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EMED Final > General Surgery > Flashcards

General Surgery Flashcards

(60 cards)

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1
Q

Why do we care about a patient’s EtOH/illicit drug use?

A

Possibility of withdrawal in OR or post op

Anesthesia interactions

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2
Q

When should tobacco ideally be discontinued prior to surgery?

A

8 weeks

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3
Q

Do CV medications need to be d/c before surgery?

A

In general, continue taking them

Hold ACE/ARBs 24 hours prior to NON-cardiac surgery

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4
Q

Should statins be held prior to surgery?

A

NO - reduced periop mortality so continue

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5
Q

Should Antiplatelet meds be d/c prior to surgery?

A

Increased risk of bleeding, so generally d/c 7-10 days prior

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6
Q

Why do we want to ensure tight glycemic control perioperatively?

A

Reduces mortality, infection, complications

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7
Q

When does a patient need to be NPO?

A

After midnight

Depends on the facility though - clear liquids up to 2 hr prior to procedure may be ok

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8
Q

How do we rate a procedural risk?

A

Mortality <1% = Low risk

Mortality ~1-5% = Intermediate risk

Mortality >5% = High risk

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9
Q

What are the different risk assessment tools we use in pre-op?

A

ACS NSQIP surgical risk calculator

Revised Cardiac Risk Index for Pre-Op risk

MELD (patients with cirrhosis)

CAPRINI (risk for DVT)

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10
Q

Potential causes of increased risk of complications

A 
Pre-existing medical conditions
Allergies
Surgical Hx and related complications
Meds
Tobacco
EtOH
Illicit drugs
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11
Q

What is the best scoring system for functional capacity and therefore overall risk?

A

MET scores - determine’s patient’s exercise capacity

Should be applied to all surgical patients

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12
Q

A patient with 1 MET…

A 
Can they...
Take care of themself
Eat, dress, use toilet
Walk indoors around the house
Walk 1 or 2 blocks on level ground at 2-3 mph
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13
Q

A patient with <4 METs

A

Can they…

Do light work around the house, such as dusting or washing dishes

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14
Q

A patient with ≥4 METs

A 
Can they...
Climb a flight of stairs or walk up hill
Walk on level ground at 4 mph
Run a short distance
Do heavy house work 
Participate in moderate rec activities (golf, bowling etc)
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15
Q

A patient with ≥10 METs

A

Can they…

Participate in strenuous sports, such as swimming, singles tennis, football, basketball, skiing

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16
Q

A patient is considered to have poor functional capacity if their MET score is…

A

<4

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17
Q

Why is age a big risk factor for surgery?

A

Mortality increases linearly (>80yo significantly higher)

Comorbidities generally linked

Biological capacity declines with age

Nutritional status —> limited reserves

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18
Q

What is the most frequent cause of non surgical perioperative morbidity and mortality?

A

Acute MI

1/3 to 1/2 of perioperative deaths are due to cardiac events

Hx is best method of risk assessment

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19
Q

COPD increases perioperative risk by…

A

6 fold

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20
Q

Smoking increases perioperative risk by…

A

2 fold

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21
Q

Most common source of morbidity and mortality

A

Pulmonary complications

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22
Q

3rd most common complication of surgery

A

PNA - give them an incentive spirometer

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23
Q

Why should be perform PFTs perioperatively

A

Asthma optimized

SOB with unknown etiology

Lung resection surgery

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24
Q

WHo should get a CXR perioperatively?

A

New respiratory Sx

CHF

Valvular heart disease

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25
Specific criteria for determining risk for sleep apnea
STOP BANG
26
What determines the level of risk for pulmonary complications from surgery?
The closer the surgery is to the diaphragm, the higher the risk
27
Most widely validated VTE risk assessment model in surgical patients
CAPRINI Score Stratifies risk for VTE and provides validated recommendations for who should be d/c with continued prophylaxis
28
What happens to albumin levels in surgery?
Reverse acute phase reactant —> goes down with inflammation
29
Best way to assess patient’s nutrition status
Look at them not their labs
30
Thickened cystic wall, presence of pericholecystic fluid, leukocytosis, RUQ tenderness, fever, (+) Murphy’s sign
Cholelithiasis
31
Test of choice for cholelithiasis
US
32
When should you refer a patient for a cholecystectomy
After 1st episode of symptomatic cholelithiasis - don’t wait!
33
What are the complications of a cholecystectomy?
Bile leak Retained CBD stone
34
Symptoms of diverticulitis
LLQ pain Fever Rectal bleeding (Sometimes RLQ pain)
35
What makes diverticulitis complicated?
``` Abscess Phlegmon Fistula Obstruction Bleeding Perforation ```
36
Treatment for diverticulitis
NPO, abx, support Colonoscopy to confirm Dx Elective colectomy
37
Most common GI malignancy
Colon cancer
38
SSx of colon cancer
Iron deficiency anemia Rectal bleeding Change in bowel habits Bowel obstruction
39
Treatment options for colon cancer
``` Surgical Adjuvant chemo (chemo after surgery) ``` Right or left hemicolectomy LAR or APR
40
What are APR and LAR?
Abdominopelvic Resection vs Low Anterior Resection Both done to remove rectal cancer
41
_____ is used to remove cancers well above the anus
LAR (Low Anterior Resection) - provides better quality of life as it preserves the sphincter
42
____ is for cancers close to the anus
APR (Abdominopelvic Resection) Removes the sphincter and a permanent colostomy is made
43
When are prophylactic abx given prior to surgery?
Within 1 hour of incision time D/c after 24 hours post op
44
Should you remove hair prior to surgery?
According to Burt, no Use clippers immediately prior to preparation of surgical field
45
What should the patient do to prep skin at home prior to surgery?
Shower with antimicrobial soap night before surgery Chlorhexidine solutions preferred
46
When should I&Os be evaluated post op and why?
Every 4-6 hours POD 1 Every 24 hours POD 2 and beyond To monitor electrolytes and balance fluids, and prevent fluid overload
47
How do we prevent atelectasis in post op patients
Incentive spirometry and early mobilization
48
What is the order in which GI function returns and when?
Small intestine first - 24 hours Stomach - 36 hours Ascending colon - 48 hours Descending colon - 72 hours
49
What are normal caloric needs vs ‘stressed’ patients needs
Normal: 25-30 kcal/kg/day 0.8-1g protein/kg/day Stressed: 50 kcal/kg/day 2.5g protein/kg/day
50
When is pain worst?
POD 3 - varies based on type of incision and magnitude of intraoperative retraction
51
An inherited, autosomal dominant hypermetabolism involving skeletal muscle after exposure to succinylcholine —> Exothermic response, Rhabdomyolysis, cerebral edema, DIC
Malignant hyperthermia
52
What is one of the earliest signs of malignant hyperthermia?
Increased CO2
53
Antidote to malignant hyperthermia
Can’t role even
54
Procedure that connects ileum to the abdominal wall
Ileostomy
55
When is an End Ileostomy used?
Entire colon removed (like in UC or FAP) Permanent procedure
56
What is a Loop Ileostomy?
Loop of ileum brought to the skin, efferent and afferent ends Temporary
57
Procedure that connects the colon to teh abdominal wall
Colostomy Can be either temporary or permanent
58
Removal of diseased rectosigmoid colon, closure of anorexia stump and end colostomy
Hartman’s Procedure ``` Indications: UC Recto-sigmoid cancers Sigmoid volvulus Rectal injuries ```
59
Who are SBOs usually treated
Fluid resuscitation and NG tube To the OR if necessary
60
Keys to IHS SBO protocol
Insert NG tube and place on suction 2 hours after NG tube placement, give 90 ml of undiluted gastrograffin via NG tube, clamp for 1 hour then return to suction KUB Constant reassessment

EMED Final (3 decks)

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