What is meant by the prefix ‘laparo’?
Refers to the abdomen
What is meant by the prefix ‘thoraco’?
Refers to the thorax
What is meant by the prefix ‘colo’?
Refers to the colon
What is meant by the prefix ‘cysto’?
Refers to the bladder
What is meant by the prefix ‘gastro’?
Refers to the stomach
What is meant by the prefix ‘mammo/masto’?
Refers to the breast
What is meant by the prefix ‘myo’?
Refers to muscle tissue
What is meant by the prefix ‘nephro’?
Refers to the kidney
What is meant by the prefix ‘orchid’?
Refers to the testes
What is meant by the prefix ‘rhino’?
Refers to the nose
What is meant by the prefix ‘lobo’?
Refers to a lobe of an organ
What is meant by the suffix ‘otomy’?
Refers to surgically cutting open a structure
What is meant by the suffix ‘oscopy’?
Refers to viewing with a scope or keyhole surgery
What is meant by the suffix ‘ectomy’?
Refers to surgical removal of a structure
What is meant by the suffix ‘plasty’?
Refers to changing the shape of a structure
What is meant by the suffix ‘pexy’?
Refers to fixing a structure in place
What is meant by the suffix ‘centesis’?
Refers to puncturing a structure with a needle
What is meant by the suffix ‘ostomy’?
Refers to creating a new opening for a structure
What is meant by the suffix ‘itis’?
Refers to inflammation of a structure
What is meant by the suffix ‘algia’?
Refers to pain
What is meant by the suffix ‘gram’?
Refers to a recording or imaging
What is meant by the term adhesion?
Adhesions are the term used to describe scar tissue within the abdomen that attaches contents together
What is meant by the term fistula?
A fistula is an abnormal connection between two epithelial surfaces
What is meant by the term tenesmus?
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
What is a hemicolectomy procedure?
Removal of a portion of bowel
What is a Hartmann’s procedure?
Removal of the rectosigmoid colon and formation of a colostomy
What is a Whipple’s procedure?
Removal of the head of the pancreas, duodenum, gallbladder and bile duct
Which procedure is a Kocher incision used for?
Open cholecystectomy
Which procedures are Chevron/Rooftop incisions used for?
- Liver transplant
- Whipple’s procedure
- Pancreatic surgery
- UGI surgery
Which procedure is a Mercedes-Benz incision used for?
Liver transplant
Which procedure is an abdominal midline incision used for?
General laparotomy
Which procedure is an abdominal paramedian incision used for?
Laparotomy although not widely used
Which procedure is a Hockey-stick incision used for?
Renal transplant
Which procedure is a Battle incision used for?
Open appendectomy
Which procedure is Gridiron/McBurney incision used for?
Open appendectomy
Which procedure is a Lanz incision used for?
Open appendectomy
Which procedure is a Rutherford-Morrison incision used for?
Open appendectomy and colectomy
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
Which incisions are used for laparoscopic surgery?
- Several 5-10mm incisions for port insertion
- Usually the umbilicus is used for one of these
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
What are the two main types of suture material?
- Absorbable; vicryl, monocryl
- Non-absorbable; silk, nylon, polyprene
Where are absorbable sutures used?
- Within the abdominal cavity
- Closing tissues beneath the epidermis
Where are non-absorbable sutures used?
- Closing the skin surface (epidermis)
- Fixing drains in place
- Connective tissues such as tendons
Which kind of stitches are used for closing up the subcutaneous tissues?
Absorbable stitches
What techniques can be used to close the surface layer of skin (epidermis)? (5)
- Staples
- Interrupted sutures
- Mattress sutures
- Continuous sutures
- Subcuticular wound closure
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
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.
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
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
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
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
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
Which medications need to be stopped prior to surgery?
- Anticoagulants; 24-72hrs prior, monitor INR
- Oestrogen containing oral contraception; 4 weeks prior
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
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
Outline the components of VTE prophylaxis that must be considered prior to surgery?
- LMWH
- DOACs
- Intermittent pneumatic compression
- Anti-embolic compression stockings
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
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
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
What are the fundamental principles of enhancing patient recovery? (3)
- Patient mobilisation
- Patient independence
- Patient discharge as soon as deemed optimal
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
In which patients are NSAIDs contraindicated in for post-operative care? (4)
- Asthma
- Renal impairment
- Heart disease
- Stomach ulcers
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.
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
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
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
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.
When may drains be removed post-operatively?
When they are draining minimal/no fluid or blood
When may nasogastric tubes be removed post-operatively?
When they are no longer required for intake or drainage of fluid or gas
When may catheters be removed post-operatively?
When the patient is able to mobilise to the toilet
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
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
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
Which blood test must be performed post-operatively?
FBC; specifically looking at the Hb
