General Principles

Question 1

what is a clean operation and what are some examples

Answer 1

the operation does not enter a colonised viscus or lumen of the body e.g. external hernial repair

Question 2

what is the infection rate of clean operations

Answer 2

2-5%

Question 3

what is the most common pathogen causing infection in clean operations

Answer 3

staph aureus

Question 4

what is a potentially contaminated operation and what are some examples

Answer 4

procedure enters a colonised viscus or cavity but under elective and controlled circumstances

e.g. abdominal hysterectomy, appendectomy with no active infection

Question 5

what is a contaminated operation and what is an example

Answer 5

contamination of the surgical site is present, without obvious infection

e.g. spillage of intestinal material, gunshot wounds tend to be contaminated

Question 6

what is the infection risk for a potentially contaminated procedure

Answer 6

10%

Question 7

what is the infection risk for a contaminated procedure

Answer 7

20%

Question 8

what is a dirty procedure and what is an example

Answer 8

surgery where there is an active infection process occuring

e.g. intraabdominal exploration for intestinal perforation

Question 9

what is the infection risk for a dirty procedure

Answer 9

30%

Question 10

how far does a flexible sigmoidoscopy visualise up to

Answer 10

splenic flexure of the large bowel

Question 11

indications for rigid proctoscopy/sigmoidoscopy

Answer 11

Suspicion of colonic neoplasia.
Investigation of inflammatory bowel disease.
Biopsies under direct vision.
Treatment of haemorrhoids.
Prior to any a no-rectal operation.

Question 12

indications for a chest drain

Answer 12

pleural effusion
pneumothorax
post-operative

Question 13

what operations tend to have a chest drain inserted afterwards

Answer 13

thoracotomy
oesophagectomy
cardiac surgery

Question 14

where is the ‘safe triangle’ for chest tube insertion

Answer 14

between lateral borders of pec major and lat dorsi, inferior to axillary border and superior to 5th intercostal space

Question 15

what does a working chest tube look like

Answer 15

swings with inspiration (fluid level changes)

will bubble in pneumothorax

Question 16

what are features of an ileostomy

Answer 16

spouted
usually right hand side
bilious contents

Question 17

what does an ileostomy with one lumen indicate

Answer 17

end ileostomy

Question 18

what does an ileostomy with 2 lumens indicate

Answer 18

loop ileostomy - temporary

Question 19

what are the indications for a loop ileostomy

Answer 19

bowel rest
functional relief from severe incontinence
temporarily protect distal anastomoses

Question 20

what are features of a colostomy

Answer 20

flush to skin
left hand side
contents more faeculent

Question 21

how do you distinguish between an ileostomy and a urostomy

Answer 21

only way is to check contents

Question 22

what are the indications of a gastrostomy

Answer 22

stomach drainage

direct feeding

Question 23

how does a gastrostomy appear

Answer 23

narrow in calibre
flush to skin
usually in upper left quadrant
fitted with indwelling devices

Question 24

what are the early and late complications of a stoma

Answer 24

early:
necrosis
infection
high output leading to dehydration

late: 
parastomal hernia
stomal prolapse 
stoma retraction 
stenosis

Question 25

what are the early and late complications of a stoma

Answer 25

early: necrosis infection high output leading to dehydration ``` late: parastomal hernia stomal prolapse stoma retraction stenosis ```

Question 26

how should you examine a stoma

Answer 26

Ask the patient if they have any pain, or have had any issues with it. Gently palpate the abdomen for any distension or tenderness. Ask the patient to cough whilst observing for any parastomal hernia. Observe the surrounding skin quality for any signs of infection. Determine the 'type' of stoma you are dealing with, describing this to the examiner in terms of siting, spouting and contents. Observe specifically for any signs of infarction, prolapse or retraction. Listen for bowel sounds below the umbilicus. State that you would like to view the patient's fluid balance chart.