Surgery Pretest Flashcards
(41 cards)
Complication of jejunoileal bypass surgery that may cause nephrolithiasis?
Hyperoxaluria
GI conditions that cause hypomagnesemia?
malnourishment, large GI fluid loses (Crohns, UC, diarrhea)
EKG differences between hypocalcemia and hypomagnesemia?
Hypocalcemia: Long QT, T-wave inversion, heart blocks
Hypomagnesemia: Long QT and PR, ST depression, flattening or inversion of P waves, tornado de pointe
Neuromuscular effects of hypomagnesemia?
Resembles hypocalcemia: paresthesias, hyperreflexia, muscle spasm, ultimately tetany.
Antibiotic therapy for elective colon resections: # of doses, route, spectrum, need for additional doses?
: only one dose, less than one hour before surgery
Route: IV and non-absorbable oral (colon only)
Spectrum: Aerobes and anaerobes (again, colon spec)
Additional: Based on drug half-life if case is long and complex. No Abx for more than 24 hours.
In a patient with hx of MI more than 6 months ago, what is the appropriate testing for elective surgical clearance?
Cardio stress test followed by echocardiogram.
Exercise stress test is appropriate if patient is able, otherwise persantine thallium pharmacologic test is done.
Sign of uncompensated metabolic alkalosis?
normal PCO2. Respiratory compensation raises PCO2, and metabolic processes affect HCO3, not PCO2.
Patient with NG tube, hypochloremic, hypokalemic metabolic alkalosis. Tx? Pathophys?
Tx: Normal saline infusion, +/- KCl infusion.
Pathphys: Volume depletion leads to Na and water retention, reducing kidney’s output and ability to excrete HCO3. Volume replenishment reverses this.
Indications for placement of vena cava filter
1 - contraindication to heparin
2 - Failure of anticoagulation therapy (i.e. PE with adequate anticoagulation, etc.)
3 - known, free floating venous clot,
4 - previous history of PE
In other words, try anticoagulation first and place filter later if needed
Effect of transfusion reaction? Sx of intraoperative and postoperative transfusion reaction?
Diffuse loss of clot integrity. Hot compliment mediated hemolysis causes hypotension, activates coagulation and DIC. fever, chills, pain, redness on infused vein, respiratory distress, anxiety, oliguria
Intra: Sudden appearance of diffuse bleeding
Post-op: unexplained fever, apprehension, headache
HIT: Complications, immediate treatment, long term tx?
Complications: venous and/or arterial thromboembolic events.
Immed Tx: DC all heparins, use non-heparin anticoag like lepirudin or agatroban (direct thrombin inhibitors)
Long term tx: transition to warfarin only after plt > 100,000
Stages of SIRS and sepsis and their definitions?
SIRS: T 38+/36- HR 90+ R 20+/PCO2 32- WBC 12+ 4-
Sepsis: SIRS + documented infection
Severe Sepsis: Sepsis + organ dysfunction OR hypo perfusion (lactic acidosis, oliguria, AMS)
Septic shock: Sepsis + organ dysfunction AND hypo perfusion (SBP 90- or 90+ with pressors)
Timing of feeding post intestinal surgery?
Early enteral nutrition is recommended. Stomach is uncoordinated for ~24 hrs after surgery, but small intestine accepts nutrients promptly (less than 24hrs) via nasoduodenal or jejunal catheter.
Def high output fistula?
500+ mL/day
Factors that predispose to fistulae formation or prevent closure?
FRIENDS:
Foreign body, Radiation, Inflammation, Epithelialization of the tract, Neoplasm, Distal obstruction, Steroids
Signs of adrenal insufficiency?
AMS, fever, CV collapse, hypoglycemia, hyperkalemia.
Like sepsis, but with glycemic and K+ changes
Pre-op care for patients with hemophilia A?
A is for Eight! VIII deficiency
Mild hemophilia: DDAVP
Severe hemo: DDAVP and E-aminocaproic acid (anti fibrinolytic)
Replacement fluids for fluid loss in various parts of the GI tract?
Duodenum, jejunum, ileum and bile = Ringer Lactate
Saliva, gastric juice, right colon = High K+, low Na+
Pancreatic secretions = High bicarb
Kayexalate MOA?
Cation exchange resin that exchanges sodium for K+ in the gut.
symptoms of zinc deficiency?
Alopecia, poor wound healing, night blindness or photophobia, anosmia, neuritis, skin rashes. Often develops with diarrhea.
Symptoms of selenium deficiency?
Development of cardiomyopathy
Symptoms of molybdenum deficiency?
Encephalopathy due to accumulation of sulfur containing amino acids
Symptoms of chromium deficiency?
Difficult to control hyperglycemia, peripheral neuropathy, encephalopathy
Thiamine deficiency?
Beri-beri - encephalopathy and peripheral neuropathy. Cardiac symptoms and heart failure may occur as well.
