Surgery Complete Review Lecture Notes

Key Surgical Concepts and Questions

Medication Management Before Surgery

• Naproxen: Stop 7 days prior to surgery.
• NSAIDs & COX-2 Inhibitors: Cease a week before surgery.
• Herbal Supplements: Also to be stopped a week prior.
• Medications to Continue: Beta blockers, calcium channel blockers.
• Day-of-Surgery Adjustments:
  • Stop diuretics.
  • Continue long-acting insulin, stop short-acting.
  • Maintain steroid dosing, consider stress dosing.

Intraoperative Risks

• EF under 35%: 75% mortality rate during surgery.
• MI Six Months Ago: 6% mortality rate.

Smoking Cessation Pre-Surgery

• Stops 8 weeks prior due to compromised ventilation risk during surgery.

High-Risk Surgery Patients

• JVD (Jugular Venous Distension): Highest risk of surgery complication, indicative of heart failure.

Surgical Timeouts & Safety

• Occurs before skin incision.
• Includes patient identity & site verification.

Postoperative Fever Causes

• 1st Day: Atelectasis (Prevent with deep breathing exercises).
• Day 3: Pneumonia or UTI.
• Day 5: DVT.
• Day 7: Wound infection.
• Day 10-15: Abscess.

Wound Care

• Freshly debrided wounds: Wet to dry dressings.
• Healthy granulation tissue: Moisture-retaining dressings.

Skull Fractures

• Linear Skull Fracture: Managed by observation.

Pulmonary Embolism (PE) Management

• Sudden chest pain post-surgery: Give heparin.
• Use IVC filter if PE recurs or anticoagulation is contraindicated.

Surgical Procedures & Risks

• Nissen Fundoplication: Risk of vagus nerve damage.
• Paralytic Ileus: Absence of bowel sounds, prolonged by hypokalemia.

Cardiac & Respiratory Risks

• Tension Pneumothorax: Managed with needle compression.
• Pulmonary Contusion: Diagnosed post-trauma with chest x-ray.

Trauma Management

• IV Access Failure: Use femoral vein catheter for adults.
• DIC During Surgery: Manage with FFP and platelets.

Common Surgery Questions

• Bee Stings: Cause of anaphylactic shock.
• Hirschsprung’s Disease: Diagnosed with rectal biopsy.
• Intermittent Claudication: Evaluate with ABI.

Surgery Contraindications

• Diabetic coma: Absolute contraindication to surgery.

Anesthesia Complications

• Halothane & Succinylcholine: Can cause malignant hyperthermia, treated with dantrolene.

Postoperative Complications

• Recurrent Fever Post-Appendectomy: Indicates subphrenic abscess.

Digestive System & Surgery

• Chronic Pancreatitis: Requires insulin and pancreatic enzyme supplements.
• Cholangitis with Gallstone: Use ERCP.

Miscellaneous Topics

• Pseudogynocomastia: Soft fatty mass, treated with weight loss.
• Spinal Amygdoma Risk Factor: Radiation is greatest risk.
• Acute Angle Closure Glaucoma: Treated with acetazolamide.
• Bladder Cancer: Initial evaluation with cystoscopy.