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24 Cards in this Set
- Front
- Back
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When is it important to get an ECG on a pt that want to have surgery
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Men: > 40
women: > 50 unless there is a known history of symptoms of cardiac disese |
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What is another test that can be given in a pt that has 20 year history of smoking that want to have surgery?
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CXR
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How do you manage small bowel obstruction?
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with NG drainage and IV fluid
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Does many small bowel obstructions reslove with non operative management?
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YES
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What are some clinical signs of shock?
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low blood pressure (< 90 mm Hg)
fast feeble pulse low urine output pale, cold, shivering |
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What are the types of gastric ulcers?
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I: lesser curve
II: body and duodenum III: prepyloric IV: lesser curve near gastroesophageal junction V: anywhere (caused by NSAIDS) |
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What are the surgical indications for ulcers
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bleeding
perforation obstruction intractable resistance to medical therapy |
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What are the type of surgeries that are used with ulcers
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1. truncal vagotomy + pyloroplasty
2. truncal vagotomy + antrectomy (low recurrance rate) 3. Highly selective vagotomy |
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Pyloric ulcers
- caused -ass with - tx |
-ass with increased acid production
- most ass with H. pylori infection |
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H pylori
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- dx: serum antibody tes, biopsy, urea breath test, histological analysis
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What are the two types of gastric cancers?
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Intestinal: favorable prognosis
diffuse: worse prognosis -penetration into the submucosa and postive lymph nodes has a worse prognosis |
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What two views will help you see air in the abdomen
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upright abd radiography or CXR (free air underneath the diaphragm
left lateral decubitus air seen above the liver - a rigid abd also shows chemical peritonitis in a perforated ulcer -peritonitis is an indication to go to the OR!!! |
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What is the treatment of NSAID related ulcer
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NSAIDS cause a breakdown in mucosal barrier
- can close with a gram patch and discont meds - if not do a V& P |
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What is the first step in evaluation of an upper GI bleeding?
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resuscitation!!!!
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What ulcers have the highest rate of rebleeding?
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ulcer with a fresh clot and visible artery at its base
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what if a pt with a duodenal ulcer that is bleeding becomes hypotensive?
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immediate resuscitation with NS and packed RBC and go straight to the OR to oversew vessel
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what is important to remember in those who have diabetes and want to have surgery
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need to have a blood sugar between 100-250 if great then surgery needs to be postponed
-increase change of infection with high blood glucose levels |
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What liver levels in a cirrhotic are to high to do surgery?
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Bilirubin > 2
albumin < 3 prothrombin > 16 ammonia > 150 encephalopathy |
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What are some values that give you a clue about nutrition status of a pt?
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serum transferrin
albumin skin test antigen |
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What to do with a pt that has a decreased nutrition status but need surgery?
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7-10 days of nutritional support though the gut will help
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What in the vitals gives your a clue that the pt might have bacteremia
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high fevers (104)
-need blood cultures x3 start empiric antibiotic therapy |
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If a pt has a low venous pressure does this r/o PE
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YES!!!!
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What is the test wise way to work up PE?
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1. get ARG and pule oximetry to look for hypoxia and hypocapnia (Pco2 decrease)
2. CXR to r/o pneumonia, atelectasis, pneumothorax 3. VQ scan for mismatch (only work in normal lungs) or spiral CT scan 4. pulmonary angiogram (used only if the other test are not dignositic ) tx; with heparin |
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What is used of PE remains after heparinization?
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Filter time baby!
Greenfield vena cava filter |
