoscopy and laparotomy as far as recovery?

A

Laparotomy: longer recovery, hospital admission
Laparoscopy: less blood loss, less trauma, faster recovery, many can go home that day or after 23 hr OBS, can be more $

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3
Q

how is a patient selected for laparotomy vs laparoscopy?

A

Overall health
BMI
Prior surgeries

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4
Q

What is used for scoring of appendicitis and what score has a high index of suspicion?

A

Alvarado score
7-10

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5
Q

Common cause of appendicitis

A

Fecalith/appendiceal obstruction
Can be cancer

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6
Q

Work up of appendicitis

A

Labs: leukocytosis + left shift
U/S: initial imaging modality in children when body habitus permits
+/- abdominopelvic CT scan with oral contrast if concerned for perforation

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7
Q

Indications for appendectomy

A

Standard of care for acute appendicitis
Som may elect for conservative non op management if uncomplicated non perforated appendicitis, but 30% have recurrent appendicitis within 1 year

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8
Q

What abx would be given if a patient opts for non op management of appendicitis

A

IV abx for 1-3 days followed by oral
Ceftriaxone + metronidazole IV
followed by fluoroquinolone + metronidazole, 3rd gen cephalosporin + metronidazole or augmentin oral

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9
Q

What is the psoas sign?

A

Extend hip and see if pain

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10
Q

A patient should do what prior to appendectomy?

A

Void bladder to prevent bladder injury

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11
Q

Procedure of laparoscopic appendectomy

A

Pneumoperitoneum via Veress needle or open Hassan
Laparoscope inserted into abdomen and 2 additional ports placed: one in LLQ, one in suprapubic region
Patient positioned in trendelenburg with left side of table down to pull small bowel away from cecum
Abdomen inspected and cecum ID
Cecum grasped and appendix IDd
Mesoappendix grasped and divided with endoscopic stapler
Endoscopic stapler used to remove appendix from cecum
Abdomen irrigated and inspected for bleeding
If hemostasis satisfactors, ports removed under direct visualization, fascia and skin closed, dressings applied

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12
Q

Laparotomy appendectomy procedure

A

Dissection through Camper and Scarpa fascia
External abdominal aponeurosis exposed and incised
External oblique split
Internal oblique muscle and transversus abdominis split to expose transversalis fascia and peritoneum
Transversalis fascia and peritoneum grasped with 2 straight clamps
Incision with Metzenbaum scissors and peritoneal cavity entered
Appendix mesoappendix complex freed and mesoappendix ligated

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13
Q

Post appendectomy care

A

Can d/c home same day with nonperforated/uncomplicated lap appy
Admit for perforation or open technique
Abx

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14
Q

What abx are used for non-perforated/uncomplicated lap appy? What about perf-postop?

A

Lap-appy: single preop dose
perf-postop: ceftriaxone and metronidazole x5-7 days

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15
Q

Indications for cholecystectomy

A

Symptomatic cholelithiasis, may also require intraoperative cholangiogram
Asymptomatic cholelithiasis if increased risk of GB carcinoma or gallstone complications
Acalculous cholecystitis
Gallbladder polyps >.5 cm
Porcelain gallbladder

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16
Q

Contraindications for cholecystectomy

A

Diffuse peritonitis
Hemodynamic compromise
Uncontrolled bleeding disorders

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17
Q

Most common indication for open chole vs lap chole

A

Inability to safely perform a lap chole or highly suspect cancer
have hemodynamic conpromise and will not tolerate introp pneumoperitoneum

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18
Q

work up of cholecystectomy

A

RUQ US
+/- abdominal CT scan
Labs
+/- MRCP
+/- ERCP

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19
Q

Complications of cholecystectomy

A

Common bile duct injury/CBD leaks/obstruction
Bowel injury
Liver injury
Intra-abdominal abscess
Bleeding
dyspepsia and diarrhea

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20
Q

When should you suspect common bile duct injury/CBD leaks/obstruction

A

fever
abdominal pain
2-10 days postop

may lead to peritonitis/infection

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21
Q

how would you confirm common bile duct injury/CBD leaks/obstruction

A

U/S or CT

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22
Q

how is common bile duct injury/leak/obstruction treated?

A

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

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23
Q

post-op care if uncomplicated lap chole

A

d/c home same day
give po pain meds no abx needed
f/u in office in 5-7 days

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24
Q

post-op care if open or complicated lap chole

A

admit for 1-3 days
pain meds
typically no abx needed unless surgery contraindicated
monitor for complications

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25
Q

common colon surgeries

A

right colectomy: cecum, ascending colon, hepatic flexure, first portion transverse colon
left colectomy: second portion transverse colon, splenic flexure, descending colon, sigmoid colon
total colectomy
sigmoid colectomy
proctocolectomy: includes the anus
colostomy

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26
Q

indications for colon surgery

A

tumors/masses
ulcerative colitis
diverticulitis/perforation
ischemic colitis: vasculopath, intestinal volvulus/obstruction

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27
Q

work-up for colon surgery

A

PE- palpable mass?
Labs: tumor markers (CEA/CA 19-9)
Colonoscopy
CT abdomen and pelvis w/IV and oral contrast

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28
Q

What are reasons for benign disease colectomy?

A

IBD
Diverticular disease
Rectal prolapse
Colonic dysmotility

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29
Q

What are neoplasia reasons for colectomy?

A

Polyps not amenable to resection via colonoscopy
Colorectal cancers
Hereditary colon cancer syndromes: familial adenomatous polyposis and hereditary nonpolyposis colorectal cancer

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30
Q

Compared with open colectomy, laparoscopic surgery has been shown to be associated with decreased ….

A

post op pain and analgesia requirement, faster return of bowel function, earlier resumption of PO intake, shorter hospital stay, and better cosmesis

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31
Q

What are the drawbacks of laparoscopic colectomy?

A

Time consuming –> greater expense and require specialized training

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32
Q

Complications of colectomy

A

Anastomotic leak
Intra-abdominal abscess
Bleeding
Bowel obstruction

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33
Q

What is a colostomy?

A

Piece of colon is diverted to an artificial opening in the abdominal wall so as to bypass a damaged part of the colon

34
Q

Inidications for colostomy

A

Gangrenous/perforated bowel
Colorectal cancer
INflammatory bowel disease
Trauma: GSW/penetrating wounds
Fecal diversion: common in quad/para pts who have decubitus ulcers, prevent fecal contamination/infection

35
Q

Post-op care for colostomy

A

Admit for anywhere from 6-12 days for open procedure; 4-6 days for laparoscopic procedure
typically NPO first 24 hours, then clear liquids –> full liquids next 24, then regular diet if tolerated
Postop abx if indicated
Pain management
Ambulation - up ith assistance POD 2, walking with assistance POD 3
Incentive spirometer use
F/U in office 10 days PO (5-7 days after discharge)

36
Q

Risk factors for developing hernias

A

Straining
Fascial weakness or defect from previous incision or injury
Obesity, more common in males

37
Q

Diagnosis of hernia

A

Pain with movement
Bulge or mass that worsens with straining
Palpable mass/defect on PE
Confirm with CT

38
Q

What is an indirect hernia

A

Passes through inguinal canal and into scrotum

39
Q

What is a direct hernia

A

Originates above Hesselbach’s triangle - bulge above inguinal ligament

40
Q

what is a femoral hernia

A

bulge below inguinal ligament in area of the femoral canal

41
Q

Nerve supply to hernia

A

ilioinguinal
genito-femoral
genital
femoral
lateral cutaneous branch of femoral

42
Q

Surgery is indicated for all ….. hernias

A

inguinal and femoral
If strangulated/incarcerated- urgent/emergent surgery

43
Q

Watchful waiting can be considered with hernia for ….

A

men without symptoms; all women should have surgery due to higher risk for complications and strangulation/incarceration
Femoral hernias are more common in elderly women

44
Q

Post-op complications of herniorrhaphy

A

Hematoma/seroma MC
Chronic pain: post-hernia repair neuralgia (m/c with open) with pain lasting >3 months postop
Infection
Hernia recurrence
Mesh erosion/infection

45
Q

Most common chest surgeries

A

Lumpectomy
Mastectomy
Video-assisted thoracoscopic surgery: diagnostic or therapeutic
Open thoracotomy: lobectomy or CABG

46
Q

Indications for lumpectomy

A

Lump: fibroadenoma
Ductal carcinoma in situ
Invasive breast cancer

47
Q

Indications for mastectomy

A

Prior radiation to breast/chest wall
Radiation therapy contraindicated 2/2 pregnancy
Inflammatory breast cancer
Diffuse suspicious or malignant appearing microcalcifications
Widespread disease in multiple quadrants
Positive pathologic margin after repeat excision

48
Q

Work up for breast surgeries

A

Palpable mass on PE
Mammogram
U/S
Biopsy
Tumor markers: CA 15-3, CEA, CA 27/29

49
Q

Postop care for breast surgery

A

Admitted and monitored for a day or two
Pain control
Wound/drain care
F/U within week for drain removal

50
Q

Complications of breast surgery

A

Infection
DVT
Hematoma/Seroma
Delayed healing
Abnormal scar formation
Winged scapula - complication due to exposing long thoracic nerve during axillary lymphadenectomy

51
Q

Complications with flap/implant

A

Flap ischemia
Fat necrosis
Capsular contracture
Implant failure

52
Q

Indications for lung surgery

A

Empyema (MC due to underlying pneumonia)
Lung cancer small cell vs non small cell
Bullous lung: air space within the lung measuring >1 cm in diameter
Lung reduction surgery: COPD/emphysemia pts

53
Q

Work up for lung surgery

A

CXR/CT
Labs: inflammatory markers
Tumor markers: CEA, SCC, NSE
Blood gas
SPO2 levels

54
Q

Post op care for lung surgery

A

Admitted to ICU with close cardiopulmonary monitoring, likely to remain intubated post operatively wean as able
Chest tube management
Pain control
Wound care

55
Q

Complications of lung surgery

A

Pneumothorax: chest tubes left in place post op
Infection
Bleeding
Afib
Dyspnea

56
Q

Indications for thoracotomy for open heart surgery- CABG

A

congenital defect repair
3 vessel blockage or left main stem artery stenosis
Heart valve dysfunction
Infection: constrictive pericarditis
Pericardial tamponade/ventricular rupture

57
Q

WOrk up for CABG

A

Echo
Stress test: chemical vs bruce protocol
EKG
LAbs

58
Q

Post-op care for CABG

A

admitted to ICU and intubated with close cardiopulmonary monitoring
chest tube management
pain control
wound care

59
Q

post-op complications for cabg

A

death
bleeding
infection
afib
bradycardia
dvt
pleural effusion/pna

60
Q

indications for peripheral venous lines

A

short term access for medication administration, hydration, or blood product transfusions
suitable for patients who require frequent blood draws or intermittent intravenous therapy

61
Q

contraindications for peripheral venous lines

A

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

62
Q

procedure for peripheral venous lines

A

clean site, insert catheter into peripheral vein using aseptic technique and secure it in place. confirm placement and initiate therapy
remove dressing, gently withdraw catheter, apply pressure to site, and assess for complciations

63
Q

Potential complications of peripheral venous lines

A

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

64
Q

Indications for central venous lines

A

Long-term access for chemotherapy, prolonged antibiotic therapy, parenteral nutrition, hemodynamic monitoring
Administration of irritant medications that may cause peripheral vein damage

65
Q

Contraindications for central venous lines

A

Coagulopathy or bleeding disorders
Infection at the insertion site
Presence of severe hypotension or shock
Severe thrombocytopenia

66
Q

3 possible site for CVL placement in adult patients

A

Internal jugular
Femoral
Subclavian

67
Q

What placement of central venous line is the most direct path to the right atrium?

A

right internal jugular and subclavian valves

68
Q

what central venous line site may be better for patients who are at high risk for bleeding?

A

Femoral

69
Q

Complications of central venous lines

A

Infection
Thrombosis –> embolism –> tissue damage or blockage
Pneumothorax (d/t incorrect insertion or movement) –> respiratory distress and emergency
Hemorrhage, especially in coag disorder or anticoagulant therapy
Catheter malposition –> ineffective delivery of medication or fluids and trauma to surrounding structures
Air embolism –> stroke or MI
Nerve injury –> pain, numbness, or weakness
Skin irritation and breakdown at insertion site

70
Q

Equipment needed for central lines

A

Sterile gloves
Sterile gowns and drapes
Central line kit
Ultrasound machine
Flushing solutions: heparin or NaCl

71
Q

Indications for cut down venous access

A

Emergency situations when rapid venous access necessary
Inability to access veins using traditional methods
Pediatric patients with small veins

72
Q

Contraindications to cut down venous access

A

Presence of infection at site of incision
Thrombosis or vascular compromise in area of planned incision
Patient refusal or inability to tolerate the procedure under local anesthesia or sedation

73
Q

What is the most common vein used for cut-down venous access?

A

Saphenous vein

74
Q

Definition of intraosseous line

A

needle directly into bone marrow cavity to access systemic circulation

75
Q

indications for intraosseous line

A

emergency situations where vascular access cannot be achieved by traditional methods
patients in cardiac arrest or shock
pediatric patients with difficult peripheral venous access

76
Q

complications of intraosseous lines

A

infection at the insertion site
extravasation of fluids or medications
dislodgement of needle
bone fractures in fragile bones

77
Q

common sites for IO line

A

proximal tibia (in adults and children)
distal femur (less commonly used)

78
Q

what is vNOTES

A

new procedure where laparoscopic and vaginal approaches are combined

79
Q

indications for vNOTES

A

ovarian cysts
fibroids
tubal sterilization
abnormal uterine bleeding
adenomyosis
hysterectomy
salpingectomy
oophorectomy
removal of ovarian cysts

80
Q

benefits of vNOTES

A

shorter hospital stay
less postoperative pain
less pain medication
no visible scarring

Surgery (7 decks)

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