Nutrition / Incision / Drain / Hernia

Question 1

Poor nutrition leads to

Answer 1

impaired albumin production
impaired wound healing and colleges deposition
skeletal muscle weakness (ICU myopathy)
REDUCED neutrophil and lymphocytes

Question 2

Good measurement of BMI

Answer 2

GRIP STRENGTH

Question 3

what improves GI function

Answer 3

chewing gum

Question 4

NG and NJ tube used if

Answer 4

severe vomititng
gastric reaction
gastic outlet obstruction

Question 5

TPN use

Answer 5

when oral and TPN cannot be used

• extensive bowl resection
• w/ fistula and bowl resection like Chrons

Question 6

TPN is ass. w/

Answer 6

hyperosmolarity
Fluid overload

lack of glycemic control
Nutrient deficiencies

Liver disfunction - cholestatsis an pancreatic atrophy

Question 7

how to give TPN

Answer 7

HACKMAN line - dedicated tunnelled catheter

PICC - peripherally inserted central venous catheter

Question 8

Risk of central VENOUS CAtheritization

Answer 8

• hematoma / haemorrhage
• superinfective line / infection to surrounding skin
• line obstruction / kinking / malplacement
• damage to surrounding skin from malplacement including
  
  • pneumothorax
  • air embolism
  • cardiac dyshythmias
  • cardiac dissection

Question 9

what monitoring do patients with TPN require

Answer 9

DAILY - urea, electrolytes, glucose (UNTIL STABLE)

TWICE WEEKLY - liver function test

WEEK - Mg, Cu, manganese, zinc, phosphate

Question 10

Open passive drain

Answer 10

provides a conduit for drainage of secretions

Question 11

Closed ACTIVE drain

Answer 11

generates active suction

• redivac drain
• minivan drain

Question 12

closed passive drain

Answer 12

drain by siphon effect of gravity and capillary action

• Robinson
• NGT
• VP shunt
• Chest tube (tube thoaractomy)

Siphon - allows fluid to drain upwards and then pulled down by gravity

Question 13

T-tube

Answer 13

RARELY used after ERCP to compress the bile duct system and make sure there are no further stones

Question 14

s/e 1 week after removal of Tube

Answer 14

binary asites

Question 15

Causes of weakness of abdominal wall

Answer 15

PPASS
previous surgery
post op surgical site infection

Ageing

Smoking
steroid use

Question 16

Causes of Incease abode pressure

Answer 16

POCAH 
Pregnancy 
Obesity 
CHRONIC COUGH 
Ascites
heavy lifting

Question 17

Richter’s hernia

Answer 17

Hernia where ONLY part of the bowl circumference trapanned within hernial wall and therefore presents with partial bowl obstruction where its vomits but still passes flatus

Question 18

Pantaloon

Answer 18

is when both indirect and direct hernia occur together

Question 19

Sliding hernia

Answer 19

retroperitoneal structure such as COLON for URINARY BLADDER slides down and dorms the wall of the hernia sac

Question 20

Pathogenesis of indirect hernia

Answer 20

Leave the abdomen via DIR

• follows oblique corse through IC
• patent process vaginalisis

lies in the canal

Question 21

Direct hernia pathogenesis

Answer 21

protrude anteriorly though transversals facia (hesselback triangle)

Question 22

(hesselback triangle)

Answer 22

medical by rectus abdomens
superior IL
Laterally inferior epigastric artery

Question 23

Boundaries of Inguinal Canal

Answer 23

ANTERIOR
- EO (entire) and IO (1/3)

POSTERIOR

• CJ tendon
• TF

SUPERIOR
- IO and TA

Inferior
- IL

Question 24

Contents of inguinal canal

Answer 24

spermatic cord
vas deference

external / internal spermatic facia
cremastic facia

Testicular artery , artery to vas deference, cremasteric artery
Pampiniform plexus

Lymphatics

NERVE to cremasteric, sympathetic nerve, ilioinguinal nerve , genital branch of GF nerve

Question 25

treatment of hernia

Answer 25

Small - conservative Larger - operation Open - Lichtenstein tension free repair - Stich repair Lap - TAP (transabdominal ) - TEC (total extraperitoneal)

Question 26

complication of hernia

Answer 26

``` HEAMATOMA Infection Urinary retention Nerve damage - chronic groin pain Testicular artery damage - T Atrophy Recurence (5-10%) ```

Question 27

what can cause recurrence after hernia surgery repair

Answer 27

Infection post op avoid mesh conditions such as - chronic cough, constipation , bladder, outlet obstruction

Question 28

boundaries of femoral triangle

Answer 28

SUPERIOR: IL Lateral: medical boarder of sartoris Medially: lateral boarder of the abductor canal Floor: iliac, psoas, pectines, adductor longus ROOF: superficial fascia and GSV

Question 29

femoral canal boundaries

Answer 29

A: LL P: Perineal ligament M: lacunar ligament L : femoral ligamant

Question 30

spigelian hernia

Answer 30

perfect in the lateral boarder of the RA and lines semilunaris hernia lies between the two layers of internal and external oblique and transversals abdomens NEED CT to DX Surgery repair