SURGERY Notes Part 1

Along the way you go through surgical posting, you  mightcome across all of these disease and question in your mind. Its better you made your own note also.

Not all answers are provided here, might need to find it in text book or make your own notes for better understanding or make yourself easy for remember. This is what observed in the management in my hospital.

1. What are common antibiotic/ in surgery? Cover what organism?

⁃ IV Cefobid

⁃ IV Flagyl

⁃ IV Unasyn

⁃ IV Augmentin

⁃ IV Fortum

⁃ IV Sulperazone

⁃ IV Meropenam

⁃ IV Vancomycin

⁃ IV Cospofungin

⁃ IV Fluconazole

⁃ IV Ceftriazone, etc

2. Common Case?                                                                                                                                                                                                                                                                                                                                                                                                                                                                            

⁃ Acute Appendicitis

⁃ Cholelithiasis

⁃ Choledocolithiasis

⁃ Cholecystitis

⁃ Acute Cholangitis

⁃ Liver abcess

⁃ Upper GI Bleed

⁃ Lower GI Bleed

⁃ Dysphagia

⁃ Intestinal Obstruction

⁃ Acute Pancreatitis

⁃ Breast Ca

⁃ Colorectal Ca

                                                                                                       

3. Acute Cholangitis:

- Charcot Triad?

• Fever                                                                                                                                                                                                                                                                                                                                                                                                         

• Abdominal Pain

• Jaundice

                                                                                        

- Raynold Pentad?

• Charcot Triad + (Hypotension+ Confusion)

4. When to do laparoscopic cystectomy? When to to open?

                                                                                                                                   

                                                                                                                                                                                                                                                                                                  

5.  Colorectal Ca - Risk Factor, Staging

6. Upper GI Bleed management

7. Thyroid Disease ? Anatomy

8. Hernia? Inguinal? Direct Indirect

9. Hydrocele?

10. Lipoma?

11. Type stoma :  Colostomy? Ileostomy?

12. Mastectomy? Wide excision biopsy? Hook wire?

13. Anatomy

- Thyroid

- Breast

- Colon

- Ileum

- Hepatobiliary

- Urinary Tract

14. What to look in abdominal xray? Difference between small bowel and colon?(Geeky Medic)

15. Type of barium? Indication?

- Swallow? - To see Upper GI

- Small Bowel Follow through? - To see disorder small intestine

- Enema : Lower GI - To see abnormality in large intestine + Rectum

16. What case radiotherapy? What case need chemotherapy?

- Kurang pasti sangat. Tapi biasanya kalau kes yang metastasis kita akan refer onco to decide. If neoadjuvant is preoperative chemotx.

17. What to monitor in patient with radiotherapy

- Radioterapi ni macam “microwave”, macam bakar, so possible get dehydration - so kena monitor sign and symptom dehydration - encourage fluid intake

18. Patient mana perlukan nephrostomy?

- Contohnya, post op renal calculi (PCNL), because there is possibility of small fragment of calculi still not removed during operation, to reduce risk of blockage when stone drop to ureter or bladder , nephrostomy was keep, as alternative pathway for stone to come out, also to drain if any blood collected post operatively, prevent blockage by blood clotin the ureter or bladder .

- If tumor infiltrate to bladder, and patient had acute urinary retention, pt might to use nephrostomy life time.

- Depend on case to case basis also.

- Nephrostomy ni kalau nak senang faham, tengok gambar. We put drain (like inflate CBD, but that ballon is put in renal calyx, then straight away urine comeout to urine bag, through skin). 

19. COLON CANCER—

Anterior resection? Tranverse colostomy? Which need which surgery?

*TAKEN from ANDRE TAN book

20. If stoma output more than 500cc, how long to replace Hartmann 1 pint tu?

- Dalam plan kena tulis begini :

Monitor Stoma output : to replace 1 pint Hartman for 1 Hour if stoma loss more than 500 cc.

So, kalau AM shif masa staffnurse close I/O chart (Input Output), stoma loss more than 500cc, SN PM shift yang akanreplace Hartman tu.

- Kalau overall 1 day total only stoma loss more than 500 cc, SN AM shift next day will replace with Hartmann solution.

- So, konklusinya, for every stoma loss more than 500cc, whether per shift or per day, need to replace the losses.

Which one come first. But depend on case, sometime the plan - to replace stoma loss with equal amount, if more than 500 cc, if loss 700 cc, replace also 700cc, etc.

21. Function Lomotil?

- Usually given if patient ada banyak stoma loss, per shift more than 500 cc, dua tiga hari. Utk treat diarrhea. T Lomotil 2/2 TDS or 1/1 TDS. Antiperistaltic drug.

22. Which case can give C Tramal, which case give Celebrex? Morphine? Oxynorm? Oxycontin? Amytriptyline? Fentyl Patch?

23. What is liver bracytherapy?

Insertion of radiotherapy agent in the liver.

24. Daily sodium and potasium requirement?

25. Post operative care?

Incentive spirometry to prevent?

- atlectesis

TED stockinette/SC Heparin or Sc Fonda to prevent DVT.

26. Indication enteral/parenteral feeding?

27. Refeeding syndrome?