Surgery E2 last min things

Injured nerve in winged scapula

Long thoracic nerve

Injured nerve with hoarse/breathy voice

Recurrent laryngeal nerve

Unilateral recurrent laryngeal nerve damage

Paralysis of ipsilateral vocal cord --> hoarse/breathy voice

Bilateral recurrent laryngeal nerve damage

Loss of speech and airway control

Injured nerve with loss of voice quality --> deeper and quieter voice

Superior laryngeal nerve

Required tx for bilateral recurrent laryngeal nerve injury

Re-intubation or tracheostomy

Cancer: hot or cold nodules?

Cold

What is herniated in a type III hiatal hernia?

EG junction AND fundus of stomach

Nissen fundoplication

GERD/hiatal hernia tx

Upper or lower esophagus:

Adenocarcinoma

Lower

Upper or lower esophagus:

SCC

Upper

Chagas disease

Achalasia

Surgical tx for achalasia

Heller myotomy

Muscle affected in Zenker's diverticulum

Cricopharygeal m.

Surgical tx for Zenker's diverticulum

Cricopharyngeal myotomy + diverticular excision or fixation

Diagnostic imaging for esophageal perforation

CT esophagram

Ideal pressure/volume needed for peritoneum in laparoscopic surgery

4 L/min at 15 mmHg

Chandelier sign

PID

Charcot's sign

Choledocholithiasis

Courvosier's sign

Periampullary tumor, pancreatic cancer

Cullen's sign

Hemoperitoneum, pancreatic cancer

Grey Turner's sign

Hemorrhagic pancreatitis

Iliopsoas sign

Appendicitis, retrocecal abscess

Kehr's sign

Hemoperitoneum (splenic)

Murphy's sign

Acute cholecystitis

Rovsing's sign

Acute appendicitis

MC site of bleeding in duodenal ulcer

Gastroduodenal artery

Pathogens associated with overwhelming post-splenectomy sepsis (OPSS)

Encapsulated bacteria:

S. pneumo, H. influenza, N. meningitidis

Vaccinations recommended for pts without a spleen

Pneumovax, H. influenza, N. meningitidis

Jaundice and palpable, non-tender gallbladder

Courvosier sign

Indicates obstruction of distal CBD due to tumor

Courvosier sign

Purple-blue discoloration around umbilicus

Cullen's sign

What is removed in a Whipple procedure?

Gall bladder, part of CBD, part of duodenum, head of pancreas

When should GB polyps be removed?

If 6 mm or larger

Procedure that can be done intraoperatively or during ECRP

Cholangiogram

Failure of vitelline duct obliteration in utero

Meckel's diverticulum

What is resected to tx Meckel's diverticulum?

Ileus

MCC of SBO worldwide

Hernia

MCC of SBO in Western nations

Post-surgical adhesions

What bariatric surgery leads to the most weight loss?

Duodenal switch

Surgical tx for UC

Total colectomy with mucosal proctectomy and IAPP

What is the J pouch procedure used to tx?

UC (part of IAPP)

Kidney/coffee bean appearance

Volvulus

Round stapler device used for sigmoid colectomy

EEA device

Time frame for correction of testicular torsion

6 hours

Gold standard for diagnosis of prostate cancer

Prostate tissue biopsy

What is removed in a radical prostatectomy?

Prostate, seminal vesicles, portion of urethra

What type of hernias form in Hesselbach's triangle?

Direct

MC organ in inguinal hernia sac in males

Small intestine

MC organ in inguinal hernia sac in females

Ovaries/fallopian tubes

Congenital diaphragmatic hernia

Bochdalek

Appendix in hernia

Amyand

Meckel's diverticulum in inguinal hernia

Littre

Portion of anti-mesenteric bowel wall incarcerated in hernia

Richter

Portion of the hernia sac is made up by a viscus (bowel/bladder)

Sliding

Fascial weakness, NOT a hole

Diastasis recti

Lateral border of Hesselbach's triangle

Inferior epigastric vessels

Inferior border of Hesselbach's triangle

Inguinal ligament

Medial border of Hesselbach's triangle

Rectus abdominis

Lateral edge of rectus muscle at semilunar line

Spigelian hernia

What age group may present with a Spigelian hernia?

>50 y/o

Location of Spigelian hernia

Lateral and inferior to umbilicus

Uterus is resected into small pieces and removed via laparoscope

Laparoscopic hysterectomy

What is removed in a partial/subtotal/supracervical hysterectomy?

Upper part of uterus

(Cervix is left in place)

What is removed in a total hysterectomy?

Whole uterus and cervix

What is removed in a radical hysterectomy?

Whole uterus, tissue on both sides of cervix, and upper part of vagina

Surgical tx for pituitary adenoma/prolactinoma

Transphenoidal resection

Buerger's sign

PAD

Dependent rubor

Buerger's sign

Dangling pt's foot produces red color distal to arterial occlusion, foot becomes white when raised

Buerger's sign

What population does Leriche syndrome occur in?

Men with aortoiliac disease

S/sx of Leriche syndrome

Claudication of calf/thigh/butt muscles, impotence, decreased femoral pulses, possible transient numbness of extremity

ABI that warrants vascular specialist referral

<0.8

ABI that is emergent

<0.5

ABI that usually shows signs of claudication

<0.7

Virchow's triad

Stasis, endothelial injury, hypercoagulability

FENa <1%

Prerenal azotemia- intravascular depletion, heart failure, cirrhosis, third spacing

FENa >2%

Intrinsic renal parenchyma dysfunction

Lateral lymphatic drainage of breast

Axillary nodes

Medial lymphatic drainage of breast

Parasternal nodes (parallel with internal mammary artery)