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Flashcards in Surgery LE 1 - Boxes Deck (59):
1

Locations and Causes of Referred Pain

Right Shoulder

Liver
Gallbladder
Right hemidiaphragm

2

Locations and Causes of Referred Pain

Left Shoulder

Heart
Tail of pancreas Spleen
Left hemidiaphragm

3

Locations and Causes of Referred Pain

Scrotum and Testicles

Ureter

4

Nonsurgical Causes of the Acute Abdomen - 3

Endocrine and Metabolic Causes

Hematologic Causes

Toxins and Drugs

5

Surgical Acute Abdominal Conditions - 5

Hemorrhage

Infection

Perforation

Blockage

Ischemia

6

Associated symptoms can be important diagnostic clues.

What are they?

Nausea, vomiting, constipation, diarrhea, pruritis, melena, hematochezia, and/or hematuria can all be helpful symptoms if present and recognized.

7

Murphy's sign

Pain caused by inspiration while applying pressure to right upper abdomen


Acute cholecystitis

8

Rovsing's Sign

Pain at McBurney’s point when compressing the left lower abdomen

Acute appendicitis

9

Aaron's Sign

Pain or pressure in epigastrium or anterior chest with persistent rm pressure applied to McBurney’s point

Acute appendicitis

10

Technique to test Peritonitis

– ask pt to take a deep breath → sudden sharp
pain (+ sign) do not shake the bed

11

Obturator sign

Flexion and external rotation of right thigh while supine creates hypogastric pain

Pelvic abscess or in ammatory mass in pelvis

12

Order-specific steps in physical examination:

1. General Appearance
2. Vital signs
3. Inspection
4. Auscultation
5. Percussion
6. Palpation

G VIA PerpP

13

Iliopsoas

Elevation and extension of leg against resistance creates pain

Apppendicitis with retrocecal abscess

14

Clean Wound

(5%)

o No infection is present
o Surgery of breast, thyroidectomy and simple hernia
o Cut under sterile conditions
o No prophylaxis

15

Clean Contaminated –

(10%)

o Respiratory, alimentary or genitourinary under
controlled circumstances without spillage of contents

o Give prophylactic antibiotics immediately prior to
surgery --
Immediately prior to surgery (30min/1hr)
1 dose only unless the procedure is longer than the half life

16

Contaminated

(15%)

o Contamination of sterile area of the body due to
spillage of contents (e.g. stab wounds)

o With antibiotic prophylaxis

o e.g. acute appendicitis

17

Dirty

– 3.1-12.8%

Necrotic tissue and purulent material is present (e.g. fecal material)

e.g. diabetic foot gangrene

18

UNDER AGE 50 consulting for

in order!!

Non-specific abdominal pain

Appendicitis

Cholecystitis

19

OVER AGE 50 consulting for

in order!!

Cholecystitis

Non-specific abdominal pain

Appendicitis

20

pain in EPIGASTRIC REGION:

stomach, duodenum, biliary tract

21

pain in PERIUMBILICAL:

small bowel, appendix, cecum

22

Referred Pain

Ureteral obstruction –




testicular pain.

23

Referred Pain

2) Subdiaphragmatic infection –

ipsilateral shoulder or supraclavicular pain.

24

Referred Pain

3) Biliary disease –

right infrascapular pain.

25

Referred Pain

4) MI –

epigastric, neck, jaw or UE pain.

26

Referred Pain

5) Gynecologic pathology –

back or proximal lower
extremity

27

5 Categories of Acute Abdomen

(BIOPI)

• Bleeding or rupture of vessel, or tumor

• Ischemia or Infarction

• Obstruction

• Perforation

• Inflammation

28

5. Most common cause of ssi

A. Enteric microorganism

29

6. not a host defense of skin:

A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage

D. macrophage

30

7. organ in which presence of microorganism is important for host defense:

A. urogenital tract
b. Biliary tract
c. lungs
d. colon

d. colon

31

Infection rate of elective cholecystectomy

10%

32

CHARACTERISTICS OF PAIN

Precipitating or Alleviating Factors
• Quality – Bright, sharp, dull, achy
• Radiation – Scapula, inguinal, supraclavicular
• Severity – 1-10 scale (intensity is based on the frame
of reference of the patient. Be careful in suggesting a
scale)
• Timing – Sudden, insidious, crampy or continuous

33

The type of wound with multiple deep abrasions and lacerations secondary to vehicular accident

contaminated

34

29. Multiple cutaneous abscesses that spread
through dermis into the subcutaneous region and are commonly seen in diabetic patients.

A. feruncle
B. carbuncle
C.hydradentis suppurativa
D. cellulitis

B. carbuncle

35

Handwashing using chlorine water

Ignaz Semmelweis

36

Stated that the patient dies due to inflammatory response to infection

William Osler

37

5. Most common cause of ssi

A. Enteric microorganism
B. Anaerobic gram (+)
C. aerobic skin commensal
D. Aerobic gram (-)

A. Enteric microorganism

38

6. not a host defense of skin:

A. epithelial surface
b. Chemical substance
c. shredding of the epithelium
D. macrophage

D. macrophage

39

7. organ in which presence of microorganism is important for host defense:

A. urogenital tract
b. Biliary tract
c. lungs
d. colon

d. colon

40

Infection rate of elective cholecystectomy

5%
10%
15%

10%


explanation:
5% = clean
10% = clean contaminated
15% = contaminated

41

Wound classification of penetrating abdominal trauma

Contaminated

42

peritonitis seen in patients with ascites and patients undergoing peritoneal dialysis

primary

43

12. type of peritonitis which requires minimal surgical intervantion

Primary

44

Type of peritonitis seen in perforated acute appendicitis

Secondary

45

14. Type of peritonitis seen after colon resection and anastomosis of perforated diverculitis

Secondary

46

15. Type of peritonitis managed by surgery

a.primary
b.secondary
c.tertiary
d.peritonitis like syndrome

b.secondary (ans)

47

What is the most common cause of pyogenic liver abcess

cholecystitis

any infection in gut

48

This is frequently seen in acne and usually begins in hair follicles

Furuncle

49

Surgical removal of perforated sigmoid
dirty wound

contaminated

50

Thyroid gland surgery is a

- Clean wound

51

Most common cause of abdominal pain under 50 -

Non specific abdominal pain

52

Protein-energy malnutrition and dietary deficiencies = Marasmus

a. lack of protein and calories
b. lack of protein only

lack of protein and calories

53

Protein-energy malnutrition and dietary deficiencies = Kwashiorkor

a. lack of protein and calories
b. lack of protein only

b. lack of protein only

54

LOW RESIDUE ISOTONIC FORMULA

1st line formula for stable patient with intact GI tract

55

ISOTONIC FORMULAS WITH FIBER

Fiber stimulates pancreatic lipase activity and are
degraded by gut bacteria into short-chain fatty acids, an
important fuel for colonocytes

56

IMMUNE ENHANCING FORMULAS

Additives includes glutamine, arginine, branch-chain amino acids, omega-3 FA, nucleotides and beta-carotine

57

CALORIE-DENSE FORMULA

Greater caloric value for the same volume to 2 Kcal/mL

58

HIGH-PROTEIN FORMULAS

 Isotonic and nonisotonic mixtures and are proposed for critically ill or trauma patients with high protein requirements

59

ELEMENTAL FORMULA

 Predigested nutrients