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1
Q

UGI bleed

A

High urea

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2
Q

Stomas and mx

A

Colostomy- LHS, formed stool, no spout

Ileostomy- RHS, loose stool, spouted due to alk conts irrit skin, dehyd risk, often give loperamide and fluid restric.

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3
Q

Anterior resection

A

Can anast immed.
Indics- L side CA, healthy bowel
Temp stoma somet

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4
Q

Diversion stoma

A

Eg for clean surg

Temp or perm

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5
Q

Hartmanns

Ant resection and end colostomy

A

Indications- L side CA, diverticulitis
Stoma as cant anast with inflamm/contam, decr BS, pt facs (imm comprom, steroids, DM etc).
Might be perm

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6
Q

Fentanyl AE

A

Drop BP

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7
Q

base excess

A

Metabolic alkalosis

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8
Q

Right hemicolectomy

A

Reomove ileum to part of TC

Indication- R side CA

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9
Q

sub total colectomy

A

Rectum preserved

Can anast

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10
Q

pan procto colectomy

A

Remove rectum and anus

End ileostomy

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11
Q

APER

Abdomino perineal excision of rectum

A

Indication- very distal rectal CA

Stitched back passage

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12
Q

colonoscopy indications

A

Bleed
Anaemia, Fe defic
Volvulus
Susp polyp/CA for remov/biop

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13
Q

colonoscopy risks

A

Perforation- higher risk if colitis, large polpectomy, heavy sedat
Bleed- more comm than perf esp with polypectomy
Missing a small CA or polyp
Fail to reach caecum

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14
Q

polypectomy

A

Injec dye, adrenaline and gelofusine
Lifts away from musc layer
Then snare.
This is endoscopic mucosal resection (EMR)

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15
Q

Bowel CA screening

A 
Low pick up rate
Age 60 plus
FOB test ev 2 yr til 75yo
Positive result then go for colonoscopy
Now bowel scope screen for over 55s
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16
Q

WHO screen criteria

A 
Important prob
Recognisable latent or early symp stage
Nat hx known
Accepted tx
Accurate test
Acceptable
Policy on who to tx
Facils for dx and tx
Econ balanced
Contin process
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17
Q

Adjuvant chemo

A

Us only if dukes C

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18
Q

Epidural risks

A

N damage, bruising
Epidural haematoma esp if eg anticoag, can cause comp
Hypot, more comm with spinals. Give phenylephirine infus to vasocontrict.
Infec eg abcess. More comm in epi than spinal.
Subdural space- patchy block.
Dural punc- CSF leak, reduc press, postural headache. Mx- PK, hydration, epidural blood patch.

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19
Q

LA s/e

A

Allergy

Toxicity- if too much abs eg BV damage. Fits, LOC, RSD, CVS collapse.

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20
Q

Opiate s/e

A

Nausea
Constipat
RSD
Itching

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21
Q

Epidural and spinal

A 
Numb from T4 down
Spinala ccording to dose and posit
T4 blocks some of chest wall musc
Total spinal block if too high
CSC- combined, lasts longer
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22
Q

LA

A

Regional
N block
Local infilt

23
Q

NG loss

A

Aspiration to check abs levels

24
Q

Sepsis

A

Vasodilat
Give fluid resus and vasocontrictors
Resulting oedema, then need to mx this, alb and diuretics.

25
CPAP
Press ag exhalation | Opens collapsed small airways
26
Ionotropes and pressins
-
27
ECG
Axis- leave/reach in V1 and aVF
28
Central venous catheter
``` R IJV shorter than L Can do R subclavian- more risk pneumothorax Rarely femoral- risk infec and hidden Flush and head down to prev air embol CXR- check for pneumothorax, psoit Stay in max 10d ```
29
PIC line | Peripherally inserted cannula
Used mainly for TPN Also chemo Stay in for up to 6wk
30
midline
Shorter | Used for eg AB, fluids, drugs if LT admission.
31
hickman
Porter cath under skin
32
IPE ischaemic bowel
Hx- eld, CVS hx (AF, PVD, atherosclerosis), bloody diarr due to nec, diffuse or non specif pain, high lactate Can lead to perf then peritonitis and sepsis High mort Early sign cramp after eat
33
blood gas
Arterial gas if resp fail Venous gas if no concern resp fail- diff interp of pO2, pCO2 and sats. Base excess- very neg means TOO MUCH ACID Important things- pH 7.35-45, pCO2, pO2, lactate, base excess, HCO3. PH low and CO2 high means resp acidosis Both low means metab acidosis Lactate norm 0.4-0.8- indics tiss perfus. High in eg sepsis, isch bowel, DKA. Look at base excess with lactate HCO3 slow resp by kidn to chronic CO2 reten
34
Hypoxia
Hypoventil- reduc hypox drive, RD, CVA | Resp causes- asthma, pneum, PE, consolid, pthorax, sepsis.
35
acidosis mx
Fluid BP Infec source control
36
Chest drains
Safe space- 2nd ICS mid clavic fo tension pthroax, 5th ICS mid ax. NV bundle in on underside of rib, so insert over top of rib. Seldinger tech uses guide wire.
37
C diff
Gram pos RF- clindamycin, cephalosporins Mx- metronidazole, vanco 2nd line
38
R colon CA px
Bleeding Anaemia Not us bowel change
39
L colon CA px
Hard stool Then overflow diarr Cyclical
40
LI obstruc causes
``` Neoplasia- benign or malig Stricture- inflamm eg divertic, IBD Volvulus Infec Impaction Hernia Intussusception Ext comp ```
41
LI obstruc mx emergency | Mx framework for everything
Hx, exam Resus Init assess- reviwe images, prev surg etc, NBM, NGT, analgesia, fluids Imaging- AXR, erect CXR, CT abdo pelvis plus IV dye
42
Splenectomy
Risk encaps infec eh pneumococcus, haemphilus, meningococcus. Mx- vaccines for the above, prophylactic penV High risk malaria if travel.
43
Prep before colonoscopy
Bowel prep laxative- stimulant or osmotic
44
Prep before siggy
Enema
45
bowel N supply
No pain Rs | Stretch Rs so inflation and str causes pain
46
Endoscopy meds
Midazolam- amnesia Fantanyl short acting Occas use entonox- but delay onset and reduc coop
47
Bowel prep caution if
Renal disease HF Immobile
48
pyloric sten causes
CA Duod ulcer Hypertrophy in babies ZE
49
NV and diarr
Hypochloraemic alkalosis | HypoK
50
Gastric outlet obstruc signs
Distension Projectile high vol vomit Succussion splash
51
Stomach region functions
Body and cardia produce acid | Antrum prods gastrin
52
HypoK causes
``` Chronic kidney dis Diuretics Vomiting Aldosteronism DKA Diarr Excesisve alc ```
53
Tympanitic on percussion | Resonant throughout
Gas in LI | Pneumoperitoneum

Periop (21 decks)

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