Surgery Residents Flashcards
Questions asked by residents (68 cards)
name of the classification system for perihilar cholangiocarcinoma
Bismuth-Corlette
classification of gastric ulcers
1: antrum, near lesser curvature.
2: combined gastric and duodenal
3: prepyloric
4: proximal stomach, near cardia
antecolic vs. retrocolic approach for Roux-en-Y gastric bypass
retrocolic creates more potential internal hernia sites (i.e. Petersen defect), more bowel obstructions. antecolic requires longer length of the roux limb and puts more strain on the limb.
rouviere’s sulcus (incisura hepatica dextra, Gans incisura)
naturally occurring cleft in the R lobe of the liver. useful landmark for beginning dissection of Calot’s triangle.
Petersen defect
opening between the mesentery of the alimentary loop and the transverse mesocolon. a potential internal hernia site for a retrocolic roux limb in lap RNYGB.
Rigler’s triad for gallstone ileus
SBO + gallstone outside the gallbladder + pneumobilia
name of the classification system for bile duct injury
Strasberg
what is the most common bile duct injury?
transection of the CBD
what is the recurrence rate for PSC after liver transplant?
up to 10%
when patient has total colectomy for ulcerative colitis, which of the associated symptoms is cured?
erythema nodosum
McBurney’s point
1/3 distance from ASIS to umbilicus
Rovsing sign
positive if palpation of LLQ increases pain in RLQ
RNYGB vs. sleeve gastrectomy
RNYGB: both restriction and malabsorption, greater weight loss. SG:
why does patient has multiple bowel movements after total colectomy?
no colon for water absorption so increased water in stool
what is acceptable blood glucose levels for wound healing?
140-180
how does hyperglycemia contribute to poor wound healing?
increased amount of blood sugar leads to stiff and rigid cell walls > impaired blood flow through small vessels located at wound surface > impedes flow and permeability of RBCs (required for development of dermal tissue). impair Hb release of O2 > starves affected area of oxygen and nutrients that promote wound healing.
how long do you have to be off Plavix (clopidogrel) and why?
aspirin and/or plavix should be stopped 7-10 days before surgery. platelets blocked by clopidogrel are affected for the remainder of their lifespan (7-10 days).
what is the mechanism of action of Plavix?
irreversibly blocks P2Y12 component of ADP receptors on platelet surface > prevents activation of GPIIb/IIIa receptor complex > reducing platelet aggregation
cantlie’s line
a plane without any surface markings running from the gallbladder to the L side of the lVC divide the liver into R and L lobes; also known as portal fissure or the line of the main scissura
what are the watershed areas?
regions of the body that receive dual blood supply from the most distal branches of two large arteries. splenic flexure receives blood from SMA and IMA. sigmoid colon and rectum receive blood from iliac and pudendal circulations.
what is the significance of watershed area?
during times of blockage, these regions spared from ischemia because of dual blood supply. during systemic hypoperfusion, these regions particularly vulnerable to ischemia because they are supplied by the most distal branches of their arteries and thus least likely to receive sufficient blood.
what is the normal size of the cecum?
3-6-9 rule: <3cm dilation for small bowel, <6cm dilation for colon, <9cm dilation for cecum and sigmoid
why do patients on neostigmine have to be on tele? what is treatment?
causes bradycardia. stop neostigmine drip and give atropine.
types of endoleak
type 1: leak after graft ends (inadequate seal); 1a= proximal, 1b=distal, 1c=iliac occluder.
type 2: sac filling via branch vessel; MC after AAA repair; 2a=single vessel; 2b=2+ vessels.
type 3: leak through defect in graft fabric (mechanical failure of graft); 3a=junctional separation of modular components;3b=fractures/holes involving endograft.
type 4: generally porous graft (intentional design graft).
type 5: endotension.
