Surgery Flashcards
(104 cards)
1
Q
What are these?
A
Mayo-Hegar
- Long Moderately heavy tips
- Medium to course needles
2
Q
When doing an Abdominal Exploration and you have the Abdo open what order should you explore?
A
- Must be systematic
- Diaphragm and Liver
- Right kidney/adrenal
- Left Kidney/adrenal
- Stomach, S. Intestine, L. Intestine
- Bladder, Repro
- Examination
- Visual
- Textile
- Odour
3
Q
If we have an infected/contaminated wound what kind of dressing should we use?
A
Hypertonic saline
4
Q
Describe Scalpel Blade numbers
10, 11, 12, 15, 20
A
- 12 - Stitch Cutter
- 11 - Stab Upside down
- 15 - Stab
5
Q
What is the formula to overcome dehydration?
A
Maintenance + Deficit + Ongoing Losses
6
Q
A dog has an infected laceration what do I do?
A
Must get rid of the infection before closing. Never close an infected wound
7
Q
What are these?
A
Halstead (Mosquito) hemostatic forceps
- Fine tips
- Transverse grooves on entire surface of jaws
- Straight or Curved
- Use on small vessels
- Traumatic
8
Q
Explain Suture Material
Nylon (Ethilon)
- What is it made from?
- What type of filament is it?
- Absorbable or Non-Absorbable? If so how and timeframe?
- Tensile Strength?
- Knot Security?
- Reactivity?
- Handling?
A
- Thermoplastic Polymer
- Monofilament, but also Braided (stronger)
- Non-Absorbable
- Moderate Strength Loss of 30% @ 2yrs,
- Poor to Fair
- Inert
- Poor Handling
9
Q
What are these scissors used for?
A
Suture Removal Scissors
10
Q
What are these two called?
What is the differences
What are they used for?
A
Osteotome/Chisel
- Cutting of Bone
- Ostemotome - bevel on both sides
- Chisel - Bevel on one side
- Ostemotome will cut in a straighter direction
11
Q
What is this used for?
A
Needle holders
- Forceps with short, heavy, blunt tips with a cross pattern
- Specifically for holding needle
- May have groove to faciliate grasping needle
- Do not use tissue forceps for this task
12
Q
What are these?
A
Hand-Held Retractors
- Aid exposure of tissue
- Army-Navy (largest looking one)
13
Q
What are the classifications of Suture Material?
A
- Absorbable - degradation and rapid loss of tensile strength <60Days
- Non-Absorbable - >60 Days
They can be Natural or Synthetic
14
Q
What are these?
A
Kelly Hemostatic Forceps
- Heavier Tips
- Transverse grooves on half of surface
- Straight or Curved
- Crile (grooved on entire surface)
- Use on moderate sized vessels
- Traumatic
15
Q
- What Suture type gives the best apposition?
- What is Apposition?
A
- Simple Interupted
- Bringing like tissue layers together for best healing
16
Q
- What size suture should you use?
- To get better hold what do you do?
A
- The Smallest Possible
- Put more Sutures in before going to larger Size material
17
Q
Explain the differences between these suture materials
A
- Monofilament
- Slides Easy however knot security is decreased
- Twisted Multifilament
- Grips and Drags more, contamination can sit inbetween gaps, better knot security
- Braided Multifilament
- Passes through a little easy than Twisted, slightly less secure
18
Q
Draw/Explain a graph of Wound Strength v Phases of Wound Healing/timeline
A
19
Q
When closing a ex lap, what suture material and pattern is used for the External Rectus?
A
- Material
- Monofilament absorbable or nonabsorbable
- NOT CATGUT
- Polydioxanone, Polyglyconate Nylon
- 2/0-1 (35kg dog would use 0 or 1)
- Pattern
- Simple Continous
- Secure square knots at either end
- Tissue
- Must Engage external Rectus Sheath
- 5-10mm from edge, 5-10mm apart
20
Q
What are these and what are they used for?
A
Babcock Grasping tissue forceps
- No Teeth
- Small Longitudinally grooved contact end
- Minimally traumatic
- Holding power perpendicular to line of pull
- Suitable for visceral tissue
21
Q
What are these and what are they used for?
A
Adson (Rat Tooth) Thumb Forceps
- Single Tooth
- Opposite Interdigitation
- Very focal hold -> may damage very delicate tissue
- Atraumatic
22
Q
If you have dropped the left ovarian pedicle and/or its bleeding how do you gain access bact to it?
A
xGrab the Mesocolon - Small Intestine to the right, which exposes :-
- Left Kidney/ureter
- Left Adrenal
- Left Ovary
- Gonadal Vessels
- Spleen
Open omental bursa to see left pancreas
23
Q
- Explain the difference between Circlarge and Transfixing Sutures
- What are these used for?
A
- Circlarge is a ligature that goes around a small vessel, where a transfixing passes through the centre of the vessel and tie on each side.
24
Q
What bacteria does Cephazolin work against?
A
- Wide spectrum of activity against Gram-Positive organisms
- Variable against Gram-Negative organisms
- Poor activity against Anaerobic infections
25
Explain Suture Material
Polyester (Mersilene, Tevdek, Dacron, PolyDek)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polyester
2. Multifilament
3. Non-Absorbable
4. Excellent
5. Good Knot Security
6. Significant Tissue Reaction
7. Good Handling
Used for replacing a tendon
26
Explain Suture Material
Silk
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Natural, Cocoon of silk worm
2. Multifilament often coated
3. Non-Absorbable but will break down over time
4. Fair, 30% @ 14days, 50% @ 1year, 100% @ 2years
5. Good Security
6. Moderate Reaction
7. Excellent Handling (Gold Standard)
27
What equipment should you have when planning a Coeliotomy?
* Assistance
* Suction (Poole)
* Laparotomy sponges
* Balfour Retractor
* Haemostatic Agents
* Biopsy Instruments
* Other
* Electrosurgery
* Drainage
28
What does this symbol represent?
What is it used for?
Reverse Cutting Needle
When lifting up the tissue less likely to cut through. Used when doing skin sutures
29
What is this?
Olsen-Hegar Needle Holders
1. Combination of Scissors and Needle holders
2. Suitable for small to medium needles
3. Helpful for Lone Surgeons
30
What are these used for?
Doyen (Pean) intestinal forceps
* Longitudinal grooves along jaws
* Jaws do not completely compress in middle
* Suitable for use on bowel to prevent spillage.
31
Regarding Antimicrobials what does
MIC
MBC
Mean?
* MIC = Minimal inhibitory concentration - Lowest concentration that inhibits visible bacterial growth
* MBC = Minimal bacteriocidal concentration - Lowest concentration that kills 99.9% of the bacteria in the animals plasma or tissues
32
What are the pros and cons or Interrupted verses Continuous Suturing Patterns
Interrupted
* Single Sutures
* If one fails, remainder not affected
* Longer time
* More Suture Material
* More Knots -\> more irritation
Continuous
* Sutures linked together
* Failure
* Less suture material
* Quicker
33
What influences Oncotic (Colloid-oncotic) pressure
Proteins (Main one is Albumin) are negatively charged and attract Na, usually into the vascular space, this is the osmotic drive. However when the vessels become leaky Albumin leaks into the interstitial space which then attracts Na which then drags water causing oedema
34
Explain Suture Material
Poliglecaprone 25 (PGC25, Monocryl)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polymer
2. Monofilament
3. Absorbtion by Hydrolysis, Complete absorbtion 90-120Days
4. Strength Moderate - loss of 50% by 10days, 100% by 21days
5. Good Knot security
6. Minimal to no reactivity
7. Good Handling, Soft, Flexible, No tissue Drag
35
When would you provide antimicrobial prophylaxis for an upcomming surgery?
* Based on wound classification & considerations of other factors
* Primarily recommended for "Clean-Contaminated" and selected "contaminated" wounds
* Not indicated in clean procedures
EXCEPT
* Long procedures (\>90mins)
* Implant Placement
* Infection likely to be castrophic
* Immunocompromised
36
If you have dropped the right ovarian pedicle and/or its bleeding how do you gain access bact to it?
Use the mesoduodenum to pull the small intestine to the left. This exposes :-
* Right Limb of pancreas
* Right kidney/ureter
* Caudate process of the caudate lobe
* Adrenal
* Ovary
* Gonadal Vessels
* CVC, Aorta PV
37
What does this symbol mean?
What is this best used for?
Blunt Point Needle
For delicate tissue like parencema of the liver
38
What are these?
Gelpi Self Retaining Retractors
* Soft Tissue retractor
* Retracts Muscle, fascia
* Sharp pointed tips for minimal tissue contact and minimal trauma
39
There are 3 fluid compartments in the body, what are they?
* Intracellular Fluid (40% total body weight)
* Interstitial Fluid (15% total body weight)
* INtravascular Fluid (Blood 8% Total Body Weight)
We only have access to influence the blood
40
List in order of days for complete absorption of suture material
41
What are these? What are they used for?
Ewald Thumb Forceps
## Footnote
Grooved tips
Moderate / Poor grasping ability
Atraumatic
42
Explain Suture Material
Polydioxanone (PDS)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polymer of Polydioxanone
2. Capillarity - Monofilament
3. Absorbtion - Hydrolysis, Timeframe some absorbtion by 91days, Complete by 182 days (Disadvantage as this is too long)
4. Strength is Excellent - Greater than Nylon, polypropylene, Loss 26% by 14days , 42 by 28days, 86% by 56days
5. Knot Security is Good
6. Little Reaction
7. Difficult to handle - memory, flexability
43
What are these?
What are they used for?
Brown-Adson Thumb Forceps
## Footnote
They have multiple teeth, which have good grasping ability (needle)
Atraumatic
Rather Traumatic?
44
Explain Suture Material
Polyglytone 6211 (Caprosyn)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. ?
2. Monofilament
3. Absorbable 56days for complete absorbtion
4. Only really good for vessel ligation - loss of 50% 5days, 70-80% @ 10 days, 100% at 21days
5. Excellent
6. ?
7. ?
45
What are the physical stages of Wound Healing?
1. Hemostasis
* Vasoconstriction
* Formation of Platelet plug
* Formation of Fibrin Plug
2. Inflammation
* Increased capillary permeability
* Leukocyte migration
* Debridement stage
* Neutrophils
* First 6hrs
* Peak -24-48hrs
* potent chemoattractants
* Monocytes
* Essential
* Later 12hrs
* Peak 48-72hrs
* Wound Macrophage
3. Wound Repair
* Fibroblast Migration
* Migration
* Proliferation
* Desposition of Collagen
* 3-5 days Lag
* Rate \> 7-14days
* Granulation Tissue
* Fills the defect
* Protects the wound (very vascular)
* Barrier
* Surface for epithelial migration
* Wound Contraction (5-9days visible)
* Epithelialization
* Independent event
* \<24hrs phenotypic alterations
* Accumulation of Basement Membrane
* Firmly attached
* Stratify
4. Maturation
* Transition from ECM to "scar"
* Remodeling of ECM (becomes less vascular)
* Months to Years
46
What does Hartmanns (Ringers) have in it other than NaCl
Potassium, Calcium, Magnesium
47
What is the treatment difference between contamination and infection?
* Contamination - you treat topically
* Infection - you treat systemicly
48
Explain Suture Material
Chromic Gut (Cat gut)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strenght?
5. Knot Security?
6. Handling?
7. How can ti be steralized?
1. Composition - Formaldehyde treated submucosa (collagen) of Sheep SI
2. Capillarity - Multifilament
3. Absorbable - Phagocytosis
4. Poor Tensile Strenght
* Chromic Gut - Loss of 50% by 7days, 83% by 14days, 100% by 21days
5. Good Knot security when Dry, when wet it swells decreasing security
6. Good Handling
7. Cannot be Autoclaved as heat denatures proteins
* Ionizing Radiation
* Ethylene Oxide will prolong absorbtion.
49
What is this?
Bone Curette
* Scooping out bone/debris from bony Cavity
50
If you have a surgical site infection what would be the most likely culprit bacteria?
Staph - Gram Positive
51
What type of Scissors are these?
What are they used for?
Metzenbaum
* Used for delicate tissue
* Sharp and Blunt dissection
52
What are the types of wounds you may need to manage?
* Abrasions
* Puncture Wounds
* Bite, Penetrating Object, GunShot
* Lacerations
* Degloving Injuries
* Contusions (Bruise)
* Surgical Wound
* Thermal Burns
* Decubital Ulcers
53
What influences Osmotic Pressure?
Osmotic pressure = determined by number osmotic active particles
* Electrolytes (Na, K)
* GLucose
* Urea
54
Explain Suture Material
Stainless Steel
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Surgical Grade Austentic Steel
2. Monofilament but also can be braided
3. Non-Absorbable
4. Excellent (highest of any)
5. Excellent (Highest)
6. Inert
7. Poor, Fine Suture will cut tissue, can break through twisting and cycling.
55
* We have an non-infected open wound which is exudative and had granulation tissue what dressing would we use?
* If there was no granulation tissue for the same wound what dressing?
* Synthetic Foam
* HydroColloid
56
What is this
Jacob's Bone Chuck
* Adjustable chuck used to hold pins, drill bits, wire
* Key used to tighen chuck
57
Of the absorbable suture material Which ones lose their strenght the quickest and which ones are slower
List them in order
58
What is this?
Backhaus Towel Clamp
* Curved, sharply pointed grasping instrument
* Specifically for attaching towel to skin
* Are contaminated once placed
* Various Sizes
59
How do we prevent infection and promote wound healing in any wound?
* Reduce Microorganism load
* Remove devitalised tissue
* Control Inflammation
* Improve tissue perfusion
* Avoid Cytotoxic environment
60
How often are you required to change a bandage?
Could be up to every 4 days, depending on if the fluid (exudate) starts comming through the bandage.
61
What kind of dressing would we place on a wound with intact epithelium or is a surgical wound.
62
What are these? What are they used for?
Allis Tissue Forceps
* Used to Grasp and retract tissue
* Small Toothed contact end
* Traumatic
* Holding power along the line of pull.
* Use on tissue being removed
* Do not use on skin or viscera
63
When performing a Ovariohysterectomy what ligament do you need to rupture to be able to lift up the pedicle?
Suspensory Ligament
64
What is the Immediate wound care required for any fresh wound?
* Control Hemorrhage
* Reduce microbial contamination
* Lavage
* Topical agents
* Antibiotics
* Antiseptics
* Non-Antibiotic agents - hypertonic saline, honey, essential oils, hydrophilic dressings
* Bandaging
65
What is an Orchiectomy?
Male Sterilisation
66
What bacteria does Ceftazidime (3rd gen Cephalosporin) against?
* Wide spectrum of activity against both **Gram-negative and Gram-positive organisms;** Effective against **Pseudomonas aeruginosa**
67
Name the different types of Wound Debridement
* Layered
* En Bloc - surgical removal of wound
* Enzymatic
68
What is this called?
Balfour abdominal retractor
* Specifically for retracting abdominal wall
* Several Sizes
69
What does Hydrocolloid dessing do/used for?
* Absorb wound fluid --\> gel covered on wound
* Promotes Granulation tissue
* Used on moderate to perfuse exudate
* Keeps wound moist
70
What are these used for?
Ronguers
Bone Cutting, debriding bone
Cannot salvage any bone that is cut.
71
If we have an Dry open wound which either is an Abrasion, in late repair or chronic granulation what kind of dressing would we use?
72
1. What is the weakest part of a suture?
2. With interrupted how many throws do you use?
3. With Continuous how many throws do you use?
1. The knots, reduce strenght by 30-50%
2. 4
3. 5
73
What are some Wound Management/Healing practices/types?
* Primary Wound Closure
* First Intention Healing
* Delayed Primary Closure
* Healing by Contraction and epithelialization (2nd intention healing)
* Second Intention Healing
* Secondary Closure (Third Intention Healing)
74
What is this
Spay Hook (Snook Hook)
* Long instrument with blunt hook at end
* Used specifically for retreiving uterine horn from abdomen
75
Explain Suture Material
Polypropylene (Prolene)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polypropylene Plastic Polymer
2. Monofilament
3. Non-Absorbable
4. Poor Strength Will retain strength in tissue but may break
5. Fair to Good
6. Inert, least thrombogenic
7. Poor Handling
Used for Vascular surgery
76
What is Hydrostatic Pressure?
Hydrostatic Pressure = Osmotic + Oncotic (Colloid-Oncotic)
77
What amount of fluids are given to an animal during anaesthesia?
How do we treat inter-operative hypotension?
* 5ml/kg/h
* Fluid Challange = 3ml/kg over 3mins
* Re-evaluate
* repeat if transient improvement and increase to 10ml/kg/hr
* Re-evaluate
* repeat as long as you can see improvement
78
What is this?
Michele trephine
* Used to cut a core of bone
* Biopsy
* Make a hole into a bone cavity
* Sinus, medullary cavity
79
What are some complications of Wound Healing?
* Inflammation
* Redness, Swelling, Pain, Exudate?
* Seroma (Fluid in dead space)
* Treatment. Prevention
* Dehiscence
* Contracture
80
What are these?
Rochester-Carmalt hemostatic forceps
* Longitudinal Grooves
* Cross sections at tips
* Straight or Curved
* Use on large vessels/pedicles
* Atraumatic
* No space when closed
81
A wound exposed to the environment would more than likely bave Gram Positive or Gram Negative bacteria in it?
Gram Negative
82
What is a Coeliotomy?
What everyone calls a laparotomy (This is actually if you go in from the flank).
A ventral midline incision
83
What is this?
Periosteal Elevator
## Footnote
Used to lift Muscle off bone
84
Explain Suture Material
Caprolactam (Vetafil, Supramid, Braunamid)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polyamide Plastic Covered by coating of proteinaceous material (Nylon)
2. Multifilament
3. Non-absorbable
4. Good
5. Fair Security
6. Coating breaks down and increases tissue drage
7. Good Handling
85
When closing SubCutis and Skin after an Ex Lap what suture material and types would you use?
* Subcutis
* Simple Continous
* Bites close to skin either parallel or perpendicular
* 4/0 - 3/0 monofilament absorbable
* Skin
* Cruciate, Interupped, Interlocking
* 4/0 - 3/0 monofilament nonabsorbable
* Intraedermal
86
How much Fluid/kg/hr is Maintenance?
2ml/kg/hr
87
You have a wound on an animal which you need to prepare the area around the wound before surgery. How do you do this?
You dont want the surgical preperations to enter the wound so you need to temporally close the wound by either :-
* Gauze spounge in the wound
* Towel Forceps
* Sterile water soluble lubriucating jelly
* Contiunous Suture
88
What is this
Yankauer Suction Tip
89
What bacteria does Cefoxitin (2nd gen Cephalosporin) work against?
* **Anaerobic** and **Gram-negative** bacilli
90
Surgical wounds are classified by degree of contamination what are these classifications? And give examples of these.
* Clean
* Ex Lap
* Castration
* Ovariectomy/Ovariohysterectomy
* Orthopaedic procedures
* Clean Contaminated
* Enterotomy
* Intestinal anastamosis
* Cystomtomy
* Cholecystectomy
* Pyometra
* Contaminated
* Enterotomy/intestinal anastamosis with spillage
* Cystotomy and Cholecystectomy with leakage of INFECTED urine or bile
* Pyometra with leakage
* Recent dog bite wound
* Dirty
* Leakage from perforated viscera
* Infected operation sites
* Septic peritonitis
* Abscesses
91
What does this symbol mean?
What is it used for?
Conventional Cutting Needle, Curved 3/8
Cutting through tissue however this can be bad.
92
What is the purpose of Suturing?
* Provide wound strength during lag phase
* Promote tissue apposition
* Allow Primary (1st intention) wound healing.
* Water tight seal (Viscus)
93
What are these for/Called?
DeBakey Thumb Forceps
* Longer tissue forcep
* Longitudinal groove with transverse, recessed groove in centre
* Atraumatic
* Moderate / Poor tissue grasping effect
* Deep Surgical fields, delicate tissue
94
What orthopedic tools are these
Bone Cutting Forceps
* Paired Chisel tips
* Sharp (imprecise) cutting of bone
* Some Crushing/Damage to bone edges
* Single or double action.
95
What does Ringers with Lactate do in the body?
This will produce more HCO3 which is then metabolised to CO2 and H20
96
What are these scissors and what are they used for?
Mayo
* Dense Tissue
* Sharp Dissection
* Heavier and Shorter than the Metzenbaum Scissors.
* Used for cutting Dense Tissue like fascia
97
If you have an open wound that you need to bandage, what dressings would you use?
* Hydrogel (Hydrophillic)
* Hydrophillic foam
* Hydrocolloid
* Hypertonic Saline (Curasalt)
* Silver Nanoparticle Impregnanted dressing
98
What are these?
Finochetto rib retractor
* Retracting thoracic wall (ribs)
* Ratchet System
* Mechanical advantage
* Care not to over retract and fx ribs.
99
* A solution which has less salt than normal plasma what is this called?
* If the solution salt level matches the plasma what is it called?
* What is it called if the solution has more salt than plasma?
* Hypotonic 0.4% - used for Maintainence
* Isotonic 0.9% - Used for replacement fluids
* Hypertonic 7.5% - Used for increase osmotic fluid (during shock)
100
What is this
Stifle Retractor
* Veterinary Specific
* Asymmetric Jaws
* Self Retaining
In OSCE Exam!
101
Explain Suture Material
Polyglactin 910 (PG910, Vicryl)
1. What is it made from?
2. What type of filament is it?
3. Absorbable or Non-Absorbable? If so how and timeframe?
4. Tensile Strength?
5. Knot Security?
6. Reactivity?
7. Handling?
1. Polymer of glycolic and lactic Acid
2. Capillarity - Multifilament
3. Absorbable - Hydrolysis, Complete absorption by 40-90days
4. Good Tensile Strength
* Loss of 50% by 14days, 80% by 21days
5. Poor Knot Security
6. Well Tolerated
7. Good Handling but considerable tissue drag
102
What are some factors that can inhibit wound healing?
* Physical Factors
* Infection
* Foreign Bodies (Sutures)
* Vascularity
* Electrosurgery, Laser
* Nutrition
* Radiation
* Disease
* Diabetes Mellitus
* Hyperadrenocortism (Cushings Disease)
* Liver Disease
* Obesity
* Drugs
* Corticosteroids (Therapy, Stress, Hyperadrenocorticism)
* NSAIDS
* Anabolic Steroids
* Chemotherapy
103
What does this symbol mean?
What is it used for?
Taper Point Needle
Very Sharp penetrate easy subcutaneous tissue
104
What does this symbol represent?
What is it used for?
Tapercut needle
Used for suturing intestine, urinary bladder or some fascia.
