Exam 3 (Gen & Gyn surgery)

Question 1

What does the body release during the first few minutes of a abdominal insufflation of CO2?

Answer 1

Catecholamines & vasopressin

Question 2

What is the desired IAP in a laparotomy?

Answer 2

< 20 mmHg

Question 3

What are the pulmonary effects of a laparoscopy?

Answer 3

• Increased PaCO2 d/t decreased compliance & FRC,
• increased PIP
• atelectasis development
• SubQ emphysema from improper trocar placement
• Pneumothorax if diaphragm is punctured
• Pneumomediastinum
• Gas embolism
• Endobronchial intubation

Question 4

How do you treat the pulmonary side effects of a laparoscopy?

Answer 4

Increase Vm (Vt hard d/t PIP; increase RR)

Question 5

• What is the best early S/S of a gas embolism during a laparoscopy?

Answer 5

Decreased EtCO2

Question 6

How is a gas embolism treated?

Answer 6

• Cease gas insufflation
• Trendelenburg
• 100% O2
• Aspirate air thru CVL if present
• Vasopressor support
• Fluid bolus

Question 7

At what IAP pressures are hemodynamics affected?

Answer 7

> 10 mmHg

Question 8

What are the CV effects of IAP?

Answer 8

• Decreased CO
• Increased arterial
• Increased & SVR/PVR

Question 9

What meds can be used to treat the CV side effects of IAP?

Answer 9

Use short acting meds as effects are temporary (esmolol, propofol, remifentanil, VA, cardene)

Question 10

What nerve can be affected from stirrups?

Answer 10

Peroneal nerve

Question 11

What is the largest overall complication of laparoscopies?

Answer 11

Intestinal injuries

Question 12

When are laparoscopies contraindicated?

Answer 12

Pts with increased ICP, tumors, trauma, hydrocephalus

Question 13

What position will the Pt be in for Gallbladder removal?

Answer 13

Reverse Trendelenburg & left

Question 14

What are the SCIP Abx of choice for most cases?

Answer 14

Cefazolin & Cefoxitin (1-2gm IVPB)

Question 15

A Pt undergoing a Nissen procedure should do what in the morning of Sx?

Answer 15

Take his/her PPI meds

Question 16

Which esophageal dilator is safer to use?

Answer 16

Maloney dilator

Question 17

What position will the Pt be in for a Nissen procedure?

Answer 17

Supine, low lithotomy, reverse trendelenburg

Question 18

What are the 5 F’s stand for?

Answer 18

• Female
• Forty
• Fair skin
• Flatulent
• Fat

Question 19

What is given preop for a cholecystectomy Pt?

Answer 19

• Bicitra
• Prokynetic

Question 20

What procedure has a chance for Sphincter of Oddi spasms?
How is it treated?

Answer 20

• Cholecystectomy
• Treated with glucagon

Question 21

What are the indications for a spleenectomy?

Answer 21

• ITP: Immune thrombocytopenic purpura
• hemolytic anemia
• trauma
• Lymphoma

Question 22

What should Pts having a spleenectomy have done preoperatively?

Answer 22

• Receive pneumococcal, meningococcal & H influenza vaccinations
• 1wk preop

Question 23

What kind of access should be established for a spleenectomy?

Answer 23

Large bore IV’s (14ga or 16ga)

Question 24

What is the Pt position for a spleenectomy?

Answer 24

• 45 degree right lateral decubitus
• Kidney rest & table flexed

Question 25

What medications are often given prior to a bowel resection & why?

Answer 25

- Mu-opioid antagonists - To help resolve ileus faster

Question 26

What positions could a Pt going for a bowel resection be in

Answer 26

Supine or lithotomy

Question 27

What could be damaged during a appendectomy?

Answer 27

Nearby lymphnodes

Question 28

What position will a Pt be in for a appendectomy?

Answer 28

- Supine - Left arm tucked - Trendelenburg

Question 29

What are the downsides of Lap Banding, Sleeve gastrectomy & gastric bypass?

Answer 29

- Lap Band: Band erosion - Gastric Sleeve: suture line & overeating - Gastric bypass: suture line & malabsorption

Question 30

What are important intraoperative measures for a Pt undergoing a bariatric surgery?

Answer 30

- Good preoxygenation - RSI intubation with ETT - Remove OGT before stomach sutures/staples

Question 31

Which bariatric surgery has higher dysphagia concerns?

Answer 31

Lap Banding

Question 32

What vitamins are affected due to malabsorption?

Answer 32

- A, D, E, K - B12 - Calcium

Question 33

What is important during an open bowel resection in which the bowel is exumed?

Answer 33

Keep Pt hydrated as bowel dries out quickly

Question 34

What are indications for conversion to laparotomy?

Answer 34

- Obesity: instruments not long enough - adhesions - bleeding - unclear anatomy - staple misfire - inability to ventilate d/t CO2 compression

Question 35

What are intraop considerations for Ex-laps?

Answer 35

- GETA - Profound muscle relaxation - NGT - Consider epidural unless emergent - Consider multi-modal pain control - Keep Warm!!!!

Question 36

What are PONV risk factors?

Answer 36

- Female - Laparoscopy or Laparotomy - Opioids - Volatile anesthetics

Question 37

Pulling on what vaginal structure can lead to bradycardia? How is it treated?

Answer 37

Cervix - Treat or preemtively with Robinol

Question 38

Which GYN surgery does not necessarily call for SCIP Abx?

Answer 38

D&C

Question 39

How can uterine bleeding be stopped? What is the side effect?

Answer 39

- With Pitocin (20 units in 500-1000cc given rapidly) - Post op pain due to uterine cramping

Question 40

Where is pitocin secreted from?

Answer 40

Posterior pituitary gland(neuro-hypophysis)

Question 41

Sorbitol is not good for which type of Pt undergoing a hysteroscopy? What about glycine? What about hypotonic solutions?

Answer 41

- Diabetics - Liver Pt's (d/t ammonia build-up) - Anemics (d/t hypotonic solutions can cause RBC rupture)

Question 42

How much post-op pain do hysteroscopy Pts typically have?

Answer 42

None to minimal

Question 43

What must you have for a Condyloma surgery?

Answer 43

Laser evacuation procedures - Laser mask - Smoke evacuation from cautery

Question 44

Which GYN surgeries do not necessarily require ETT and can be done using LMA's?

Answer 44

- Condyloma - Urethral slings - Repair procedures (Ex: Bladder prolapse)

Question 45

What is the difference between a Partial, total & BSO?

Answer 45

- Partial: Only uterus is removed - Total: uterus & cervix are removed - BSO: Total + fallopian tubes & ovaries are removed

Question 46

What are the surgical options for hysterectomies?

Answer 46

- Vaginal - Abdominal (Pfannenstiel or vertical) - LAVH (Laparoscopic assisted vaginal hysterectomy)