Surgical Basics Flashcards Preview

FinalMB Part I - Surgery > Surgical Basics > Flashcards

Flashcards in Surgical Basics Deck (74)
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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
Q

What is a hemicolectomy procedure?

A

Removal of a portion of bowel

26
Q

What is a Hartmann’s procedure?

A

Removal of the rectosigmoid colon and formation of a colostomy

27
Q

What is a Whipple’s procedure?

A

Removal of the head of the pancreas, duodenum, gallbladder and bile duct

28
Q

Which procedure is a Kocher incision used for?

A

Open cholecystectomy

29
Q

Which procedures are Chevron/Rooftop incisions used for?

A
  • Liver transplant
  • Whipple’s procedure
  • Pancreatic surgery
  • UGI surgery
30
Q

Which procedure is a Mercedes-Benz incision used for?

A

Liver transplant

31
Q

Which procedure is an abdominal midline incision used for?

A

General laparotomy

32
Q

Which procedure is an abdominal paramedian incision used for?

A

Laparotomy although not widely used

33
Q

Which procedure is a Hockey-stick incision used for?

A

Renal transplant

34
Q

Which procedure is a Battle incision used for?

A

Open appendectomy

35
Q

Which procedure is Gridiron/McBurney incision used for?

A

Open appendectomy

36
Q

Which procedure is a Lanz incision used for?

A

Open appendectomy

37
Q

Which procedure is a Rutherford-Morrison incision used for?

A

Open appendectomy and colectomy

38
Q

Which two incisions are used for Caesarean section? (2)

A
  • Pfannenstiel Incision; curved incision two fingers width above the pubic symphysis
  • Joel-Cohen Incision; straight incision that is slightly higher
39
Q

Which incisions are used for laparoscopic surgery?

A
  • Several 5-10mm incisions for port insertion

- Usually the umbilicus is used for one of these

40
Q

What are the two types of diathermy and when are they used?

A
  • 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
Q

What are the two main types of suture material?

A
  • Absorbable; vicryl, monocryl

- Non-absorbable; silk, nylon, polyprene

42
Q

Where are absorbable sutures used?

A
  • Within the abdominal cavity

- Closing tissues beneath the epidermis

43
Q

Where are non-absorbable sutures used?

A
  • Closing the skin surface (epidermis)
  • Fixing drains in place
  • Connective tissues such as tendons
44
Q

Which kind of stitches are used for closing up the subcutaneous tissues?

A

Absorbable stitches

45
Q

What techniques can be used to close the surface layer of skin (epidermis)? (5)

A
  • Staples
  • Interrupted sutures
  • Mattress sutures
  • Continuous sutures
  • Subcuticular wound closure
46
Q

At which points is the WHO Surgical Safety Checklist carried out? (3)

A
  • Before the induction of anaesthesia
  • Before the first skin incision
  • Before the patient leaves theatre
47
Q

Outline some of the factors considered when completing the WHO Surgical Safety Checklist?

A
  • 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
Q

What factors need to be considered as part of pre-operative care? (6)

A
  • Pre-operative assessment carried out
  • Consent
  • Bloods (G&S +/- RXM)
  • Fasting
  • Medication changes
  • VTE assessment
49
Q

What needs to be considered as part of a pre-operative assessment?

A
  • Anaesthetic risk
  • Co-morbidities
  • PMHx
  • PSHx
  • DHx
  • Allergies
  • Smoking
  • Alcohol
  • Pregnancy in women of child-bearing age
  • Nourishment status
50
Q

Outline the American Society of Anaesthesiologists (ASA) grading of anaesthetic risk?

A
  • 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
Q

Which investigations may be required as part of the pre-operative assessment?

A
  • ECG
  • Echocardiogram
  • Lung function tests
  • Arterial blood gas testing
  • HbA1c
  • U&Es
  • FBC
  • CS
  • G&S +/- RXM
  • MRSA Screen
52
Q

Outline the typical fasting regimen used before surgery?

A
  • No food or feeds for 6hrs prior to procedure

- No clear fluids for 2hrs prior to procedure

53
Q

Which medications need to be stopped prior to surgery?

A
  • Anticoagulants; 24-72hrs prior, monitor INR

- Oestrogen containing oral contraception; 4 weeks prior

54
Q

Which medications need dose adjustment prior to surgery?

A

Long-term corticosteroids > 5mg prednisolone PO

  • Additional IV hydrocortisone
  • Doubling of normal dose once eating and drinking for 24-72 hrs
55
Q

Which diabetes drugs needs to be carefully considered and/or adjusted prior to surgery? (4)

A
  • Sulfonylureas; risk of hypoglycaemia
  • Metformin; risk of lactic acidosis
  • SGLT2 inhibitors; risk of diabetic ketoacidosis
  • Insulin; variable-rate insulin infusion often used
56
Q

Outline the components of VTE prophylaxis that must be considered prior to surgery?

A
  • LMWH
  • DOACs
  • Intermittent pneumatic compression
  • Anti-embolic compression stockings
57
Q

Which four things are needed for the patient to be deemed to have capacity? (4)

A
  • 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
Q

How are decisions for treatment made in patients that lack capacity? (3)

A
  • 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
Q

Outline the circumstances where each of the four types of consent form are used? (4)

A
  • 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
Q

What are the fundamental principles of enhancing patient recovery? (3)

A
  • Patient mobilisation
  • Patient independence
  • Patient discharge as soon as deemed optimal
61
Q

Aside from relief of pain, what are the other benefits of analgesia in post-operative care? (3)

A
  • Encourages patient to mobilise
  • Allows patient to ventilate their lungs fully to reduce infection risk
  • Enables adequate oral intake
62
Q

In which patients are NSAIDs contraindicated in for post-operative care? (4)

A
  • Asthma
  • Renal impairment
  • Heart disease
  • Stomach ulcers
63
Q

What is patient controlled analgesia (PCA)?

A

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
Q

Outline some of the risk factors for post-operative nausea and vomiting (PONV)? (6)

A

FUYNY HU?;

  • Female
  • Used of post-operative opiates
  • Non-smoker
  • Younger age
  • History of motion sickness or PONV
  • Use of volatile anaesthetics
65
Q

Which drugs can be used as prophylactic antiemetics at the end of the procedure? (3)

A
  • 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
Q

Which drugs can be used as rescue antiemetics in the post-operative period? (3)

A
  • 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
Q

What is the P6 acupuncture point?

A

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
Q

When may drains be removed post-operatively?

A

When they are draining minimal/no fluid or blood

69
Q

When may nasogastric tubes be removed post-operatively?

A

When they are no longer required for intake or drainage of fluid or gas

70
Q

When may catheters be removed post-operatively?

A

When the patient is able to mobilise to the toilet

71
Q

What are the main ways a patient may receive enteral feeding? (3)

A
  • By mouth (oral intake)
  • Via a nasogastric (NG) tube
  • Via a percutaneous endoscopic gastrostomy (PEG) tube
72
Q

What option is used to provide total nutritional requirements to patients unable to use their gastric tract?

A

Total parenteral nutrition (TPN); involves and intravenous infusion of carbohydrates, fats, proteins, vitamins and minerals

73
Q

Outline the most common post-operative complications? (13)

A
  • 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
Q

Which blood test must be performed post-operatively?

A

FBC; specifically looking at the Hb