How'll App Flashcards Preview

GI2 > How'll App > Flashcards

Flashcards in How'll App Deck (116):
1

fluid maintenance rate of elderly

why?

25 mL/Kg

older pts are unlikely to tolerate the robust fluid

2

fluid maintenance regimen for young?

4 ml/kg for the first 10 kg

2 ml/kg for the second 10kg

1 ml/kg for every kg remaining

3

blood sugar goal for surgical patients

why?

180-200 mg/dL

can't risk hypoglycemia- when body is stressed it has slight elevations of glucose that will normalize shortly after surgery

4

why would you think of an obstruction in a surgical patient

starts to complain of n/v, obstipation and constipation, distention

large surgical history (suggestive of adhesions)

5

test to determine if pt has obstruction?

CT of abdomen

6

how do you treat obstruction (N/V)

NG tube

esp Salem Slump

7

Abdominal pain and urgency to void, but with challenges in initiating and completing micturation

DISTENDED BLADDER

8

tx of distended bladder

foley Cath

urology consult

9

low urine output but normal bladder scan

pre-renal (hypovolemia)

10

5 W of post op fever

Wind (atelectasis, PNA)
Water (UTI, iV line)
Wound (infxn, abscess)
Walking (DVT, PE)
Wonder drug (B-lactam abx)

11

Signs of likely infection: (6)

Fever occurring > 48hrs post-op

Pre-operative trauma

An initial temperature elevation above: 38.6°C (>101.5°F)

Leukocytosis greater than 10,000/L

Post-op BUN of 15 mg/dL+

Poor protoplasm

12

PE of post op fever

#1 check the wound/surgical site

#2 listen to lungs; do heart/abd/extremity exam

#3 check IV sites, central line, Foley, drains/ tubes

13

the MC pancreatic carcinoma?

Adenocarcinoma

14

Where is the MC location of pancreatic carcinoma?

Head of the pancreas, followed by body and then the tail.

15

What are some genetic variants/risks associated with pancreatic carcinoma?

First degree relative,

BRCA gene, HNP-CC, FAP

16

social hx risk factors of pancreatic CA

Smoking, Drinking and DM

17

What is the palpable mass of the RUQ called?

Courvoisier Sign

palpable gall bladder

18

pancreatitis and jauncie

painless obstructive jaundice due to mass in head of pancreas causing biliary obstruction

19

pruritus and pancreatic CA

common in pts due to biliary obstruction

Benadryl will not help (not histamine issue)

ERCP stent placement to expand duct

20

virchow's node

Palpable cervical node,

most prominently in the medial end of the supraclavicular aspect

21

blumer's shelf

presence of metastatic mass in the rectal pouch

22

sr. Mary joseph's nodule

Periumbilical subcutaneous nodule

highly suggestive of metastatic disease

23

what study should be done to evaluate a pancreatic mass?

Abdominal CT with contrast

MRCP would also work

24

lab marker for pancreatic CA

CA 19-9

> 100 highly specific for malignancy

25

surgical procedure done to manage pancreatic CA?

What stage is most appropriate?

Whipple

stage 1-2

26

post - op MI work up

CXR
Cardiac Enzymes

also if symptoms are GI related then CT abdomen and Pelvis w/contrast to ensure it is ok

27

wound vac

pulls fluid from the wound to reduce swelling and help clean wound to remove bacteria

**promotes granulation tissue development ***

28

how many days before you can take out a suture:

on head

4-5 days

29

how many days before you can take out a suture:

UE/LE

5-7 days

30

how many days before you can take out a suture:

Torso

7-10 days

31

keloid

3-12 months after injury and extend beyond

tx with kenalog (surgical correction

32

where is MC spot for keloid

earlobe, deltoid, presternal and upper back lesions

33

kenalog

tx of choice fir keloid

steroid reaction causing skin atrophy

34

hematoma effect on wound

distort wound edges and impinge on vital structures

blood will leak thru suture

35

seroma

Fluid, other than pus or blood, which collects at the operative site, delaying healing and increasing the risk of infection.

36

issue with seroma of groin?

left to resolve on own w/surveillance bc increased risk of infection with aspiration

37

three phases of wound healing

inflammatory
proliferative
maturation

38

first cell to enter a wound?

platelet

contact with damaged collagen causes degranulation and release of growth factors to attract cells to wound

39

What cell predominates in the inflammatory phase?

neutrophils

40

what effect do PMNs have on wound healing and recovery

PMN’s do not heal the wound and persist presence will delay wound healing

41

Oxygen free radicals are produced by

macrophages

42

If the wound is deprived of the following blood cell, delayed wound healing and poor tissue strength should be effected?

A. Platelets
B. Macrophages
C. Neutrophils
D. Lymphocytes

Macrophages

43

This cell predominates in the proliferative phase of wound healing, and what is it’s role?

Fibroblast: synthesizes and secretes collagen, for wound deposition

44

GI is a challenge in wound healing why?

heavy bacterial burden

inability to provide adequate "rest" of the system

pH changes in HI

early and marked lysis of collagen

45

GI healing complication when NOT enough healing occurs

dehiscence, leaks, fistulas

46

GI healing complication when TOO MUCH healing occurs

strictures/stenosis of lumen (adhesions)

47

Why does cartilage suffer so greatly following wounding?

It is avascular, must depend on diffusion for adequate nutrient and oxygen supply;

no inflammatory response.

48

contaminated wound

15% infx rate,

spillage from the GI, GU, and pulm system. + trumatic wounds w/soil

49

clean contaminated

8% infx rate, including Gi, GU or Pulm system w/o spillage of contents

50

dirty

35% infx rate, at side of existing abscess and infx

51

clean wound

3% infx rate, no break in sterile field

52

abrasion

superficial epithelial loss

no closure just cleaning, tx with petroleum gauze

53

puncture wound tx

deep tissue injury assessment, valuation for foreign bodies and ongoing infection

tetanus management

54

avulsion

shearing force and part of wound doesn't have underlying fat and muscle

closure by anchoring to underlying tissue and finding edges

55

vermillion border

line up sutures here


found across hair or eyebrow

better cosmetic results

56

Primary Wound Closure

approximating the epithelial wound edges with suture, staples or adhesive immediately after cleaning and debridement.

done right away

57

Secondary Wound Closure

The wound is allowed to close by granulation tissue proliferation followed by contraction and epithelialization from the edge of the wound

58

Tertiary Wound Closure

after a delay of days to a week, the edges of the wound are debrided and closed like a primary closure.

59

neuroendocrine pancreatic CA

arises out of endocrine tissue of pancreas

typically benign but CAN be malignant

secrete peptides (insulin, glucagon, gastrin, VIP)

60

Insulinoma + tx

pt presents with recurrent hypoglycemia (insulin) or hyperglycemia (glucagon)

tx with surgical resection

61

Gastrinoma

large amounts of gastrin produced, increased gastric acid production = refractory PUD

gastrin > 150

62

ZES tumor found where?

pancreas or duodenum

63

how do you confirmZES

fasting secretin test

gastrin levels increased .200

64

VIPoma syndrome

WDHA

Watery Diarrhea
Hypokalemia
Achlorhydria

65

TXA

interferes with hyperfibrinolysis (excessive clot formation in truama)

CRASH -2 = ok to give if <3 hrs post injury

66

necrotizing fasciitis

ecchymosis, hemorrhagic bullae, cellulitis, crepitation

pain out of proportion to exam

67

necrotizing fasciitis tx

aggressive surgical debridement

broad spectrum abx

hyperbaric O2

68

lab assessment of hyponatremia + tx

FeNa

correction slowly (< 10 mEq/L in 24hrs)

69

hyperkalemia EKG

Peaked T, flat P, shortened QT,

muscle weakness, respiratory paralysis

70

hyperkalemia tx

Medications: - Calcium, D50, Insulin-

Loop Diuretric, Albuterol, and Dialysis

71

hypokalemia s/s

Flat T’s, depressed ST, prolonged PR interval and widened QRS.

fatigue, weakness, paresthesias and an Ileus

72

tx of hypokalemia

K supplementation

IV or PO (both have bad side effects)

73

isotonic fluid order that can reduce these electrolyte derangements in the immediate post-operative period?

D5W 1/2 NS + 20mEq KCL @ 75cc/hr

74

wound dehiscence

rupture of total or partial layers of surgical wound

75

systemic factors causing dehiscence

DM, renal failure, obesity,

immunosuppression, low albumin, CA, sepsis

76

when does dehiscence MC occur?

5-8 days post op

77

how is dehiscence described?

sudden ripping or tearing sensation

78

local factors causing dehiscence

inadequate closure
increased intraabdominal pressure
deficient wound

79

how is hepatic CA diagnosed?

ONLY one that doesn't need Bx

contrast CT scanning

repeat u/s in 3 months

80

risk factors for HCC

Hepatitis B and C,
Hemochromatosis
Cirrhosis

EtOH/Tobacco, NASH, Alpha1Antitrypsin

81

factors that are considered protective against HCC?

statin use, white meat/fish, omega 3 fatty acid consumption

82

how are high risk patients for HCC screened?

RUQ U/s and AFP

83

what GI CA known to present with fever

Hepatocellular and Cholangiocarcinoma

84

four neoplastic syndromes in hepatocelluar carcinoma?

1. Hypoglycemia,
2. Erythrocytosis,
3. Hypercalcemia,
4. Diarrhea

85

the four common sites of metastatic spread in hepatocellular carcinoma?

1. bone,
2. adrenal glands,
3. lymph nodes (intra-abdominal)
4. lung

86

Prognostic tool for hepatocellular carcinoma

Child-Pugh Classification

87

Child-Pugh Score 7-9

B Moderate

88

Child-Pugh Score 5-6

A Mild

89

Child-Pugh Score 10-15

C Severe

90

Child-Pugh Score who gets resection?

Child-Pugh A and B

91

Child-Pugh Score who gets chemo?

NONE
chemo resistant

92

Child-Pugh Score who gets transplant?

Child-Pugh c

93

When the liver is found to have metastatic disease of cancer, but the liver is not believed the primary site- what two areas are believed the source?

Lung and Breast

94

MC bacteria for PNA

GNR

95

considering tx for post op PNA, what do you want to cover for?

polymicrobial infection

96

how do you tx hypoxia?

increased FiO2

97

how do you tx hypercapnia?

increase minute ventilation

98

oliguria

UOP < 30 cc/hr or less than 400 mL/day

99

condition marked by compression of the common hepatic duct by an impacted stone in the gallbladder neck?

Mirizzi Syndrome

100

Gallbladder CA typically diagnosed?

late stage, intraoperatively

Ideal would be u/s! But unfortunately, not going to happen until late

101

how do you cure gall bladder CA?

surgical management can be curative

BUT not often done due to late stage presentation

102

What are the agents that are often used for PCA?

Morphine,
Dilaudid,
Fentanyl
Meperidine

103

PCA last drug of choice?

Meperidine

avoid in elderly, renal failure, or concurrent MAO inhibitor tx

104

PCA drug of choice

morphine

105

What is one vital sign measure that is a limitation for pain management when admitted?

RR <12

106

Dilaudid

onset of action + duration of action (IM)

onset: 20-30 min

lasts for 4-6 hrs

107

Dilaudid

onset of action + duration of action (IV)

onset: 5 min
Last: 2-4 hrs

108

Fentanyl
onset of action + duration of action (IM)

onset: 8 min

last: 1-2 hrs

109

Fentanyl

onset of action + duration of action (IV)

onset: <1 min

lasts: 0.5-1 hr

110

MOA for Narcotics?

Binding the receptors in the CNS, increasing pain threshold altering pain reception, inhibits ascending pain pathways

111

Side effects of Narcotics?

Respiratory and CNS depression, as well as Constipation

112

How do you want to address constipation w/outpt opioids?

Colace

113

what must be accomplished prior to pt being discharged

Urinated

Get out of bed

Tolerate small amount of oral intake

114

MOA + Dose
Promethazine (Phernergan)

H2 blocker and mesolimbic dopinergic
12.5-25 mg

115

MOA + Dose
Metoclopramide (Reglan)

Blocks dopamine receptors and dependent serotonin receptors

10 mg

116

MOA + Dose

Ondansetron (Zofran)

Blocks serotonin, working in vagal nerve an central chemoreceptors


4-8 mg