Surgery LE 1 - Boxes Flashcards by Frankie Aguinot

Locations and Causes of Referred Pain

Right Shoulder

Liver
Gallbladder
Right hemidiaphragm

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Locations and Causes of Referred Pain

Left Shoulder

Heart
Tail of pancreas Spleen
Left hemidiaphragm

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Locations and Causes of Referred Pain

Scrotum and Testicles

Ureter

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Nonsurgical Causes of the Acute Abdomen - 3

Endocrine and Metabolic Causes

Hematologic Causes

Toxins and Drugs

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Surgical Acute Abdominal Conditions - 5

Hemorrhage

Infection

Perforation

Blockage

Ischemia

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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.

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Murphy’s sign

Pain caused by inspiration while applying pressure to right upper abdomen

Acute cholecystitis

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Rovsing’s Sign

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

Acute appendicitis

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Aaron’s Sign

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

Acute appendicitis

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Technique to test Peritonitis

– ask pt to take a deep breath → sudden sharp

pain (+ sign) do not shake the bed

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Obturator sign

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

Pelvic abscess or in ammatory mass in pelvis

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Order-specific steps in physical examination:

General Appearance
Vital signs
Inspection
Auscultation
Percussion
Palpation

G VIA PerpP

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Iliopsoas

Elevation and extension of leg against resistance creates pain

Apppendicitis with retrocecal abscess

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Clean Wound

(5%)

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

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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

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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

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Dirty

– 3.1-12.8%

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

e.g. diabetic foot gangrene

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UNDER AGE 50 consulting for

in order!!

Non-specific abdominal pain

Appendicitis

Cholecystitis

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OVER AGE 50 consulting for

in order!!

Cholecystitis

Non-specific abdominal pain

Appendicitis

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pain in EPIGASTRIC REGION:

stomach, duodenum, biliary tract

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pain in PERIUMBILICAL:

small bowel, appendix, cecum

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Referred Pain

Ureteral obstruction –

testicular pain.

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Referred Pain

2) Subdiaphragmatic infection –

ipsilateral shoulder or supraclavicular pain.

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Referred Pain

3) Biliary disease –

Study These Flashcards

right infrascapular pain.

Referred Pain 4) MI –

epigastric, neck, jaw or UE pain.

Referred Pain 5) Gynecologic pathology –

back or proximal lower | extremity

5 Categories of Acute Abdomen

(BIOPI) * Bleeding or rupture of vessel, or tumor * Ischemia or Infarction * Obstruction * Perforation * Inflammation

5. Most common cause of ssi

A. Enteric microorganism

6. not a host defense of skin: A. epithelial surface b. Chemical substance c. shredding of the epithelium D. macrophage

D. macrophage

7. organ in which presence of microorganism is important for host defense: A. urogenital tract b. Biliary tract c. lungs d. colon

d. colon

Infection rate of elective cholecystectomy

10%

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

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

contaminated

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

Handwashing using chlorine water

Ignaz Semmelweis

Stated that the patient dies due to inflammatory response to infection

William Osler

5. Most common cause of ssi A. Enteric microorganism B. Anaerobic gram (+) C. aerobic skin commensal D. Aerobic gram (-)

A. Enteric microorganism

6. not a host defense of skin: A. epithelial surface b. Chemical substance c. shredding of the epithelium D. macrophage

D. macrophage

7. organ in which presence of microorganism is important for host defense: A. urogenital tract b. Biliary tract c. lungs d. colon

d. colon

Infection rate of elective cholecystectomy 5% 10% 15%

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

Wound classification of penetrating abdominal trauma

Contaminated

peritonitis seen in patients with ascites and patients undergoing peritoneal dialysis

primary

12. type of peritonitis which requires minimal surgical intervantion

Primary

Type of peritonitis seen in perforated acute appendicitis

Secondary

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

Secondary

15. Type of peritonitis managed by surgery a. primary b. secondary c. tertiary d. peritonitis like syndrome

b.secondary (ans)

What is the most common cause of pyogenic liver abcess

cholecystitis any infection in gut

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

Furuncle

Surgical removal of perforated sigmoid | dirty wound

contaminated

Thyroid gland surgery is a

- Clean wound

Most common cause of abdominal pain under 50 -

Non specific abdominal pain

Protein-energy malnutrition and dietary deficiencies = Marasmus a. lack of protein and calories b. lack of protein only

lack of protein and calories

Protein-energy malnutrition and dietary deficiencies = Kwashiorkor a. lack of protein and calories b. lack of protein only

b. lack of protein only

LOW RESIDUE ISOTONIC FORMULA

1st line formula for stable patient with intact GI tract

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

IMMUNE ENHANCING FORMULAS

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

CALORIE-DENSE FORMULA

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

HIGH-PROTEIN FORMULAS

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

ELEMENTAL FORMULA

 Predigested nutrients

Surgery LE 1 - Boxes Flashcards

(59 cards)