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Surgery 2 Lec 2
Nova Orlando
69
Health Care
Graduate
05/01/2011

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Cards

Term
blood supply of the heart
Definition
left main artery branches into LAD and LCX.
considered right dominant if it arises from the RCA. left dominant if it arises from the LCX
LAD supplies anterior LV, apex of heart, intraventricular septum and part of the RV (AKA widowmaker).
LCX has marginal vessels that supply the LV.
RCA supplies the lateral portion of RV.
Term
Posterior Descending Artery
Definition
PDA arises from the RCA and supplies AV node
Term
aortic valve
Definition
between LV and aorta, has 3 leaflets
Term
mirtal valve
Definition
between LA and LV, has 2 leaflets
Term
this attaches the valve leaflets to the papillary muscles, tethering the leaflets to the ventricle wall
Definition
chordae tendinae
Term
common cause of mortality in the US
Definition
coronary artery disease
Term
risk factors for coronary artery disease
Definition
HTN, +FHx, hypercholesterolemia, smoking, obesity, diabetes, physical inactivity
Term
this population has increased risk of mortality after CABG
Definition
diabetics
Term
leading cause of death in women in the US
Definition
coronary artery disease
Term
_______ is an independent risk factor for survival after CABG
Definition
renal insufficiency
Term
treatment of CAD
Definition
cardiac catheterization (diagnostic and therapeutic), coronary artery bypass graft (CABG)
Term
complications following CABG
Definition
Q wave infarction, non-Q wave infarction, myocardial stunning, ventricular dysfunction, severe dysnfunction in high risk patients
Term
medical management of CAD
Definition
CCB, ACEI, lipid lowering agents, lifestyle changes
Term
CABG harvest choices
Definition
greater saphenous vein, lesser/short saphenous vein, internal mammary artery, radial artery
Term
CABG harvest choices
Definition
greater saphenous vein, lesser/short saphenous vein, internal mammary artery, radial artery, ulnar artery, popliteal vein/artery, anterior tibial vein/artery, peroneal vein/artery, cephalic vein
Term
how do you dx acquired valvular heart disease?
Definition
echo - assess severity of stenosis, regurg, and valve anatomy.
transthoracic echo - non-invasive.
transesophageal echo - definition of aortic and mitral valve anatomy
Term
what may be necessary to confirm the dx of acquired valvular heart disease?
Definition
catheterization
Term
common cause of left ventricular outflow obstruction
Definition
aortic stenosis
Term
sxs of aortic stenosis
Definition
angina, syncope, and heart failure, occasionally sudden death.
Term
where is the murmur of aortic stenosis heard best?
Definition
systolic murmur best heard at the base, radiating to the carotid arteries
Term
how do you dx aortic stenosis?
Definition
ECG (LVH, LAE), xray (calcification), echo, cardiac cath
Term
only effective therapy for aortic stenosis
Definition
aortic valve replacement
Term
tx of congenital aortic stenosis
Definition
almost all undergo balloon aortic valvotomy. mechanical prosthesis can be considered in childhood
Term
disease of valve leaflets, prolapse of the valve --> a central leak. may be sx free for long periods, eventually LV dysfunction manifests
Definition
aortic insufficiency (regurg)
Term
characterized by a wide pulse pressure, and high frequency crescendo-decrescendo diastolic murmur
Definition
aortic insufficiency (regurg)
Term
how do you dx aortic insufficiency?
Definition
CXR (enlarged cardiac silhouette), ECG (LVH, LAE), doppler echo to confirm dx, cardiac cath (to determine severeity)
Term
treatment of aortic insufficiency
Definition
nifedipine, ACEI, symptomatic aortic insufficiency requires elective surgical therapy (aortic valve replacement) before the left ventricle has irreversibly dilated.
Term
etiology of mitral stenosis
Definition
rheumatic fever, SLE, RA
mitral apparatus becomes defoemed and scarred during healing --> stenosis
Term
describe the murmur of MS
Definition
rumbling, diastolic murmur best heart at the apex, decreased with inspiration, preceded by an opening snap
Term
how do you dx mital stenosis?
Definition
xray (LAE/calcification), echo is gold standard
Term
treatment of a symptom free pt with mitral stenosis
Definition
only bacterial endocarditis prophylaxis
Term
treatment for a symptomatic pt with mitral stenosis
Definition
med: diuretics, BB/CCB, digoxin (for afib), warfarin.
surgical indications: pulmonary HTn, mitral valve reduced to 1cm, systemic emoblization, endocarditis.
Surgical options: balloon mitral valvuloplasty, open surgical mitral valvuloplasty, mirtal valve replacement
Term
etiology of mital regurg
Definition
abnormalities of the mitral valve, chordal rupture, endocarditis, rheumatic fever, mitral valve prolapse, papillary muscle infarction
Term
sxs of mitral regurg
Definition
SOB, dyspnea on exertion, orthopnea, pulmonary edema, diminished exercise tolerance
Term
describe the murmur of MR
Definition
holosystolic murmur heard best at the apex, radiating to the axilla and left scapular region. Pulm exam may reveal rales
Term
how do you dx MR?
Definition
ECG (LAE, afib), xray (LAE, cardiomegaly)
Term
medical mangement of MR
Definition
diuresis, ACEI (afterload reduction), heart failure from acute MR = IV vasodilators (nitroprusside)
Term
surgical indications for MR
Definition
symptomatic despite medical management, severe MR in the presence of an identified structural abnormality (rupture chordae tendinea, pulmonary HTN, deteriorating LV contractile function).
Surgical options = Mitral valve replacement, mitral valve repair
Term
compression of the subclavian vessels and nerves (brachial plexus) in the region of the thoracic inlet
Definition
thoracic outlet syndrome
Term
pt inspires maximally while the neck is extended and the head turned toward the affected side, loss of ipsilateral radial pulse = + test
Definition
scalene (relief) test
Term
how do you dx thoracic outlet syndrome?
Definition
chest and c-spine radiography (CT, MRI, or myelogram), doppler studies, nerve conduction velocities
Term
treatment of thoracic outlet syndrome
Definition
nonsurgical behavior modifications, operation for failed conservative tx is complete removal of the first rib.
Term
peri-operative risks of lung surgery
Definition
comorbidities associated with increased risk = smoking, increased age, COPD, asthma, obesity
Term
how can you minimize post-op morbidity from lung surgery?
Definition
adequate pain control = IV analgesics (PCA, thoracic epidural catheter, intercostal nerve blocks after thoracotomy), pulmonary exercises to expand the lungs (incentive spirometry, and mobilization within 24 hrs)
Term
MC thoracotomy approach used
Definition
poterolateral
Term
curvilinear incision underneath the inferior border of the pectoralis major muscle
Definition
anterior or anterolateral thoracotomy
Term
vertical incision from the sternal notch to the xiphoid, followed by sternal saw
Definition
median sternotomy
Term
when is a transverse sternotomy (clamshell) used?
Definition
large mediastinal tumors, hilar dissections, lung transplantation
Term
minimally invasive procedure for pneumothorax, open lung biopsy, and staging of thoracic malignancies
Definition
video assisted surgery (VATS)
Term
sxs of lung cancer
Definition
often present in late stages: hoarseness, chest wall pain, horner's syndrome, dysphagia
Term
sxs of lung cancer
Definition
often present in late stages: hoarseness, chest wall pain, horner's syndrome, dysphagia, pleural effusion, phrenic nerve paralysis
Term
sxs of a very large lung cancer
Definition
hemoptysis, dyspnea, obstruction, pain
Term
how do you dx lung cancer?
Definition
cytologic exam of sputum, CXR, fiberoptic bronchoscopy, FNA, CT of the chest
Term
treatment of lung cancer
Definition
stage dependent:
surgery for localized disease,
chemo for mets disease,
RT for local control in pts whose condition is not amenable to surgery
Term
tx of pulmonary mets
Definition
primary isloated mets = surgery/radiation.
extraregional mets = systemic chemo.
RT can be used to tx or palliate the local effects of mets disease.
Term
staging of lung cancer
Definition
TNM
Term
rare malignant lesion derived from the visceral pleura
Definition
mesothelioma
Term
risk factors for mesothelioma
Definition
asbestos, cigarette smoking
Term
sxs of mesothelioma
Definition
chest pain, dyspnea, fever, decreased breath sounds from pleural effusion
Term
how do you dx mesothelioma?
Definition
CXR (pleural effusion), thoracentesis (bloody fluid - cytology = malignant cells), pleuroscopy and biopsy
Term
treatment of mesothelioma
Definition
survival > 2 yrs = rare.
extrapleural pneumonectomy (entire lung and pleura), chemo and RT = expiramental
Term
occurs when air enters the space between the visceral and parietal pleura
Definition
simple pneumothorax
Term
defect in the chest wall allows continuous entry of air from outside the body
Definition
open pneumothorax
Term
defect in the visceral pleura allows ait to enter the space but not escape
Definition
tension pneumothorax
Term
who does a spontaneous pneumothorax occur in?
Definition
tall, thin, young males or those with bullous emphysema or mechanical ventilation, with placement of central venous catheters, infection (TB or pneumocystis carinii)
Term
PE of pneumothorax
Definition
Asx, sudden pleuritic chest pain and dyspnea, decreased breath sounds, hyperresonance, dispalced trachea with tension pneumo
Term
how do you dx pneumothorax?
Definition
CXR
Term
treatment of pneumothorax?
Definition
< 20% deflation = watchful observation with oxygen.
chest tube (thoracostomy).
reapir of an open chest wall defect.
Term
what type of pneumo is a surgical emergency?
Definition
tension pneumo, requires STAT needle thoracotomy at the MCL, 2nd intercostal space on the affected size to decompress the chest.
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