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Residency -- Surgery Pimp Questions > General > Flashcards

General Flashcards

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1
Q

Normal color of the gall bladder

A

Robin Egg Blue

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2
Q

Function of the gallbladder

A

Store and concentrate bile

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3
Q

What is emulsification

A

Combination of two immiscible liquids.

Bile increases the surface area of fat by clumping them together to allow enzyme action, digestion, and absorption.

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4
Q

Arterial supply of the gallbladder, where does that come from

A

Cystic artery from right hepatic

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5
Q

Innervation of the gallbladder

A

Sensory —coeliac plexus (Greater/Lesser Splanchnic)

Sympathetic — coeliac plexus (Greater/Lesser Splanchnic)

Parasympathetic — Vagus

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6
Q

Lymph node of the gallbladder

A

Lund/Mascagni’s node — In triangle of calot inferior to cystic artery.

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7
Q

What are you looking for during gallbladder surgery?

A

Cystic Artery, Cystic Duct, Common Bile Duct

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8
Q

What is calot’s triangle

A

common hepatic duct medially, the cystic duct laterally, and the inferior edge of the liver superiorly.

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9
Q

What are ducts of lushka

A

Carry bile from liver to gallbladder

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10
Q

Function of the appendex

A

Production of immunoglobins
Used in reconstruction surgery
Store ‘good’ bacteria

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11
Q

Arterial supply of appendix -

A

Appendicular artery from Ileocolic from SMA

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12
Q

What does sma stand for

A

Superior Mesenteric Artery

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13
Q

Falciform ligament (function)

A

Attaches the liver to the anterior wall and divides the liver in left/right lobes.

Contains the round ligament which is the embryologic remanent of the umbilical vein

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14
Q

Stomach arterial supply

A

Greater Curvature — Right Gastroepiploic (inf), Left Gastroepiploic (sup), Short Gastric (upper)
Lesser Curvature — Right Gastric (inf), Left Gastric (sup)
Fundus — Short Gastric

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15
Q

Origins of the stomach arteries.

A

Left Gastric&raquo_space; Celiac Trunk&raquo_space; Aorta

Right Gastric&raquo_space; Hepatic Proper&raquo_space; Cmn Hepatic&raquo_space; Celiac Trunk&raquo_space; Aorta

Right Gastroepiploic&raquo_space; Gastrodoudenal&raquo_space; Cmn Hepatic&raquo_space; Celiac Trunk&raquo_space; Aorta

Left Gastroepiploic&raquo_space; Splenic&raquo_space; Celiac Trunk&raquo_space; Aorta

Short Gastric&raquo_space; Splenic&raquo_space; Celiac Trunk&raquo_space; Aorta

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16
Q

Where does the short gastric branch from

A

Splenic Artery

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17
Q

Name some pathologies of the bile duct

A

Stricture, Cholangitis, Bile duct leaks

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18
Q

What do we order after doing a port?

A

CXR

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19
Q

Why do we order CXR following a port insert

A

Risk for pneumothorax

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20
Q

What is a pneumothroax?

A

air leaks into the space between your lung and chest wall.

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21
Q

Why are we worried about pneumothorax

A

Cause death second to cardiovascular compromise

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22
Q

How does pneumothorax cause cardiovascular compromise

A

Compresses the SVC or IVC

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23
Q

How do we treat a pneumothroax?

A

Needle decompression

O2 therapy

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24
Q

What are the needles we use to treat a pneumo

A

3.25 inch 14 gauge

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25
What’s the function of a NG tube?
Drain bile Aspiration of stomach Nutrition
26
How much bile produced a day?
2 liters
27
How much urine does adult produce?
0.5-1.0 cc/kg/hr (800-1500 mL/day)
28
How much urine does peds produce?
Neonate (<1yo): 2 cc/kg/hr Toddler (1-3yo): 1.5 cc/kg/hr Child/Teen: 1.0 cc/kg/hr
29
How long does it take a wound to heal?
Hemostasis, Inflammation, Proliferation, Maturation 6-8 weeks
30
What percentage of sleeve patients has gallstones
40%
31
What infections are there in the gallbladder when u have cholangitis
Escherichia coli, Klebsiella, Enterococcus, Enterobacter, Pseudomonas, and anaerobes
32
What is cholangitis
Inflammation/infection of the bile duct system
33
What antibiotics do we use to treat cholangitis
piperacillin-tazobactam (Zosyn), ticarcillin-clavulanate (Timentin), ceftriaxone + metronidazole or ampicillin-sulbactam (Unasyn)
34
What size are we worried about adrenal masses
6cm
35
What are the layers of the abd - think in terms of above arcuate line
External oblique aponeurosis >> Anterior lamina of the internal oblique aponeurosis >> Rectus abdominis muscle >> Posterior lamina of the internal oblique aponeurosis >> Transversus abdominis aponeurosis.
36
What is GIST
gastrointesntial stromal tissue
37
What does ERCP stand for
Endoscopic retrograde cholangiopancreatography
38
What does MRCP stand for
Magnetic resonance cholangiopancreatography
39
Who do we call if we want ERCP or MCRP done?
GI
40
How do we treat pancreatitis
IV fluids and NPO (bowel rest)
41
What are we worried about for sleeve complication wise
Perf and acid reflux
42
What infections you worried about after surgery
``` Wind — Lungs (PNA, Aspiration, etc…) Water — UTI Walking — DVT Wound — Incision Wonder Drugs — Meds/Blood Products Wabscess Waterway — Line infection ```
43
Know dosage of heparin for active pe patient
80 units/kg followed by 18 units/kg/hr | 5000 unit bolus followed by 1300 units/hr
44
What is D-dimer
protein fragment from breakdown of blood clot
45
What antibiotics gives redman syndrome
Vancomycin
46
Why do you get liver enzyme elevation after sleeve or gallbaldder surgery
Manual manipulation/palpation
47
Where does white bile come from
colorless fluid found due to blockage of the bile duct
48
Know compositions of cholesterol stones
20%-80% cholesterol
49
Pigmented gallstone composition
Excess bilirubin
50
Risk factors for gallbladder stones
Pancreatitis, Cholangitis
51
What vein are you going for in port insertions
Subclavian, sometimes jugular, femoral
52
Where do you insert the port
MCL 2nd ICS
53
Where do you insert needle decompressioin to treat pneumos
MCL 2nd ICS
54
What’s the function of a hida scan
Radioactive dye is injected in the blood stream and followed by x-ray. Detects issues in the GB and biliary tree. Normal Ejection fraction 35%-65%.
55
Where does ureter pass under
Internal iliac | Uterine arteries
56
What is it called when stomach isn’t working?
Gastroparesis
57
What are the 3 most likely starting points for carcinoid tumor?
Tip of the appendix Rectum Small intestine
58
Symptoms of carcinoid tumor
Flushing, Diarrhea, Wheezing
59
Dx/Treatment for pheo
24 hour metanephrines and you can do 24 hour unfractioned catheolamines Control HTN/Surgery
60
What is caput medusa
distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen
61
What causes caput medusa
portal vein hypertension
62
What is cirrhosis
chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue
63
What is pneumatosis
Gas in the bowel wall (gas cysts) from mucosal disruption second to trauma, infection, immunosuppression, ulceration, and erosions.
64
Where does that air come from in a pneumatosis
Three Theories: Mechanical Bacterial gas Retroperitoneal Pulmonary
65
What age for colonscopy
50
66
For colon cancer, what length do you have to leave from the proximal start of the cancer?
5 inches
67
What does kvo stand for?
Keep Vein Open
68
What structures are retroperitoneal?
``` S = Suprarenal (adrenal) glands A = Aorta/Inferior Vena Cava D = Duodenum (second and third segments)
 P = Pancreas U = Ureters C = Colon (ascending and descending only) K = Kidneys E = Esophagus R = Rectum ```
69
Lesser and great omentum - attachments
Greater — Greater curvature of the stomach, Anterior transverse colon, Posterior abdominal wall Lesser —Diaphragm, Lesser curvature of stomach, Liver
70
What’s the purpose of the omentum?
Fat deposition, having varying amounts of adipose tissue. Immune contribution, having milky spots of macrophage collections. Infection and wound isolation; It may also physically limit the spread of intraperitoneal infections.
71
How many times stronger is dilaudid than morphine?
5-10
72
Post drainage fluid from gallbladder is white, why?
White bile like substance is excreted from the biliary tree. If the fluid drained is white, there is an obstruction above the biliary tree.

Residency -- Surgery Pimp Questions (1 decks)

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