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Principles Of Science > Principles Of Surgery > Flashcards

Principles Of Surgery Flashcards

1
Q

What are the 3 types of surgical site infections?

A

Superficial: skin and subcutis

Deep: underlying muscle

Organ/body cavity infections: areas deep int he body entered at the time of surgery

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2
Q

What are the impacts of type 1 and 2 surgical site infections?

A

Increase morbidity/ illness

Increase hospitalization time

Increase costs

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3
Q

What are the impacts of type 3 surgical site infections?

A

Surgery failure

Mortality/ death

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4
Q

What is the definition of a septic technique?

A

A set of specific practices and procedures performed under carefully controlled conditions with the goal of minimizing contamination of surgical sites by pathogens…and so reducing risk of surgical site infections

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5
Q

What is sterilization?

A

The complete destruction of microbial viability, bacteria, viruses, fungi, and spores, on an inanimate objects

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6
Q

What is disinfection?

A

Destruction of pathogenic microbes, may not include all viruses and bacterial spores.

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7
Q

What are the 4 sterilization techniques?

A

Steam sterilization, autoclave

Chemical sterilization
Ethylene oxide
Hydrogen peroxide gas plasma

Gamma irradiation

Cold sterilisation

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8
Q

What are the steps of asceptic technique for preparing the patient?

A

Hair removal

Skin prep

Transfer to theatre

Drape

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9
Q

What are the 3 antiseptics?

A

Chlorhexidine gluconate

Povidone iodine

Alcohol

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10
Q

What are antiseptics?

A

The kill or inhibit the growth of pathogenic microbes and can be used on the skin of living animals

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11
Q

Which antiseptic kills both negative and positive bacteria, enveloped virus, and yeasts. It works variably on. Mycobacterium, protozoa and fungi. It kills 96 % in 30 seconds, and 98 % in 3 minutes. And in ineffective in the presence of soap and detergent.

A

Chlorhexidine

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12
Q

Which antiseptic kill all bacteria, fungi and Protozoa, but has a rapid kill 77% in 3 minutes. Has decreased activity in presence of organic material, and can cause acute dermatitis in 50% of dogs.

A

Povidone Iodine

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13
Q

Why chlorhex more preferable to iodine in dogs?

A

Iodine has a 50% incidence of skin reactions in dogs

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14
Q

Which anti septic kills bacteria, and mycobacterium and fungi, but not viruses. And has a rapid kill of 98-99% in 30-60 seconds. Should never be used on open wounds, and dehydrates skin

A

Alcohol

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15
Q

What are the 3 generic steps of hand rubbing for asceptic technique?

A

Good hand hygiene

Wash hands and arms to elbows with pure soap

Apply alcohol based hand rub to hands and arms 1 Mina no 30 secs

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16
Q

When are per-operative antibiotics indicated?

A

At risk dental procedures

Leukopenia patients

Contaminated surgery

Orthopedic, major abdominal, thoracic surgery, 90 min or longer

Consequences of infection would be disastrous

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17
Q

What are the 4 classifications of surgical wounds?

A

Clean

Clean - contaminated

Contaminated

Dirty

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18
Q

What is a clean surgical wound?

A

Non traumatic elective procedure

No entry into gastrointestinal, urogenital, or respiratory tract

No break in aseptic technique

Surgical site infection 2 to 4.9%

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19
Q

What is a clean - contaminated surgical wound?

A

Entry to a hollow organ with
No significant spillage, no significant infection

Clean procurer with minor break in aseptic technique

Surgical site infection Rae 3.5 to 4.5 %

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20
Q

What is a contaminated surgical wound?

A

Fresh ( less than 6-8 hours old) traumatic wound

Spillage from a contaminate hollow organ during surgery

Entry into hollow organ in presence of infection

Clean surgery with major break in aseptic technique

SSI rate 4.6 -9.1%

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21
Q

What is a dirty surgical wound ?

A

Infected surgical site

Purple tissue discharge encountered

Wound open and untreated for longer the 6-8 hours

Surgical site infection 6.7-17.8%

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22
Q

True or false: the use of antibiotics in dirty surgeries is an prophylactic

A

False: mainly contaminated sx, longer clean contaminated sx

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23
Q

What are the component of a basic surgical kit?

A

Cutting instruments
Scalpels/ scissors

Tissue holder
Thumb forceps
Tissue forceps
Hemostatic forcep

Needle holders

Retractors

Towel clamps

24
Q

What is the use and action of a scalpel?

A

Use for tough tissue and tissues under tension

Action is a single bold incision

Pencil grip for curve of blade

Finger grip for flat of blade

25
Q

What is the difference between a metzenbaum and a mayo scissor?

A

Metzenbaum: 1/4 length blade, incision to shape and blunt dissection of fine tissue below skin, flaccid tissue

Mayo: 1/3 length blade, incision of dense heavy tissue, such as fascia, linea alba.

26
Q

What are/ use for utility scissors?

A

Straight blades with blunt sharp tips

Reserved for inanimate objects like drapes, suture materiall

27
Q

What type of scissors have long arms, one serrated blade, and finger rings that do not meet.

A

Ligature scissors

28
Q

What are the 4 types of thumb forceps?

A

Debakey: viscera/ fine tissue

Adson{ rat tooth}: fascia skin

Adson brown: lots of teeth

Dressing: smooth

29
Q

What is the proper grip for thumb forceps?

A

Pencil grip to steady tissue for action cutting or passing needle through

30
Q

What are the 3 types of tissue forceps?

A

Allis tissue forceps: teeth, hold tissue firmly, traumatic: do not hold tissues that will stay in the body

Babcock tissue forceps: no teeth, hold tissue atraumatically, stomach and intestine

Doyen/bowel forceps: longitudinal a traumatic teeth, to clamp intestine to prevent leak

31
Q

What are the 3 types of hemostatic forceps?

A

Mosquito hemostats: fine and small, holding individual fine blood vessels

Kelly hemostats: medium sized, tips partially serrated, holding large blood vessels plus surrounding tissue

Rochester carmalt forceps: longitudinal teeth, larger instrument, holding tissue plus blood vessels( uterus) passing drains, feeding tube through skin exit holes

32
Q

What are the different types of hand held retractors?

A

Send

Army and navy

Langenbeck

33
Q

What the different types of self retaining retractors?

A

Gelpi

Baby gelpi

Adson baby

Weitlaner

Balfour ( abdominal)

Gusset ( abdominal)

Thoracic ( finochietto)

34
Q

Why is hemostasis important in surgery?

A

Bleeding obscures the surgical field

Blood provide an ideal medium for arterial growth

Extravasated blood is irritation to tissues

Severe hemorrhage leads to shock, hypoxemia, and death

Preventative planning is key
Ligate vessels
Gentle and accurate dissection

35
Q

What are the hemostasis options?

A

Pressure

Suture ligation

Cautery

Metal clips

Hemostatic Agents’s

Vessels sealing devices

36
Q

What are the different ways to ligate vessels?

A

Hand ties

One hand tie? Two hand tie

Instrument tie

37
Q

How do you use swabs for hemostasis?

A

Count swabs
Blot do not wipe
Apply pressure
Open out the swab to reduce trauma

38
Q

What are the different ligation patterns for vessels?

A

Simple encircling ligature

Double ligature

Transfixing ligature

39
Q

What size vessel can be cauterized?

A

Up to 2mm

40
Q

What are the two types of cautery?

A

Mono polar diathermy: cut and coagulate, apply through surgical instruments, larger vessels

Bipolar diathermy : less current used, reduced tissue trauma, effective wet field

41
Q

What size vessel can metal clips be used on?

A

About 1/2 to 3/4 in width, deep in the abdomen

42
Q

What are the indications for surgical drains?

A

Contaminated wounds

Dead space

43
Q

What are the two types of surgical drains?

A

Passive: penrose due to gravity and capillary action

Active: Jackson Pratt drain, actively remove fluid, against gravity if necessary, closed suction using vacuum

44
Q

When should a drain be removed?

A

Less the 2mls of fluid/ kg/day

No more bacteria present

Inflammation reduced

1-3 days for most penrose drains

3-5 days for large dead space

45
Q

What are the different classification structures of suture materials?

A

Natural vs synthetics

Absorbable vs non-absorbable

Multifilament vs monofilament

46
Q 
Vicryl
Dexon
Polysorb
Panacryl-poly
Are what type of suture? And used for what
A

Synthetic absorbable multifilament

Vessel ligation, general soft tissue closure ( skin, mouth, opthamology)

Do not use in contaminate dirty wounds

47
Q

Monocryl and caprosyn are used for what and are what kind of suture?

A

Synthetic rapid absorbable monofilament used for general soft tissue closure

Visceral closure: monocryl

48
Q

What type of suture are PDS II, Maxon, and biosyn and what are they used for?

A

Synthetic slow absorbable suture for soft tissue needling long support and muscle, fascia, lineal alba, viscera

49
Q

What are the uses and type of synthetic non absorbable monofilament?

A

Prolene/ surgipro- polypropylene

Nylon ET Hilton/monosof

Flexon - steel

Skin, stoma, vessels, prolonged support: hernia, tendon

50
Q

What are the types and use of synthetic non absorbable multifilament suture ?

A

Polyester

Polybutester- novafil

Caprolactam- supramid

Ligament prosthesis

Skin closure

51
Q

What kind of suture is cat gut and how does it compare to other suture materials?

A

Natural absorbable multifilament, it is relatively weak and best for ligation and rapidly healing tissue. Absorbs in 2-3 weeks and has poor not security

52
Q

What is a natural non-absorbable suture?

A

Silk, absorbs after 2 years, large vessels ligation, NOT in viscera, ulcers and calculi not infected wounds

53
Q

What factors should be considered when selecting suture material?

A

Tensile strength should match tissue strength: fascia/skin>viscera>muscle/fat

Rate of loss of strength = gain in wound strength
Rate of healing viscera>skin>fascia

Local wound environment

Will suture alter healing biologically

54
Q

What are the general rules to avoid complications with sutures?

A

Avoid multifilament material in contaminated wounds

Avoid non-absorbable sutures in hollow organs

Use of inert material in the skin

Avoid reactive material for stoma creation

Use slowly/non-absorbable material in fascia/ tendons

Avoid burying and suture from a multi use cassette

Avoid catgut in inflamed, infected or acidic wounds

55
Q 
Match the tissue to the kind of suture:
Skin
Subcutis
Fascia
Muscle
Hernia
Viscera
Tendon
Vessel ligation
Vessel repair
Nerve
A

SKIN:Non-abs mono( nylon, prolene)
SUBCUTIS: Abs mono/multi (monocryl, vicryl, caprosyn)
FASCIA:Abs/non-abs mono (PDS, Biosyn, Prolene)
MUSCLE:Abs mono (PDS, Biosyn, Maxon)
HERNIA:Non-abs mono (prolene)
VISCERA:Abs mono (monocryl, PDS)
TENDON:Non abs mono ( prolene, nylon)
VESSEL LIGATION:Abs multi ( vicryl, polysorb) non-abs mono (prolene, silk)
VESSEL REPAIR:Non abs mono (prolene, surgipro)
NERVE:Non abs mono ( prolene nylon)

56
Q

What is the rule for choosing suture size?

A

Use the smallest size possible

3metric= dogs
2 metric = cats
1-2 metric = delicate tissue
0.5 -1 metric = tough tissue

57
Q

What are the different types of surgical needles and what are they used for?

A

Blunt : friable tissue

Taper: delicate tissue

Cutting ( taper cut, standard cutting, reverse cutting, side siting): tough fibrous tissue ( skin, periosteum, fascia)

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