Sugical Rotation

Front 1

Mallampati Classification

Back 1

Airway Evaluation Classification

Class I: Visualization of Soft Palate, Fauces, Uvula, Anterior and Posterior Tonsilar Pillars

(Fauces = Mucosa over Palatopharyngeus & Palatoglossus)

Class II: Soft Palate, fauces, uvula

Class III: Soft Palate, Base of Uvula

Class IV: Cannot See soft palate

Hint 1

#surgicalpt

Front 2

Class I Airway

Back 2

Mallampati Classification: Visualization of Soft Palate, Fauces, Uvula, Anterior and Posterior Tonsilar Pillars

Hint 2

#surgicalpt

Front 3

Class II Airway

Back 3

Mallampati Classification: Soft Palate, fauces, uvula

Hint 3

#surgicalpt

Front 4

Class III Airway

Back 4

Mallampati Classification:
Soft Palate, Base of Uvula

Hint 4

#surgicalpt

Front 5

Class IV Airway

Back 5

Mallampati Classification:
Cannot See soft palate

Hint 5

#surgicalpt

Front 6

Back 6

Mallampati Airway Classification Class I

Visualization of Soft Palate, Fauces, Uvula, Anterior and Posterior Tonsilar Pillars

Front 7

Back 7

Mallampati Airway Classification Class 2

Visualization of Soft Palate, Fauces, Uvula

Front 8

Back 8

Mallampati Airway Classification Class 3

Visualization of Soft Palate, Base of Uvula

Front 9

Back 9

Mallampati Airway Classification Class 4

Cannot See Soft Palate

Front 10

Cardiac Risk Assessment

Back 10

<35 yo & ∅ Cardiac Hx: EKG
--- if normal → pt good

>35 or Cardiac Hx: EKG ± Stress test, Echo

Hint 10

#surgicalpt

Front 11

Goldman's Risk Assessment for Non-Cardiac Surgery

Level 1: What Are the Critera
Level 2: How Many Points
Level 3: Interpret the Totals

Back 11

S3 gallop or JVD: 11 pts
MI w/in 6 mo: 10 pts
>5 PVC's/ min: 7 pts
Neither Sinus Rhthym nor SR w/ APC's: 7 pts
>70 yo: 5 pts
Emergent Operation: 4 pts
Intrathoracic, intraperitonal or aortic surgery: 3 pts
Significant Aortic Stenosis: 3 pts
Poor General Medical Condition: 3 pts

≤5pts → class 1: 1% Risk of life threatening complixns
6-12 pts → class 2: 5% risk
13-25 → class 3: 11% risk
>25 → class 4: 22% risk

page 19

Hint 11

#surgicalpt
#mastercard
#needsbreakdown

Front 12

Aortic Stenosis on the Pre-Op Eval

Back 12

↑ risk for Ischemia → MI → Sudden Death

3 points on Goldman's Risk Assessment for Non-Cardiac Surgery

Hint 12

#surgicalpt

Front 13

Abdominal Surgery & Respiratory Function

Back 13

↓ Vital Capacity by 50% and Functional Risidual Capacity by 30%

Hint 13

#surgicalpt

Front 14

Risk Factors for Pulmonary Complications

Back 14

Known Pulmonary Dz
abnormal PFT's: FEV <11, max breathing capacity < 50% predicted, FEV1 <70% predicted, VO2 <20
Smoking
>60 yo
Obesity
Uppder abdominal or thoracic Surgery
Long OR time

So an Obese 60 yo COPDer

Hint 14

#surgicalpt

Front 15

Decreasing Pulmonary Complications

Back 15

Reduce Risk:
↓ smoking 8 weeks pre-op
optimize bronchodilator therapies

incentive spirometry
early post-op ambulation
chest physical therapy/OMM
DVT prophylaxis by SCD sequential compression device and subcu heparin

NB: because their mechanism is to acccentuate systemic thrombolysis, one SCD will work as well as 2 if one lg is injured

Hint 15

#surgicalpt

Front 16

Mortality of elderly pt w/ post-op pneumonia

Back 16

pneumonia has highest mobidity/mortality of all pulmonary complications

50% in elderly

Hint 16

#quickfact

Front 17

Platelet Count vs. Bleeding

Back 17

>50k: unlikely w/ hemostasis
>20k: excessive surgical bleeding
>10k: spontaneous bleeding
<10k massive spontaneous GI bleed

NB: BUN >100 → nonfnx platlets
--corrected by DDVAP ie Desmopressin

1 pack of platelets ≈ ↑ 10k

Hint 17

#surgicalpt

Front 18

Mortality of Pt:
NH3 >150

Back 18

75%

Hint 18

#surgicalpt
#quickfact

Front 19

Mortality of Pt
INR > 2

Back 19

50%

Hint 19

#surgicalpt
#quickfact

Front 20

Return of Bowel Function: Timeline

Back 20

Small Intestine
then Stomach
then Colon

Hint 20

#quickfact

Front 21

Tappered vs Cutting Needles

Back 21

Cutting needle: sharp tip with sharp edges. Used for skin sutures.

Tapered Needles: sharp tip but smooth, round edges: less traumatic. Used for deeper (non-skin) ts.

Hint 21

#suturing

Front 22

acholic stool

Back 22

light-colored stool as a result of decreased bile content

Hint 22

#recall
#dissected

Front 23

light-colored stool as a result of decreased bile content

Back 23

acholic stool

Hint 23

#recall
#dissected

Front 24

amaurosis fugax

Back 24

transient visual loss in one eye

Hint 24

#recall
#dissected

Front 25

bariatric

Back 25

baro = weight
iatro = doctor

the medicine/surgery of weight loss

Hint 25

#recall

Front 26

celiotomy

Back 26

incision into peritoneal cavity

aka laprotomy

Hint 26

#recall

Front 27

enterolysis

Back 27

lysis of peritoneal adhesions

NB: enteroclysis = contrast study of small bowel

Hint 27

#recall
#dissected

Front 28

vocab: lysis of peritoneal adhesions

Back 28

enterolysis

NB: enteroclysis = contrast study of small bowel

Hint 28

#recall
#dissected

Front 29

Excisional Biopsy

Back 29

Removal of Entire Tumor

Hint 29

#recall
#dissected

Front 30

Vocab: Removal of Entire Tumor

Back 30

Excisional Biopsy

Hint 30

#recall
#dissected

Front 31

vocab: transient visual loss in one eye

Back 31

amaurosis fugax

Hint 31

#recall
#dissected

Front 32

Incisional Biopsy

Back 32

Biopsy with only a slice of tumor removed

Hint 32

#recall
#dissected

Front 33

Vocab: Biopsy with only a slice of tumor removed

Back 33

Incisional Biopsy

Hint 33

#recall
#dissected

Front 34

Inspissated

Back 34

Hard

Hint 34

#recall

Front 35

Lieno-

Back 35

slpenic

Hint 35

#recall

Front 36

-orraphy

Back 36

surgical repair

Hint 36

#recall

Front 37

-pexy

Back 37

fixation into place

Hint 37

#recall

Front 38

Plicae circulares vs semilunares

Back 38

ciculares: small intestine
semilunares: large intestine

Hint 38

#recall
#dissected

Front 39

Plicae semilunares vs circulares

Back 39

ciculares: small intestine
semilunares: large intestine

Hint 39

#recall
#dissected

Front 40

Folds in intestinal mucosa

Back 40

plicae ciculares: small intestine
plicae semilunares: large intestine

Hint 40

#recall
#dissected

Front 41

Succus

Back 41

Fluid

eg succus entericus is fluid from bowel lumen

Hint 41

#recall
#dissected

Front 42

Tenesmus

Back 42

urge to defecate with ineffectual straining

Hint 42

#recall
#dissected

Front 43

urge to defecate with ineffectual straining

Back 43

tenesmus

Hint 43

#recall
#dissected

Front 44

Succus Entericus

Back 44

fluid from bowel lumen

Hint 44

#recall
#dissected

Front 45

W → D

Back 45

Wet to Dry Dressing

damp gauze dressing placed on a wound and removed after the dressing dries to the wound, providing microdebridement

Hint 45

#recall

Front 46

Constant dullness to percussion in Left Flank/LUQ and resonance to percussion in right flank

Back 46

Ballance's Sign

Seen with Splenic Rupture/Hematoma

Hint 46

#recall
#dissected

Front 47

Physical Finding indicated of Splenic Rupture/Hematoma

Back 47

Ballance's sign

constant dullness to percussion in left flank/LUQ and resonance to percussion in right flank.

Hint 47

#recall
#dissected

Front 48

Beck's Triad

Back 48

Of cardiac tamponade

1. JVD
2. ↓ Heart Sounds
3. ↓ BP

Hint 48

#recall
#dissected

Front 49

JVD w/ ↓ BP and soft heart sounds

Back 49

Beck's triad of cardiac tamponade

Hint 49

#recall
#dissected

Front 50

Physical Exam Findings of Cardiac Tamponade

Back 50

Beck's Triad

1. JVD
2. ↓ Heart Sounds
3. ↓ BP

Hint 50

#recall
#dissected

Front 51

Bergman's Triad

Back 51

Fat Emboli Sro

1. Mental Status Changes
2. Petechiae often in Axilla
3. Dyspnea

Hint 51

#recall
#dissected

Front 52

SOB, mental status deterioration and thoracic petechiae

Back 52

Bergman's triad of Fat Emboli

Hint 52

#recall
#dissected

Front 53

Fat Emboli Physical Exam Clues

Back 53

Bergman's Triad

1. Mental Status Changes
2. Petechiae often in Axilla
3. Dyspnea

Hint 53

#recall
#dissected

Front 54

Blumer's Shelf

Back 54

Metastatic Dz to rectouterine pouch of douglas or rectovesical pouch. creates a shelf palpable on DRE

Hint 54

#recall
#dissected

Front 55

Palpable "shelf" on DRE

Back 55

Blumer's Shelf
Metastatic Dz to rectouterine pouch of douglas or rectovesical pouch.

Hint 55

#recall
#dissected

Front 56

Boas' sign

Back 56

right subscapular pain 2° to cholelithiasis

Hint 56

#recall
#dissected

Front 57

right subscapular pain 2° to cholelithiasis

Back 57

Boas' sign

Hint 57

#recall
#dissected

Front 58

Borchardt's triad

Back 58

Gastric Volvulus
1. Emesis followed by retching
2. Epigastric Distention
3. Failure to pass NGT

Hint 58

#recall
#dissected

Front 59

Pt vomits and retches. Epigastrium is distended by NGT will not insert.

Back 59

Borchardt's triad of Gastric Volvulus

Hint 59

#recall
#dissected

Front 60

Presentation of Gastric Volvulus

Back 60

Borchardt's triad
1. Emesis followed by retching
2. Epigastric Distention
3. Failure to pass NGT

Hint 60

#recall
#dissected

Front 61

Carcinoid Triad

Back 61

Flushing
Diarrhea
Right-sided Heart Failure

Hint 61

#recall
#dissected

Front 62

Right Sided Heart Failure
Diarrhea
Flushing

Back 62

Carcinoid Triad

Hint 62

#recall
#dissected

Front 63

Charcot's Triad

Back 63

Cholangitis:
1. Fever
2. Jaundice
3. RUQ pain

Hint 63

#recall
#dissected

Front 64

Pt presents with RUQ, fever and jaundice.

Back 64

Chacot's Triad of Cholangitis

Hint 64

#recall
#dissected

Front 65

Cholangitis presentation

Back 65

Charcot's Triad
1. Fever
2. Jaundice
3. RUQ pain

Hint 65

#recall
#dissected

Front 66

Courvoisier's Law

Back 66

Enlarged nontender gallbladder = obstruction of common bile duct, most commonly pancreatic cancer

Not seen 2° to cholelithiasis

"Koor-vwah-ze-ay"

Hint 66

#recall
#dissected

Front 67

Enlarged non-tender gallbladder

Back 67

Courvoisier's Law

obstruction of common bile duct, most commonly pancreatic cancer

Not seen 2° to cholelithiasis

"Koor-vwah-ze-ay"

Hint 67

#recall
#dissected

Front 68

Cullen's Sign

Back 68

Periumbilical bruising 2° to retroperitoneal hemorrhage

think acute hemorrhagic pancreatitis

Hint 68

#recall
#dissected

Front 69

periumbilical bruising

Back 69

Cullen's Sign 2° to retroperitoneal hemorrhage

think acute hemorrhagic pancreatitis

Hint 69

#recall
#dissected

Front 70

Cushing's Triad

Back 70

of Increased Intracranial Pressure

HTN, bradycardia, irregular respirations

Hint 70

#recall
#dissected

Front 71

Presentation of Increased ICP

Back 71

Cushings Triad

HTN, Bradycardia, irregular respirations

Hint 71

#recall
#dissected

Front 72

Pt is bradycardic, hypertensive and has irregular breathing pattern

Back 72

Cushing's Triad of Increased ICP

Hint 72

#recall
#dissected

Front 73

Dance's sign

Back 73

empty RLQ in children with ileocecal intussusception

Hint 73

#recall
#dissected

Front 74

Presentation of ileocecal intussusception

Back 74

Dance's sign: empty RLQ

Hint 74

#recall
#dissected

Front 75

Empty RQL

Back 75

Dance's sign of ileocecal intussusception

Hint 75

#recall
#dissected

Front 76

Fothergill's Sign

Back 76

mass palpable while there is tension on abdominal musculature (sitting halfway upright) → mass is in abdominal wall

used to differentiate intra-abdominal masses from intramural masses

Hint 76

#recall
#dissected

Front 77

differentiating between intra-abdominal mass and mass in abdominal wall

Back 77

Forthergill's Sign

mass palpable while there is tension on abdominal musculature (sitting halfway upright) = mass is in abdominal wall

Hint 77

#recall
#dissected

Front 78

Fox's sign

Back 78

echymosis of inguinal ligamnet seen in retroperitoneal bleeding

Hint 78

#recall
#dissected

Front 79

Ecchymosis of inguinal ligmanet

Back 79

Fox's sign, seen with retroperitoneal bleeding

Hint 79

#recall
#dissected

Front 80

Goodsall's rule

Back 80

anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline

Hint 80

#recall
#dissected

Front 81

course of anal fistulae

Back 81

Goodsall's rule: anal fistulae course in a straight path anteriorly and a curved path posteriorly from midline

Hint 81

#recall
#dissected

Front 82

Grey Turner's Sign

Back 82

Ecchymosis of Flank in pts with retroperitoneal hemorrhage

Hint 82

#recall
#dissected

Front 83

ecchymosis of the flank in absence of flank trauma

Back 83

Grey Turner sign of retroperitoneal hemorrhage

Hint 83

#recall
#dissected

Front 84

Haaman's Sign

Back 84

Crunching sound on auscultation of heart from ephysematous mediastinum/pneumomediastium

Hint 84

#recall
#notdissected

Front 85

Howship-Romberg sign

Back 85

Pain along the inner aspect of the thigh

seen with obturator hernia as a result of nerve compression

Hint 85

#recall
#dissected

Front 86

Presentation of an obturator hernia

Back 86

Howship-Romberg sign: pain along inner aspect of thigh

Hint 86

#recall
#dissected

Front 87

Pt presents with pain along inner aspect of thigh

Back 87

Howship-Romberg sign of obturator hernia (nerve compression)

Hint 87

#recall
#dissected

Front 88

Kehr's sign

Back 88

severe left shoulder pain in pts with splenic rupture

Hint 88

#recall
#dissected

Front 89

Severe left shoulder pain in pt with blunt trauma

Back 89

Kehr's sign of splenic rupture

Hint 89

#recall
#dissected

Front 90

Kelly's sign

Back 90

visible peristalsis of ureter in resposne to contact (squeezing, retraction) used to identify ureter during surgery

Hint 90

#recall
#dissected

Front 91

How can you ID the ureter during surgery

Back 91

Kelly's sign: visible peristalsis irt squeezing or retratction

Hint 91

#recall
#dissected

Front 92

Where does the colon perforate?

Back 92

Cecum because increased radius

Laplace's law:
Wall tension = Pressure * Radius

Hint 92

#recall
#dissected

Front 93

Laplace's Law

Back 93

Wall tension = pressure * radius

(eg colon preferentially perforates at cecum because of large radius)

Hint 93

#recall
#dissected

Front 94

Lower quadrant pain mid-cycle

Back 94

Mittelschmerz, due to ovluation

Hint 94

#recall
#dissected

Front 95

Mittelschmerz pain

Back 95

lower quadrant pain midcycle due to ovulation

Hint 95

#recall
#dissected

Front 96

Obturator sign

Back 96

pain with internal rotation of leg (hip and knee flexed)

seen in pts with appendicits/pelvic abscess

Hint 96

#recall
#dissected

Front 97

Pain elicited by internal rotation of leg (hip & knee bent)

Back 97

Obturator sign of appendicitis or pelvic abscess

Hint 97

#recall
#dissected

Front 98

Catgut sutures

Back 98

purified collagen from intestines of cows or sheep (not cats)

come as plain or chromic

chromic has been treated with chromium salts → ↑ collagen crosslinks → more resistant to breakdown

Hint 98

#recall

Front 99

vicryl suture

Back 99

absorbable

braided microfilaments of polymerized (lactide + glycoside)

strength retention
60% at 2 weeks
10% at 4 weeks

NB: never use purple for skin closure → tatooing

Hint 99

#recall

Front 100

PDS

Back 100

absorbable

monofilament polymer of polydioxanone (fishing line)

strength retention:
75% at 2 weeks
50% at 4 weeks
25% at 6 weeks
takes 6 months to completely resorb

Hint 100

#recall

Front 101

Silk

Back 101

non-absorbable suture

Hint 101

#recall

Front 102

Prolene

Back 102

non-absorbable suture

Hint 102

#recall

Front 103

nylon

Back 103

nonabsorbable fishing line

NB: PDS is absorbable "fishign line"

Hint 103

#recall

Front 104

monocryl

Back 104

absorbable monofilament suture

Hint 104

#recall

Front 105

What kind of suture should be used for biliary tract or urinary tract:

Back 105

absorbable - else nidus for stone formation

Hint 105

#recall

Front 106

Absorbable vs Non-Absorbable Suture Materials
(List)

Back 106

Absorbable: Catgut, Vicryl, PDS, Monocryl

Non-absorbable: Silk, Prolene, Nylon

Hint 106

#recall

Front 107

Delayed Primary Closure

Back 107

aka tertiary intention

a wound is allowed to remain opened for a time → allows for debridement & wound care to ↓ bacterial count; wound is then closed.

Hint 107

#recall

Front 108

GIA device

Back 108

gastrointestinal anastomosis device

laws two rows of staples and automatically cuts between them

Hint 108

#recall

Front 109

OP note

Back 109

PPP SAFE DISC

Preop Dx
Post-Op Dx
Procedure
Surgeon & Assistance
Anesthesia: GET (general endotracheal)
Fluid I/O
EBL
Drains
Specimen
Complixns

Front 110

Suture Ligature

Back 110

aka Stick Tie

Suture anchored by passing needle through large vessel before wrapping it around vessel (ultimately occluding vessel). Prevents knot slippage.

Hint 110

#recall

Front 111

Stick Tie

Back 111

ie Suture Ligature

Suture anchored by passing needle through large vessel before wrapping it around vessel (ultimately occluding vessel). Prevents knot slippage.

Hint 111

#recall

Front 112

Retention Suture

Back 112

Large Suture (2-0) tied full thickness through abdominal wall minus periteonum. Used for dehiscence-risk wounds.

Hint 112

#recall

Front 113

How long before a suture leaves a scar on skin?

Back 113

10 days.

sutures should be removed as soon as wound healed enough to withstand normal wear and tear.

Hint 113

#recall

Front 114

How long should a suture be left in?

Back 114

Face: 5 days
Abdomen: 7 days
Extremities: 10 days
Back & Joints: 14 days


sutures should be removed as soon as wound healed enough to withstand normal wear and tear.


10 days = scar

Hint 114

#recall

Front 115

Placing an NG tube
--what length?
--process
--how can you be sure?
--when can you feed?

Back 115

Length: w/ pts head turned to side, from nose around ear and down to 5 cm beyond xiphoid

Lube tube and advance it straight back. Have pt tilt head forward and drink water with a straw.

Be sure: inject air while auscultating epigastrium. listen for "swishing"

Want to feed? get a CXR first!

Hint 115

#recall

Front 116

Kocher incision

Back 116

right subcostal for open cholecystectomy.

Hint 116

#recall

Front 117

Rocky-Davis incision

Back 117

Transverse invision across Mcburney's point

Hint 117

#recall

Front 118

Pfannenstiel incision

Back 118

Low transverse incision (supra-pubic) with abdominal muscles retracted laterally. Used for gyn.

Hint 118

#recall

Front 119

Lithotomy

Back 119

a surgical position, pt lying supine with legs spread

Hint 119

#recall

Front 120

Surgical Pt Position: Supine with hips & knees flexed, legs spread, ankles in stirrups

Back 120

lithotomy

Hint 120

#recall

Front 121

Pt going into surgery already on meds

Back 121

discontinue anti-hypertensives, oral hypoglycemics, insulin.

Diabetics can be on 1/2 dose lente + D5 NS IV

Hint 121

#recall

Front 122

Bowel Prep

Back 122

GoLYTELEY, oral neomycin + erythromycin + IV antibiotics before invision.

No actual data to support use.

Hint 122

#recall

Front 123

Who gets a pre-op EKG?

Back 123

>40 yo

Hint 123

#recall

Front 124

Billroth procedure

Back 124

Billroth 1: antrectomy (pylorectomy) + gastroduodenostomy

Biillroth 2: antrectomy + gastrojujunostomy

Pn: 1 has one exit from stomach, 2 has 2.

Hint 124

#recall

Front 125

Brooke ileostomy

Back 125

ileostomy folded onto itself to protrude form abdomen ~2cm to allow easy appliance placement & collection of succus

Hint 125

#recall

Front 126

Bassini herniorrhaphy

Back 126

approximation of transversus abdominis aponeurosis & conjoint tendon to reflection of (Poupart's) Inguinal ligament

Hint 126

#recall

Front 127

McVay Herniorrhaphy

Back 127

approximating transversus abodminus and conjoint tendon to Cooper's ligament (pubic perisoteum)

Hint 127

#recall

Front 128

Shouldice herniorrhaphy

Back 128

imbrication of transversalis fascia, transversus abdominis aponeurosis and conjoint tendon and approximation of the transversus abdominis aponeurosis and conjoint tendon to inguinal ligament

Hint 128

#recall

Front 129

plug and patch herniorrhaphy

Back 129

prosthetic plug pushes hernia sac in and then is covered with a prosthetic patch

Hint 129

#recall

Front 130

APR

Back 130

Adomino-Perineal Resection.

Removal of rectum and sigmoid colon through adominal and perineal incisions → colostomy.

Used for rectal cancers <8cm from anal verge.

Hint 130

#recall

Front 131

LAR

Back 131

Low Anterior Resection.

Resection of low rectal tumors through an anterior abomdinal incision

Hint 131

#recall

Front 132

Hartmann's procedure

Back 132

Proximal colostomy + distal stapled off colon/rectum which is not removed.

Hint 132

#recall

Front 133

Mucous fistula

Back 133

distal end of colon brought ot abdominal skin as a stoma.

proximal end → colostomy

Hint 133

#recall

Front 134

Kocher maneuver

Back 134

dissection of duodenum from right-sided peritoneal attachment to allow mobilization and visualization of the back of duodenum/pancrea

Hint 134

#recall

Front 135

Puestow procedure

Back 135

side-to-side anastamosis of jejunum to filleted pancreas.

Hint 135

#recall

Front 136

Stamm gastrostomy

Back 136

gastrostomy placed by open surgical incision and tacked to the abodminal wall.

Hint 136

#recall

Front 137

Enterolysis

Back 137

Lysis of peritoneal adhesions

Hint 137

#recall

Front 138

Simple Mastectomy

Back 138

removal of breast and nipple without removal of nodes

Hint 138

#recall

Front 139

Graham patch

Back 139

plugging gastric or duodenal perforation with omentum, securing it with stitches

Hint 139

#recall

Front 140

Heineke-Mickulicz pyloroplasty

Back 140

Longitdinal incision through all layers of pylorus, then sewn closed perpendicular to incision → nonfunx pylorus (used after truncal vagotomy)

Hint 140

#recall

Front 141

pringle maneuver

Back 141

temproary occlusion of porta hepatis to help control liver blood flow when liver is bleeding

Hint 141

#recall

Front 142

Modified radical mastectomy

Back 142

removal of breast, nipple and axilary LN w/o mucle removal

Hint 142

#recall

Front 143

Fem-pop bypass

Back 143

femoral artery to popliteal artery bypasss using saphenous/synthetic graft. to bypass blockage in femoral artery

Hint 143

#recall

Front 144

Hartmann's pouch

Back 144

rectal stump after resection of colonic segment w/ colostomy

Hint 144

#recall

Front 145

Truncal vagotomy

Back 145

transection of vagus nerve trunks

NB: must provide drainage procedure for stomach because pylorus will not relax w/o vagus (pyroplasty)

Hint 145

#recall

Front 146

What reverses the deleterious effects of steroids on wound healing?

Back 146

Vitamin A

Hint 146

#recall

Front 147

Dakin Solutn

Back 147

Dilute Sodium Hypochlorite (Bleach)

Used in contaimnated wounds

Hint 147

#recall

Front 148

Jackson-Pratt drain removal

Back 148

1. Stitch removal
2. Sucxn discontinuation
3. Slow pull

Hint 148

#recall

Front 149

Penrose drain

Back 149

open drainage via thin rubber hose.

increased infection rate v jackson-pratt grenade

Hint 149

#recall

Front 150

Incidence of Hernias

Back 150

10% lifetime
50% indirect
25% direct
5% femoral

Hint 150

#recall

Front 151

Complete vs. Incomplete Hernias

Back 151

Complete- sac and contents protrude all the way through

Incomplete- defect exists without complete protrusion

Hint 151

#recall

Front 152

En Masse Hernia Reduction

Back 152

Reduction of hernia sac + contents together without contents exiting the sac

Hint 152

#recall

Front 153

Littre's hernia

Back 153

Hernia w/ Meckel's Diverticulum

Hint 153

#recall

Front 154

Petersen's Hernia

Back 154

Seen after Roux en Y bypass

small bowel through mesinteric defect of roux limb

Hint 154

#recall

Front 155

Lumbar hernia

Back 155

Petit's or Grynfeltt's hernias

Hint 155

#recall

Front 156

Petit's Triangle

Back 156

Lat
External Oblique
Iliac Crest

Hint 156

#recall

Front 157

Grynfeltt's Triangle

Back 157

12th Rib
QL
Internal Oblique

Hint 157

#recall

Front 158

Richter's hernia

Back 158

incarceration of only one side of the bowel.

Strangulation → reduction → perforation w/o signs of obstrx

Hint 158

#recall

Front 159

Hesselbach's Hernia

Back 159

Under inguinal ligament lateral to femoral vessels

Hint 159

#recall

Front 160

Bochdalek's hernia

Back 160

through posterior diaphragm

"Boch Da Lek" think Back on The Left

Hint 160

#recall

Front 161

Morgagni's Hernia

Back 161

anterior parasternal diaphragmatic hernia

Hint 161

#recall

Front 162

Properitoneal hernia

Back 162

between peritonerum and transversalis fascia

Hint 162

#recall

Front 163

Coopers hernia

Back 163

through femoral canal and tracking to scrotrum or labium majus

Hint 163

#recall

Front 164

Amyand's Hernia

Back 164

Hernia contains ruptured appendix

Hint 164

#recall

Front 165

DDx: mass in a healed C-section

Back 165

hernia & endometrioma

Hint 165

#recall

Front 166

Direct Inguinal Hernia Incidence

Back 166

1% M>F
Increases with age

Hint 166

#recall

Front 167

Nerves in the inguinal canal

Back 167

ilioinguinal nerve: runs with spermatic cord
--if you cut it → numbness of inner thigh & lateral scrotum, should go away in 6 mo
prophylactic cutting removes risk of entrapement and ↓ post-op pain

Genital Branch of the Genitofemoral Nerve: runs in spermatic cord. Motor to cremaster, sensory to anterior scrotum.

Hint 167

#recall

Front 168

Incidence of Indirect Hernia

Back 168

5% M & W

Hint 168

#recall

Front 169

What is in the spermatic cord?

Back 169

Cremasteric Muscule Fibers
Vas Deferens
Testicular Artery & Pampiniform Venous Plexus
Genital branch of the genitofemoral nerve

Hint 169

#recall

Front 170

Cord Lipoma

Back 170

Preperitoneal Fat on Cord Strx pushed in by hernial sack. remove surgically.

Hint 170

#recall

Front 171

Boundaries of the Femoral Canal

Back 171

Cooper's ligament
Inguinal Ligament
Femoral Vein laterally
Lacunar ligament medially.

Hint 171

#recall

Front 172

Howship-Rhomberg sign

Back 172

pain along medial aspect of proximal thigh

indicative of nerve compression from obturator hernia.

Hint 172

#recall

Front 173

pain along medial aspect of proximal thigh

Back 173

Howship-Rhomberg sign

indicative of nerve compression from obturator hernia.

Hint 173

#recall

Front 174

Corona Mortis

Back 174

retropubic anastamosis between the epigastric artery and the obturator artery.

Front 175

Inguinal Ligament is a thickening of the....

Back 175

External Oblique Aponeurosis

Front 176

Bogros Space

Back 176

Extraperitoneal but Retroinguinal Space where mesh is placed

Front 177

Where is mesh placed?

Back 177

Bogros Space

Extraperitoneal but Retroinguinal

Front 178

Gimbernat's Ligament

Back 178

Lacunar Ligament

a posteriorly oriented aponeurosis between the inguinal ligament and coopers ligament near the pubic symphsysis

Front 179

Reflected Inguinal Ligament

Back 179

Inguina ligament fibers which continue medially to form contralateral aponeurosis

Front 180

Iliopubic tract

Back 180

Transversalis Fascia which inserts into inguinal ligament. Forms posterior wall of inguinal canal. The part seen when observing via laproscopy.

Front 181

The Superficial Inguinal Ring is composed of...

Back 181

External Oblique
Splits into medial and lateral crura

Front 182

Genitofemoral Nerve

Back 182

L1-L2 from Lumbar Plexus
Descends along anterior surface of psoas

Femoral Branch: Lateral Part of femoral triangle

Genital Branch: anterior scrotum/labia majorum

Front 183

Innervation of the Scrotum

Back 183

Fenital Branch of teh Genitofemoral Nerve: atnerior surface

Anterior scrotal nerves from teh ilioinguinal nerve

posterior scrotal nerves from the perineal branch of the pudendal nerve

Perineal branches of the psterior cutaneous nerve of the thigh

Front 184

Arterial supply of the Scrotum

Back 184

Posterior scrotal branches of the perineal artery from the internal pudendal artery

anterior scrotal branches of the deep external pudendal artery from teh femoral artery

cremasteric artery from the inferior epigastric artery

Front 185

Cremasteric Muscle is a continuation of the ...

innervated by the ...

Back 185

internal oblique

innervated by the genital branch of the genitofemoral nerve

supplied by the cremasteric artery ariseing off the inferior pigastric artery

Front 186

Dartos fascia is a continuation of the ...

Back 186

Scarpa's Fascia of the abdomen

Colle's fascia of the perineum

Front 187

Spermatic Cord

Back 187

External spermatic fascia (external oblique)
Cermasteric fascia & Muscle (Internal oblique)--genital branch of the genitofemoral nerve
Internal fascia: transveraslis abdominus

Front 188

Arterial Supply of the Ductus Deferens

Back 188

Artery of the Ductus Deferens -- arises off the inferior epigastric artery