Surgical Basics Flashcards
(74 cards)
1
Q
What is meant by the prefix ‘laparo’?
A
Refers to the abdomen
2
Q
What is meant by the prefix ‘thoraco’?
A
Refers to the thorax
3
Q
What is meant by the prefix ‘colo’?
A
Refers to the colon
4
Q
What is meant by the prefix ‘cysto’?
A
Refers to the bladder
5
Q
What is meant by the prefix ‘gastro’?
A
Refers to the stomach
6
Q
What is meant by the prefix ‘mammo/masto’?
A
Refers to the breast
7
Q
What is meant by the prefix ‘myo’?
A
Refers to muscle tissue
8
Q
What is meant by the prefix ‘nephro’?
A
Refers to the kidney
9
Q
What is meant by the prefix ‘orchid’?
A
Refers to the testes
10
Q
What is meant by the prefix ‘rhino’?
A
Refers to the nose
11
Q
What is meant by the prefix ‘lobo’?
A
Refers to a lobe of an organ
12
Q
What is meant by the suffix ‘otomy’?
A
Refers to surgically cutting open a structure
13
Q
What is meant by the suffix ‘oscopy’?
A
Refers to viewing with a scope or keyhole surgery
14
Q
What is meant by the suffix ‘ectomy’?
A
Refers to surgical removal of a structure
15
Q
What is meant by the suffix ‘plasty’?
A
Refers to changing the shape of a structure
16
Q
What is meant by the suffix ‘pexy’?
A
Refers to fixing a structure in place
17
Q
What is meant by the suffix ‘centesis’?
A
Refers to puncturing a structure with a needle
18
Q
What is meant by the suffix ‘ostomy’?
A
Refers to creating a new opening for a structure
19
Q
What is meant by the suffix ‘itis’?
A
Refers to inflammation of a structure
20
Q
What is meant by the suffix ‘algia’?
A
Refers to pain
21
Q
What is meant by the suffix ‘gram’?
A
Refers to a recording or imaging
22
Q
What is meant by the term adhesion?
A
Adhesions are the term used to describe scar tissue within the abdomen that attaches contents together
23
Q
What is meant by the term fistula?
A
A fistula is an abnormal connection between two epithelial surfaces
24
Q
What is meant by the term tenesmus?
A
Tenesmus describes the feeling of a full rectum and/or the need to open the bowels without being able to pass stools. This can also be used to describe the feeling of incomplete evacuation
25
What is a hemicolectomy procedure?
Removal of a portion of bowel
26
What is a Hartmann's procedure?
Removal of the rectosigmoid colon and formation of a colostomy
27
What is a Whipple's procedure?
Removal of the head of the pancreas, duodenum, gallbladder and bile duct
28
Which procedure is a Kocher incision used for?
Open cholecystectomy
29
Which procedures are Chevron/Rooftop incisions used for?
- Liver transplant
- Whipple's procedure
- Pancreatic surgery
- UGI surgery
30
Which procedure is a Mercedes-Benz incision used for?
Liver transplant
31
Which procedure is an abdominal midline incision used for?
General laparotomy
32
Which procedure is an abdominal paramedian incision used for?
Laparotomy although not widely used
33
Which procedure is a Hockey-stick incision used for?
Renal transplant
34
Which procedure is a Battle incision used for?
Open appendectomy
35
Which procedure is Gridiron/McBurney incision used for?
Open appendectomy
36
Which procedure is a Lanz incision used for?
Open appendectomy
37
Which procedure is a Rutherford-Morrison incision used for?
Open appendectomy and colectomy
38
Which two incisions are used for Caesarean section? (2)
- Pfannenstiel Incision; curved incision two fingers width above the pubic symphysis
- Joel-Cohen Incision; straight incision that is slightly higher
39
Which incisions are used for laparoscopic surgery?
- Several 5-10mm incisions for port insertion
| - Usually the umbilicus is used for one of these
40
What are the two types of diathermy and when are they used?
- Monopolar diathermy; one electrode with a grounding plate placed beneath the area, these are used in larger operations
- Bipolar diathermy; two electrodes with current passed between them, these are used in microsurgery
41
What are the two main types of suture material?
- Absorbable; vicryl, monocryl
| - Non-absorbable; silk, nylon, polyprene
42
Where are absorbable sutures used?
- Within the abdominal cavity
| - Closing tissues beneath the epidermis
43
Where are non-absorbable sutures used?
- Closing the skin surface (epidermis)
- Fixing drains in place
- Connective tissues such as tendons
44
Which kind of stitches are used for closing up the subcutaneous tissues?
Absorbable stitches
45
What techniques can be used to close the surface layer of skin (epidermis)? (5)
- Staples
- Interrupted sutures
- Mattress sutures
- Continuous sutures
- Subcuticular wound closure
46
At which points is the WHO Surgical Safety Checklist carried out? (3)
- Before the induction of anaesthesia
- Before the first skin incision
- Before the patient leaves theatre
47
Outline some of the factors considered when completing the WHO Surgical Safety Checklist?
- Patient identity
- Allergies
- Operation to be carried out
- Risk of bleeding
- Introductions of all team members
- Anticipated critical events
- Counting of the number of instruments and sponges etc.
48
What factors need to be considered as part of pre-operative care? (6)
- Pre-operative assessment carried out
- Consent
- Bloods (G&S +/- RXM)
- Fasting
- Medication changes
- VTE assessment
49
What needs to be considered as part of a pre-operative assessment?
- Anaesthetic risk
- Co-morbidities
- PMHx
- PSHx
- DHx
- Allergies
- Smoking
- Alcohol
- Pregnancy in women of child-bearing age
- Nourishment status
50
Outline the American Society of Anaesthesiologists (ASA) grading of anaesthetic risk?
- ASA I; normal, healthy patient
- ASA II; mild systemic disease
- ASA III; severe systemic disease
- ASA IV; severe systemic disease that constantly threatens life
- ASA V; moribund and expected to die without the operation
- ASA VI; declared brain-dead and undergoing an organ donor operation before death
- ASA E; used only in emergency situations
51
Which investigations may be required as part of the pre-operative assessment?
- ECG
- Echocardiogram
- Lung function tests
- Arterial blood gas testing
- HbA1c
- U&Es
- FBC
- CS
- G&S +/- RXM
- MRSA Screen
52
Outline the typical fasting regimen used before surgery?
- No food or feeds for 6hrs prior to procedure
| - No clear fluids for 2hrs prior to procedure
53
Which medications need to be stopped prior to surgery?
- Anticoagulants; 24-72hrs prior, monitor INR
| - Oestrogen containing oral contraception; 4 weeks prior
54
Which medications need dose adjustment prior to surgery?
Long-term corticosteroids > 5mg prednisolone PO
- Additional IV hydrocortisone
- Doubling of normal dose once eating and drinking for 24-72 hrs
55
Which diabetes drugs needs to be carefully considered and/or adjusted prior to surgery? (4)
- Sulfonylureas; risk of hypoglycaemia
- Metformin; risk of lactic acidosis
- SGLT2 inhibitors; risk of diabetic ketoacidosis
- Insulin; variable-rate insulin infusion often used
56
Outline the components of VTE prophylaxis that must be considered prior to surgery?
- LMWH
- DOACs
- Intermittent pneumatic compression
- Anti-embolic compression stockings
57
Which four things are needed for the patient to be deemed to have capacity? (4)
- Understand the information and the decision made
- Retain information long enough to make a decision
- Weigh up the information in order to make a decision
- Communicate the decision
58
How are decisions for treatment made in patients that lack capacity? (3)
- Best interest decisions (BID); decided by clinicians at MDT
- Lasting power of attorney (LPA); patient legally nominates another person
- Deprivation of liberty safeguards (DoLS); application made by hospital or care home
59
Outline the circumstances where each of the four types of consent form are used? (4)
- Consent Form 1; used for patient consent
- Consent Form 2; used for parental consent for a child
- Consent Form 3; used where the patient won't have their consciousness impaired throughout
- Consent Form 4; used when the patient lacks capacity
60
What are the fundamental principles of enhancing patient recovery? (3)
- Patient mobilisation
- Patient independence
- Patient discharge as soon as deemed optimal
61
Aside from relief of pain, what are the other benefits of analgesia in post-operative care? (3)
- Encourages patient to mobilise
- Allows patient to ventilate their lungs fully to reduce infection risk
- Enables adequate oral intake
62
In which patients are NSAIDs contraindicated in for post-operative care? (4)
- Asthma
- Renal impairment
- Heart disease
- Stomach ulcers
63
What is patient controlled analgesia (PCA)?
Patient controlled analgesia involves the use of an intravenous infusion of a strong opiate that the patient can self-administer through a button active at pre-set intervals to prevent over-use.
64
Outline some of the risk factors for post-operative nausea and vomiting (PONV)? (6)
FUYNY HU?;
- Female
- Used of post-operative opiates
- Non-smoker
- Younger age
- History of motion sickness or PONV
- Use of volatile anaesthetics
65
Which drugs can be used as prophylactic antiemetics at the end of the procedure? (3)
- Odansetron (5-HT3R antagonist); contraindicated if risk of prolonged QT
- Dexamethasone (corticosteroid); caution in diabetics and immunocompromised patients
- Droperidol (D2R antagonist); contraindicated in patients with PD
66
Which drugs can be used as rescue antiemetics in the post-operative period? (3)
- Odansetron (5-HT3R antagonist); contraindicated if risk of prolonged QT
- Prochlorperazine (D2R antagonist); contraindicated in patients with PD
- Cylcizine (H1R antagonist); caution in heart failure and the elderly
67
What is the P6 acupuncture point?
A point on the inner wrist that is mentioned in the NICE guidelines as a potential point at which pressure may be applied to reduce nausea.
68
When may drains be removed post-operatively?
When they are draining minimal/no fluid or blood
69
When may nasogastric tubes be removed post-operatively?
When they are no longer required for intake or drainage of fluid or gas
70
When may catheters be removed post-operatively?
When the patient is able to mobilise to the toilet
71
What are the main ways a patient may receive enteral feeding? (3)
- By mouth (oral intake)
- Via a nasogastric (NG) tube
- Via a percutaneous endoscopic gastrostomy (PEG) tube
72
What option is used to provide total nutritional requirements to patients unable to use their gastric tract?
Total parenteral nutrition (TPN); involves and intravenous infusion of carbohydrates, fats, proteins, vitamins and minerals
73
Outline the most common post-operative complications? (13)
- Anaemia
- Atelectasis
- Infections
- Wound Dehiscence
- Ileus
- Haemorrhage
- VTE; DVT or PE
- Shock; hypovolaemic, septic or cardiogenic
- Arrhythmia
- ACS/Cerebrovascular Accidents
- AKI
- Urinary Retention
- Delirium
74
Which blood test must be performed post-operatively?
FBC; specifically looking at the Hb
