General Surgery Marrow Edition 8 Flashcards

1000 highly targeted, exhaustive vocabulary flashcards covering surgery fundamentals, general surgery principles, trauma, shock, oncology, and specialty surgical procedures directly grounded in the provided textbook notes.

Procedure-Specific Complications in Consent

Any complication with an incidence greater than 1% ($> 1\%$) that must be explicitly disclosed to the patient during informed consent.

Yellow IV Cannula

A 24G peripheral IV cannula primarily used in pediatric patients, offering a maximal flow rate of $13\,\text{mL/min}$ ($10\,\text{mL/min}$).

Blue IV Cannula

A 22G peripheral IV cannula providing a maximal flow rate of $31\,\text{mL/min}$ ($30\,\text{mL/min}$).

Pink IV Cannula

A 20G peripheral IV cannula with a maximal flow rate of $67\,\text{mL/min}$ ($60\,\text{mL/min}$).

Green IV Cannula

An 18G peripheral IV cannula capable of a maximal flow rate of $96\,\text{mL/min}$.

Gray IV Cannula

A 16G peripheral IV cannula providing a maximal flow rate of $236\,\text{mL/min}$ ($240\,\text{mL/min}$).

Orange IV Cannula

A 14G wide-bore peripheral IV cannula providing a maximal flow rate of $270\,\text{mL/min}$, specifically used in shock resuscitation.

Superficial Thrombophlebitis

The most common complication of IV cannulation, characterized clinically by a tender, cord-like swelling and managed with topical heparinoids.

Sign In Phase

The initial Surgical Safety Checklist phase occurring before induction of anesthesia, where patient identity, site, procedure, written consent, allergies, and blood loss risk ($> 500\,\text{mL}$) are confirmed.

Time Out Phase

The Surgical Safety Checklist phase performed right before skin incision, where the team confirms site, procedure name, time, antibiotic prophylaxis within the last 30 minutes, and anticipated blood loss.

Sign Out Phase

The final Surgical Safety Checklist phase completed before the patient leaves the OR, confirming counts (instruments, sponges, needles), specimen labeling, and actual blood loss.

Blood Loss Volume Estimation from Mops

A standardized estimation where a fully soaked surgical mop represents $100\,\text{cc}$ of blood, and a fist full of clots represents $500\,\text{cc}$ of blood.

Protective Zone of Operating Theater

The OT zone comprising change rooms, transfer bay, pre/post-operative rooms, and ICU/PACU.

Clean Zone of Operating Theater

The intermediate OT zone connecting the protective zone to the aseptic zone, housing the equipment store room and maintenance workshop.

Aseptic Zone of Operating Theater

The core OT zone where the operating room itself is located.

Supine / Neutral Position

The most common surgical position, primarily used for abdominal and breast procedures.

Trendelenburg Position

A surgical position with the head end low and foot end raised, commonly utilized in pelvic surgeries.

Reverse Trendelenburg Position

A position with the head end raised and foot end low, used in upper abdominal procedures and laparoscopic cholecystectomy with the right side elevated.

Right Shoulder Tip Pain in Laparoscopy

The most common complication of laparoscopic cholecystectomy in reverse Trendelenburg, caused by $\text{CO}_2$ collecting beneath the right dome of the diaphragm.

Common Peroneal Nerve Injury in Lithotomy

Nerve injury occurring in the lithotomy position if the patient's legs are not properly supported at the stirrups.

Brachial Plexus Injury in Lateral/Kidney Position

Nerve plexus injury resulting from hyperextension of the dependent or upper arm in the lateral/kidney position during procedures like Latissimus Dorsi flap reconstruction.

Prone Position Uses

Surgical position utilized specifically for spinal surgeries and pilonidal sinus operations.

Sitting / Fowler's Position

Surgical position used for posterior cranial fossa surgery, offering decreased blood loss and superior exposure but posing an increased risk of air embolism.

Positional Asphyxia in Jackknife Position

An obsolete position complication previously encountered during hemorrhoid and fissure surgeries.

Lloyd Davies Position

A surgical posture combining Trendelenburg and Lithotomy positions, used specifically in rectal cancer surgeries.

Venous Air Embolism Volume Threshold

Sucking of $50\text{--}100\,\text{cc}$ of air into venous circulation, which dysregulates cardiac function and presents with desaturation, dyspnea, and hypotension.

Durant Position

Left lateral decubitus with legs elevated (head-down/left lateral), used immediately upon suspicion of venous air embolism to trap air in the right ventricle.

Adverse Event

An unintended medical incident that directly results in harm or injury to the patient.

Near Miss

An incident that had the potential to cause harm or unwanted consequences but was prevented by chance or timely intervention before reaching the patient.

No-Harm Event

An incident that actually reaches the patient but results in no measurable injury or harm due to chance or mitigating circumstances.

No. 10 Blade

A classic surgical blade whose belly is the sharpest part, primarily used for making large skin incisions.

No. 11 Blade

A pointed stab blade utilized for incision & drainage (I&D) of abscesses and performing arteriotomies.

No. 12 Blade

A curved surgical blade designed specifically for suture removal.

Langer's Lines (Relaxed Tension Lines)

Skin lines defined by the orientation of dermal collagen fibers; incisions placed parallel to them yield superior cosmetic scars.

Bovie Tip Cautery Pad Placement

The grounding pad in monopolar electrosurgery must be placed over a well-vascularized area with a wide contact surface to avoid localized thermal burns.

Monopolar Electrosurgery Avoidance Sites

Electrosurgical mode avoided in CNS surgery, parotid/thyroid surgery, ear lobule repair, penile surgery, and patients with cardiac pacemakers due to lateral thermal spread and conduction interference.

Bipolar Cautery Mechanism

Electrosurgical system where current passes strictly between two prongs localizing the circuit, requiring no grounding pad and providing pure coagulation safe near vital structures and end arteries.

Cutting Current Waveform

Electrosurgical current characterized by low voltage and continuous waveform causing rapid cellular heating and intracellular water explosion.

Coagulation Current Waveform

Electrosurgical current featuring high voltage and alternating/intermittent waveform resulting in tissue dehydration and protein denaturation.

Ligasure Vessel Sealing Diameter

An energy device utilizing heat and pressure to denature collagen and elastin, featuring automatic discontinuation upon seal closure and safe for vessels up to $7\,\text{mm}$ in diameter.

Harmonic Scalpel Oscillatory Frequency

An ultrasonic surgical instrument oscillating at $20{,}000\text{--}50{,}000\,\text{Hz}$, causing protein denaturation and coagulation without direct heat generation.

CUSA (Cavitron Ultrasonic Surgical Aspirator)

A specialized harmonic scalpel variation used for liver resections because hepatocytes possess high water content and low collagen, making them selectively susceptible to ultrasonic fragmentation.

Thunderbeat S

A hybrid surgical energy device combining the tissue-sealing mechanism of Ligasure with the ultrasonic cutting efficiency of a Harmonic Scalpel.

Radio Frequency Ablation (RFA) Size Limit

An energy modality using high-frequency alternating current requiring a grounding pad, effective for hepatic tumor ablation up to $3\,\text{cm}$.

Microwave Ablation Advantages

Thermal ablation modality operating between infrared and radiowaves that requires no grounding pad, operates faster than RFA, and produces a homogeneous ablation zone.

Romovac Suction Drain

A closed negative-pressure drain used after mastectomy, thyroidectomy, and neck dissection, but strictly avoided in the abdominal cavity due to perforation risk from its rounded profile.

Jackson Pratt Drain

A closed negative-pressure drain featuring flat flexible tubing that allows safe placement within the abdominal cavity.

Underwater Seal Drain Mechanism

A chest drain setup where the exit tube is submerged under water to prevent atmospheric air from being sucked back into the pleural cavity.

Square / Reef Knot

The standard surgical knot formed by two consecutive square throws made in opposite directions.

Surgeon's Knot

A surgical friction knot comprising a double throw (two wraps) followed by a single square throw to prevent slippage.

Principles of Skin Suturing

Surgical skin closure rules requiring everted wound edges, needle entry perpendicular (90^\n\circ) to skin, bite width $X$ on each side, and inter-suture spacing of $2X$.

Vertical Mattress Suture

A two-step mattress technique ('far-far, near-near') incorporating superficial and deep skin bites along the same perpendicular line to achieve superior edge eversion and hemostasis.

Horizontal Mattress Suture

A mattress suturing technique placed parallel to the wound margin at equal depth, offering the lowest tissue cut-through rate.

Subcuticular Suture Material

Cosmetic continuous skin closure placed in the dermal layer using 3-0 Monocryl on a cutting needle.

Purse String Suture Uses

A continuous circular suture used to invert tissue, specifically for burying an appendiceal stump or performing cervical encerclage.

Shoe String Technique

A gradual tensioning suturing technique used for closure of fasciotomy wounds, resulting in healing by third intention (delayed primary closure).

Round Body Needle Applications

Atraumatic needle profile that splits rather than cuts tissue, used on delicate structures ('B's: Bowel, Bladder, Blood vessels, Common Bile Duct).

Cutting / Reverse Cutting Needle Applications

Traumatic needle profile that cuts through tough fibrous tissues ('S's: Sheath, Skin, Fascia).

Needle Holder Placement

Surgical instrument grip rule specifying that a curved needle should be grasped at the junction of the distal $\frac{2}{3}$ and proximal $\frac{1}{3}$ of its body.

Suture Material Color Codes

Standardized color identification: Brown for Catgut, Violet for Vicryl, Blue for Prolene, and Black for Silk.

Natural Absorbable Suture Degradation

Suture materials (e.g., Catgut) derived from biological tissue that incite a strong inflammatory reaction and undergo degradation via enzymatic proteolysis.

Synthetic Suture Degradation

Man-made suture materials (e.g., Vicryl, PDS) that evoke minimal tissue inflammation and degrade predictably via chemical hydrolysis.

Monofilament Suture Handling Properties

Single-strand sutures (e.g., Prolene, PDS, Nylon) possessing high memory and stiff handling properties, requiring a greater number of knot throws for security.

Braided Suture Handling Properties

Multi-strand woven sutures (e.g., Vicryl, Silk) providing superior pliability and knot security, but harboring higher infection risks due to tissue capillarity.

Chromic Catgut Absorption Timeline

A treated natural suture retaining tensile strength for $21\text{--}28\,\text{days}$ and undergoing complete phagocytic absorption within $90\,\text{days}$.

Vicryl (Polyglactin 910) Complete Absorption

A braided synthetic absorbable suture used for bowel (3-0), bladder (3-0), and CBD (5-0) that undergoes complete hydrolytic absorption within $60\text{--}90\,\text{days}$.

Vicryl Plus Coating

Polyglactin suture coated with the antibacterial agent Triclosan to reduce the incidence of surgical site infections.

Polydioxanone (PDS) Absorption Duration

A synthetic monofilament absorbable suture that maintains prolonged tensile strength and absorbs completely in $180\,\text{days}$; used for tracheobronchial repairs and childhood rectus sheath closure.

Silk Suture Characteristics

A black braided natural non-absorbable suture derived from silkworm cocoons, used for drain fixation (1-0, 2-0), skin (2-0, 3-0 cutting), and outer intestinal layers (3-0 round body).

Jenkin's Rule for Abdominal Sheath Closure

Surgical rule stating that the total length of continuous suture used must be at least 4 times ($\ge 4\times$) the total length of the abdominal wound.

Vascular Repair Prolene Gauges

Monofilament polypropylene suture sizing: 2-0 for Aorta, 4-0 for Femoral Artery, and 6-0 for Popliteal Artery.

Suture Removal Duration by Body Region

Earliest on Face ($3\text{--}5\,\text{days}$); Scalp and Neck ($5\text{--}7\,\text{days}$); Thorax, Perineum ($10\text{--}12\,\text{days}$); Abdomen ($12\text{--}14\,\text{days}$).

Strongest Layer in Bowel Anastomosis

The submucosa, which provides the primary structural strength for holding sutures during intestinal anastomosis.

Albert Layer in Two-Layer Anastomosis

The inner continuous absorbable suture line encompassing all bowel wall layers during a classic two-layer intestinal anastomosis.

Lembert Layer in Two-Layer Anastomosis

The outer interrupted non-absorbable seromuscular suture line placed to invert the intestinal mucosa during anastomosis.

Cheatle's Split

A longitudinal split performed along the antimesenteric border of the narrower bowel loop to enlarge its lumen for end-to-end anastomosis.

Connell Loop

A specialized inverting continuous suture technique placed along the edge of a bowel anastomosis to ensure proper mucosal inversion.

Atelectasis Post-Op Day

The collapse of alveoli, representing the single most common cause of fever on Post-Operative Day 1 (POD 1).

Post-Op Fever Timeline (POD 4-5)

Urinary Tract Infection (UTI), which stands as the most common cause of hospital-acquired infections overall.

Serous / Salmon Fluid Sign

Pathognomonic salmon-colored fluid discharge soaking abdominal dressings on POD 6, indicating acute rectus sheath dehiscence or burst abdomen.

Emergency Management of Burst Abdomen

Immediate bedside manual repositioning of exposed bowel loops followed by application of a sterile urobag / Bogota bag laparostomy.

Morrison's Pouch (Hepatorenal Pouch) Abscess

The most common anatomical location for intra-abdominal fluid collections or abscesses in a completely supine patient.

Pelvic Abscess Clinical Presentation

Intra-abdominal abscess collection in the pouch of Douglas causing pelvic diarrhea with mucus discharge and urinary frequency.

Surgical Site Infection (SSI) Timeframe Definition

Wound infection occurring within 30 days of surgery without an implant, or within 1 year if a surgical implant is placed.

Southampton Wound Score Grade IV

A wound scoring classification corresponding specifically to clear pus or purulent discharge from the incision.

Class I (Clean) Wound SSI Rate

Surgical wounds without inflammation or entry into GI/GU tracts (e.g., thyroidectomy, elective hernia), having an SSI rate of 1\n\text{--}2\% and requiring no prophylactic antibiotics unless mesh/implant is placed.

Class II (Clean-Contaminated) Wound Examples

Uncomplicated operative entry into GI/GU tracts without active inflammation, including elective cholecystectomy, elective appendectomy, and LSCS.

Class IV (Dirty) Wound Definition

Infected wounds with frank pus, visceral perforation/fecal contamination, or neglected traumatic wounds older than 6 hours, carrying an un-prophylaxed SSI rate of $20\text{--}40\%$.

Decisive Period of Wound Contamination

The crucial $4\text{-hour}$ window between initial skin incision and establishment of bacterial colonization.

Hair Removal for Surgical Preparation

Hair removal performed strictly using electric hair clippers immediately before surgery; shaving is forbidden as microabrasions increase SSI rates.

Prophylactic Antibiotic Administration Timing

Optimal time for IV antibiotic infusion is $30\text{--}60\,\text{minutes}$ prior to surgical incision, with a repeat dose given after 4 hours in prolonged procedures.

Laminar Air Flow Requirements in OT

Ultra-clean air circulation using HEPA filters ($90\%$ efficient for particles $> 0.5\,\mu\text{m}$) maintaining 4 fresh air changes per hour under positive pressure.

Day Care Surgery Definition

Elective surgical management where the patient is formally admitted and discharged within a total period of 12 hours.

Day Care Surgery BMI Limits

Pre-operative body mass index threshold required for day care selection: $\le 38$ for laparoscopic procedures and $\le 40$ for surface procedures.

Reactionary Hemorrhage Timeline

Post-operative bleeding occurring within $4\text{--}24\,\text{hours}$ after surgery, typically caused by dislodgement of a clot or slippage of a suture knot.

Secondary Hemorrhage Etiology

Post-operative hemorrhage occurring $7\text{--}14\,\text{days}$ after surgery, directly resulting from infection-induced sloughing of the vessel wall.

Apfel Score

A clinical scoring system utilized specifically to predict the risk of Post-Operative Nausea and Vomiting (PONV).

ERAS Pre-Op Fasting Guidelines

Enhanced Recovery Protocols permitting solid food up to 6 hours, carbohydrate loading $2\text{--}3\,\text{hours}$, and clear liquids up to 2 hours prior to surgery.

Pre-Albumin as Nutritional Indicator

A short half-life hepatic protein that serves as a far more sensitive biochemical marker for acute malnutrition than serum albumin.

Significant Unintentional Weight Loss Criteria

An unintentional body weight loss greater than $10\%$ ($> 10\%$) over a 6-month period, serving as a primary indicator of severe malnutrition and poor surgical prognosis.