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Comp 3 - Surgery
Nova Orlando
144
Health Care
Graduate
05/07/2011

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Cards

Term
-ectomy
Definition
removal, excision, resection
Term
-plasty
Definition
surgical repair, surgical correction
Term
-scopy
Definition
process of visual examination
Term
-(o)stomy
Definition
opening
Term
-(o)tomy
Definition
incision, to cut into
Term
an agent, such as heat, radiation, or a chemical, that disinfects by destroying, neutralizing, or inhibiting the growth of disease-carrying microorganisms
Definition
Disinfectant
Term
destruction of pathogenic organisms to prevent infection. Processes, procedures, or chemical treatments that kill or inhibit microorganisms to prevent infection.
Definition
antisepsis
Term
without contamination with bacteria or other microorganisms. Not producing micoorganisms or free from micoorganisms.
Definition
aseptic
Term
preventing bacteria from growing or multiplying but possibly not killing them.
Definition
bacteriostatic
Term
an agent that destroys bacteria
Definition
bactericidal
Term
type of anestehsia used in outpt clinics
Definition
propofol
Term
agent used to reduce the MAC of inhalation agents
Definition
opiods
Term
benefits of opiods as anesthesia
Definition
profound analgesia with minimal cardiac depression.
blunt HTN and tachycardic response to ET inbutation.
extend analgesia and facilitate a smoother awakening from anesthesia.
Term
mainstay of anesthesia
Definition
inhalation agents
Term
only depolarizing agent in use today
Definition
Succinylcholine
Term
SE of succinylcholine
Definition
hyperkalemia and malignant hyperthermia
Term
first local anesthetic used
Definition
cocaine
Term
most widely used local anesthetics (2)
Definition
lidocaine, mepivacaine, novocaine
Term
SE of local anesthetics
Definition
oral numbness, lightheadednes, altered tase, tinnitus
Term
what can be added to a local anesthetic to accelerate penetration?
Definition
bicarbonate
Term
why epinephrine added to local anesthetics? when can it not be added?
Definition
to keep the anesthetic localized, decreased systemic absorption, increase the duration of action.
Not added when working on the nose, penis, fingers, or toes.
Term
reversal agent for benzos
Definition
flumazenil (romazicon)
Term
reversal agent for narcotics (opiods)
Definition
naloxone (Narcan)
Term
SE of naloxone use
Definition
it reverses ALL narcotic effects --> HTN, stroke, tachycardia, arrhythmias, CHF, cardiac arrest.
Term
elective surgery cannot proceed with out this
Definition
informed consent
Term
persons (usually family) who make decisions when a pt cannot speak for themselves
Definition
surrogate decision makers
Term
legal documents that inform health care providers about the pts wishes regarding the level of care to be delivered when the pt is unable to do so
Definition
advanced directive
Term
what type of history should be taken for a surgical case?
Definition
Allergies
Meds
PMHx
Last oral intake
Events preceeding the emergency
Term
3 major risks for a DM pt undergoing surgery
Definition
derrangements in blood sugar (want to maintain between 150-200)
CV complications
increased risk of infection
Term
complications of hyperthyroidism with surgery
Definition
increased risk of thyroid storm and arrhythmia (a-fib)
muscle weakness
decreased healing
Term
what is used to measure the operative risk of a hepatic dysfunction pt?
Definition
Child Pugh criteria
Term
when do alcohol withdrawals occur? peak?
Definition
occur within 1-5 days
peak at 3 days
Term
alcoholic "cocktail"
Definition
vitamins, thiamin, folate
Term
how do you tx alcoholic DT's?
Definition
librium or valium
Term
acute adrenal insufficiency is seen in pts on steroids for how long? tx?
Definition
> 5 days
use supplemental steroids so pt can stand the stress of surgery
Term
best indication of nutritional status
Definition
albumin
Term
complications of malnutrition for a surgery pt (3)
Definition
decreased healing
infection
increased pulmonary complications
Term
can you access dialysis catheters if you need an IV and can't get it?
Definition
No!
Term
what should you be conscious of with a renal pt in surgery?
Definition
don't used K+ IV fluids
use the "renal" dose of abx
Term
when should prophylactic antibiotic therapy be started?
Definition
pre-op in time to reach adequate tissue levels before contamination, adequate levels must be maintained throughout surgery
Term
prophylactic abx if anaerobic flora is NOT suspected
Definition
cefazolin
Term
prophylactic antibiotic with suspected colonic anaerobes?
Definition
cefotan
Term
prophylactic abx with suspected bacteroides
Definition
cefotan
Term
prophylactic abx used for colonic surgery
Definition
nicols prep: neomycin/erythromycin
Term
when are prophylactic abx not effective?
Definition
tracheostomy
indwelling catheters
burns
Term
T/F the larger the suture prefix the larger the suture?
Definition
False!
The larger the prefix, the smaller the suture
Term
what size suture: face, scalp, trunk/extremities, deep tissues
Definition
face: 5-0, 6-0
scalp: 3-0
trunk/extremities: 4-0, 5-0
deep tissues: 3-0, 4-0
Term
when should sutures be removed: face/neck, scalp/body, extremities
Definition
face/neck = 3-5d
scalp/body = 5-7d
extremities = 7-10d
Term
how is total body water and blood volume distrubted in the body?
Definition
2/3 of TBW is intracellular
1/3 of TBW is extracellular
85% of total blood volume is venous
15% of total blood volume is arterial
Term
what is of the utmost importance with post-op infection
Definition
recognition
Term
signs of post-op infection (5)
Definition
pain, fever, hemodynamic changes, wound discharge, erythema
Term
tx for Gram + post op infections
Definition
cefotaxime, ceftizoxime, ceftriaxone, ceftazadime, aztreonam
Term
tx for gram - post op infections
Definition
gentamycin, trobramycin, amikacin, fluoroquinalones
Term
tx of anaerobic post op infections
Definition
clindamycin, metronidazole, chloramphenicol
Term
superficial wounds usually appear how long post op?
Definition
5 days
Term
organisms common of superficial post op wounds above the waist
Definition
staph aureus, +/- strep
Term
organisms common of superficial post op wounds in the axillae
Definition
prominent gram - bacteria
Term
organisms common of superficial post op wounds below the waist
Definition
mixed aerobic/anaerobic gram - flora
Term
tx of intra-abdominal infections
Definition
ampicillin/gentamycin/clindamycin
unasyn, piperacillin
Term
when should you d/c post op antibiotics?
Definition
if pt is afebrle x 48 hrs, consider d/c or change to PO rx for 7-10 days
Term
risks inherent to surgery (4)
Definition
bleeding, infection, pulmonary complications, DVT's
Term
co-morbid illnesses that increase the risk of infection
Definition
DM, heart failure, COPD
Term
most fevers within the first 24 hrs are related to
Definition
normal physiologic responses from surgery
Term
5 W's of post op wound infection
Definition
wound
wind
water
walk
weird drugs/what did we do?
Term
superficial wound infections: early, late
Definition
early: think necrotizing soft tissue
late (5-10d): superficial abscess
Term
intra-abdominal abscesses usually occur when?
Definition
5-10 days post-op
Term
Wind
Definition
atelectasis (collapse of small airways, within the first 24 hrs)
aspiration - pneumonitis, pneumonia
Term
Water
Definition
UTI
Term
Walk
Definition
DVT, thrombophlebitis
Term
virchow's triad
Definition
stasis, hypercoagulability, endothelial damage
Term
calf edema, tenderness, + Homan's
Definition
DVT
Term
risk factors for DVT
Definition
age, obesity, OC's, malignancy, leg trauma, ortho surgery, immobility
Term
what is the normal return of GI motility post op
Definition
small bowel returns first
stomach activity within 24-48 hrs
colon activity is last > 48 hrs
Term
Pt is NPO until when after surgery?
Definition
bowel sounds are auscultated and pt passes flatus
Term
tx for post op ileus
Definition
pass an NG tube
Term
partial or total disruption of any/all layers of a post-op wound: early, late
Definition
early: wound dihiscence
late: incisional hernia
Term
collection of liquefied fat, serum, and lymphatic fluid, often opened or aspirated
Definition
seroma
Term
collection of blood, usually in the subcutaneous layer of a recent incision
Definition
hematoma
Term
tx of hematoma
Definition
compression of the airway = evacuated immediately
small = often resorb
Term
3 types of wound closure
Definition
primary - immediate closure
secondary - no closure
tertiary - delayed primary
Term
risk factors for delayed post op wound healing
Definition
advanced age, malnutrition, diabetes, morbid obesity, immunosuppression, coexisting remote infection, colonization with bacteria, prior radiation therapy, smoking
Term
causes of abnormal wound healing
Definition
DIDNT HEAL

DM
Infection
Drugs
Nutritional Problems
Tissue necrosis
Hypoxia
Excessive tension
Another concurrent wound
Low Temperature
Term
MC pathogen of SSI
Definition
staphylococcus aureus followed by:
staphylococcus coagulase negative
enterococcus
escherichia coli
Term
how does protein effect wound healing?
Definition
protein catabolism results in delayed wound healing
Term
how does vitamin C affect wound healing?
Definition
deficiency can affect wound healing.
tx = 100-1000 g/day
Term
how does vitamin A affect wound healing?
Definition
deficiency impedes monocyte activation and vitamin A contributes to lysosomal activity and directly counteracts the effect of glucocorticoids
Term
how does vitamin K affect wound healing?
Definition
vitamin K metabolism is impeded by antibiotics
Term
how does zinc affect wound healing?
Definition
zinc deficiency results in early wound healing delays
Term
summary of post op fever: day 1-2, day 3-5, day 5-7, day 7+
Definition
1-2 = wind (atelectasis)
3-5 = water (UTI)
5-7 = wound (infection)
7+ = wonder drugs
Term
dyspnea, SOB, hemoptysis, tachycardia
Definition
PE
Term
what should you monitor while the pt is on heparin? warfarin?
Definition
heparin = PTT
warfarin = PT
Term
rapid rise in body temp, muscle rigidity/stiffness, dark brown urine, muscle ache
Definition
malignant hyperthermia
Term
triggers of malignant hyperthermia
Definition
inhaled halothane anesthetics
succinylcholine
Term
gold standard for dx of malignant hyperthermia
Definition
IVCT (in vitro contracture test)
+ occurs with contracture of muscle fibers to halothane or caffeine
Term
treatment of malignant hyperthermia
Definition
dantrolene via rapid IVP, d/c the triggering anesthetic
Term
complications of malignant hyperthermia
Definition
rhabdo, renal failure, myopathy, death
Term
post op fever weeks later
Definition
endocarditis, infected prostheses
Term
divisions of the pharynx (3)
Definition
nasopharynx
oropharynx
hypopharynx
Term
divisions of the larynx
Definition
supraglottis (epiglottis)
glottis
subglottis
Term
where does most lip cancer occur?
Definition
lower lip (often in the 50-80 yo group)
Term
MC type of lip cancer
Definition
squamous cell carcinoma
Term
MC cancer of the upper lip
Definition
basal cell carcinoma
Term
formation of an opening that will close spontaneously (5-7days)
Definition
tracheotomy
Term
formation of a permanent opening(remains open after removal of the tube)
Definition
tracheostomy
Term
MC use for a tracheostomy today
Definition
mechanical ventilation (after 3 days of intubation - 2-3 weeks)
Term
most common breast tumor in young women
Definition
fibroadenoma
Term
most common cause of bloody nipple discharge
Definition
papillomas
Term
firm nodular breast lesions, cysts, epithelial hyperplasia
Definition
fibrocystic disease
Term
risk factors for malignant disease of the breast
Definition
increasing age
+FHx breast or ovarian cancer
HRT
Alcohol consumption
early menarche
late menopause
nulliparity
radiation exposure
Term
primary survey
Definition
Airway
Breathing
Circulation
Disability (neurologic)
Exposure of the pt, Environment
Term
MC complication from breast cancer tx
Definition
lymphedema
Term
dual carcinogenic role of ionizing radiation
Definition
disrupts cellular DNA
induces chronic TSH stimulation by damaging the production of thyroid hormone
Term
in regards to thyroid cancer, what does hot/cold mean on a radionuclide thyroid scan?
Definition
hot = not (benign)
cold = low levels of uptake, minimal function, 5% = malignant
Term
4 types of thyroid cancer
Definition
anaplastic - most malignant/aggressive
medullary - asstd with MEN 2A or 2B
follicular - iodine deficiency
papillary - MC in the US, grows slowly, mets via lymph, asstd with exposure to ionizing radiation
Term
with regards to a toxic adenoma, what does hot mean on thyroid scan?
Definition
hot = functional, not malignant
Term
raising the arms above the head --> venous compresson of the thoracic inlet --> engorgement of the head and neck and a feeling of strangulation
Definition
Pemberton's sign
Term
How is TSH affected in thyrotoxicosis? Hashimoto's?
Definition
thyrotoxicosis = decreased TSH
Hashimotot's = increased TSH
Term
what is the defintive dx for thyroid nodule?
Definition
FNA
Term
when is a solitary cystic nodule considered resolved?
Definition
if the fluid has negative cytology, and the mass disappears
Term
when should you follow up a pt who has a solid, benign nodule?
Definition
3-6m, give thyroid hormone PO to suppress tumor growth
Term
risk factors for CAD (7)
Definition
HTN
+ FHx
hypercholesterolemia
smoking
obesity
diabetes
physical inactivity
Term
how does DM affect the risk for CAD?
Definition
increased risk for CAD and increased mortality rate after CABG
Term
how does being a woman afffect risk for CAD?
Definition
lower incidence of CAD than men
CAD = leading cause of death in US women
mortality rate after CABG is higher than men
Term
what is an independent risk factor for survival after CABG?
Definition
renal insufficiency
Term
tx for CAD
Definition
cardiac catheterization (diagnostic and therapeutic)
Term
medical management of CAD
Definition
CCB, ACEI
Lipid lowering agents
lifestyle changes
Term
CABG harvest choices
Definition
GSV, LSV
internal mammary
radial artery, ulnar artery
PTV/A
ATV/A
peroneal vein/artery
cephalic vein
Term
2 types of hiatal hernia
Definition
sliding - only significant when gastric acid is refluxed into the lower esophagus
Paraesophageal hernia - fundus can become incarcerated
Term
hiatal hernias are usually found in who?
Definition
women who have been pregnant
overweight men and women
Term
hiatal hernias predispose a person to?
Definition
GERD
Term
tx of hiatal hernia
Definition
most pts respond to medical therapy
H2RA, PPI, antacides
if no response - reconstruction of the valve mechanism (Nissen fundoplication, Hill, Belsey)
Term
fibrotic ring at the LES from chronic reflux
Definition
Schatzki ring
Term
epithelium change from squamous to columnar at the LES
Definition
Barrett's esophagus
Term
Barrett's esophagus is the precursor to
Definition
adenocarcinoma of the esophagus
Term
failure of the LES to relax, occurs at the distal esophageal circular muscular segment, results in progressive dilation of the esophagus
Definition
achalasia
Term
what disease is associated with achalasia?
Definition
Chagas disease
Term
bird beak deformity on xray
Definition
achalasia
Term
tx of achalasia
Definition
CCB
surgery (most reliable)
esophageal myotomy (Heller), modified fundoplication can be done at the same time
Term
caused by a dysfucntion of the cricopharyngeal muscle
Definition
Zenker's diverticulum
Term
pt regurgitates recently swallowed food or pills, and has a foul odor to their breath, dx?
Definition
Zenker's diverticulum
Term
tx of Zenker's
Definition
myotomy of the cricopharyngeal muscle and excision or elevation of teh diverticula
Term
All of lecture 12 (abdomen) is fair game
Definition
Term
all of lecture 13 (vascular) except accesses and ports)
Definition
Term
the highlights of lecture 14 (surgical specialties)
Definition
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