OME Gen Surg June 2017 Flashcards
(62 cards)
Components of Child-Pugh score
Low alb, high bili, high INR, ascites, encephalopathy
Why treat dvt with heparin bridge to coumadin
Because coumadin makes hypercoagulable initially (disrupts proteins c and s)
manage a surgical wound infection presenting as fever and wound erythema and tenderness ~7 days postop
US to rule out deep abscess not palpable on exam
PO Abx if cellulitis only
IV Abx if toxic appearing
I and D if abscess
Laparotomy if dehiscence or evisceration
doing all postop care right, but now postop day 3 fever anyway, what is it probably due to
UTI
POD 1 atelectasis POD 2 PNA POD3 UTI POD 5 DVT POD 7+ wound
72 hours after surgery pt has htn tachyc hallucinations diaphoresis and ams
what is it
she is one step from ___
alcohol withdrawal
she is one step from seizing
general mechanism of alcohol withdrawal
upregulation of GABA receptors (compensating for chronic neural inhibition/depression) then withdrawal of the depressant leaves autonomics overly excitatory
order of alcohol withdrawal symptoms
hypertensiona and tachycardia then tremor then diaphoresis and anxiety then hallucinations - visual usually ending with seizure
really old patient with total colonic dilation the only diagnosis is ______
treat with
Ogilvie syndrome
treat with rectal tube for decompression or neostigmine
what part of bowel does Ogilvie syndrome affect
colon only, like a paralytic ileus of the colon only
what part of the bowel does a paralytic ileus affect
the whole thing, the ENTIRE GI SYSTEM
how does duration of anuria after cath removal affect management
6 hours
(normal to urinate 4x/day, so roughly every 6 hours)
reassure before then
intervene after then - in/out cath to assess for residual volume – give fluids if low, leave cath in if high
abdominal compartment syndrome
- classic presentation
- management
ex lap trauma case got tons of fluids to support pressure intraoperatively and can’t close abdomen at end of case because both organs and fascia are swollen
leave open and cover with wound vac or absorbable mesh to prevent infection
why don’t you close abdominal compartment syndrome, aka ex lap trauma case got tons of fluids to support pressure intraoperatively and can’t close abdomen at end of case because both organs and fascia are swollen
because even if forced closed, organs will die from pressure and patient will die
ZERO urinary output in hospitalized patient suspect these 2 things
kinked foley most commonly, very rare even with big hypotensive hit / hemorrhage to have ZERO output, so reposition foley or give it a flush
ATN e.g. from hypotension/ischemia possible but will usually have SOME output early on in first 12 hours or so, so really suspect kinked foley
treat alcohol withdrawal
IV lorazepam or other short acting benzodiazepine
when do you use chlordiazepoxide in setting of alcohol withdrawal
to prophylax against withdrawal (long acting oral benzo)
use short acting benzo like lorazepam, to treat actual withdrawal
72 year old guy postop after significant abdominal surgery gets delirious, what do you do first
first supplement oxygen e.g. 100% non-rebreather
then lots of things as you work him up e.g. BMP blood glucose pause any narcotics cxr
how does a 100% non-rebreather oxygen mask work
what is the advantage
100% O2 inhaled from inflated bag, exhale through one-way valve into room air
allows for higher oxygen delivery than nasal cannula
TF
postop foley urine output gradually declining to concerning levels after a period of hypotension but patient has since been hemodynamically stabilized – first step reposition and flush catheter?
F
reposition and flush if acute ZERO urine output highly suspicious of kinked foley obstruction
gradual urine output drop in setting of just prior episode of hypotension probably prerenal aki – so give 1L NS fluid bolus
painful jaundice in an adult is essentially always caused by…
gallstones
painful jaundice in an adult consistent with probable obstructing gallstone, what do you expect to see on biliary tree sonogram
dilated biliary tree
no obstructing stone
(obstructing stone rarely seen on US but will see on ERCP)
non-obstructing gallstones in gallbladder
(even though obstructing stone difficult to see on US, will probably see other stones in gallblader)
describe acute cholecystitis on US
pericholecystic fluid, thickened gallbladder wall, and gallstones
pericholecystic fluid, thickened gallbladder wall, and gallstones on RUQ US describes what diagnosis
acute cholecystitis
distended thin-walled gallbladder with biliary dilation on RUQ US describes what diagnosis
painless jaundice associated with slowly-progressing cancer
