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Surgery Extra Notes

This document provides information on various anatomical structures and clinical topics. It lists retroperitoneal organs like the pancreas, ureter, and kidney. It also discusses toxic megacolon as an indication for surgery in ulcerative colitis patients, acute diverticulitis management, common bile duct stones, blood transfusion risks, the FAST exam, Horner's syndrome, damage control surgery principles, and criteria for sepsis, SIRS and qSOFA.

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84 views2 pages

Surgery Extra Notes

This document provides information on various anatomical structures and clinical topics. It lists retroperitoneal organs like the pancreas, ureter, and kidney. It also discusses toxic megacolon as an indication for surgery in ulcerative colitis patients, acute diverticulitis management, common bile duct stones, blood transfusion risks, the FAST exam, Horner's syndrome, damage control surgery principles, and criteria for sepsis, SIRS and qSOFA.

Uploaded by

rohalawi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

Meckel D.

RETROPERITONEAL ORGANS
MCC: PUKIDADAS
Adult: Obstruction Pancreas (except tail)
Pedia: Bleeding Ureter
Kidney
Toxic Megacolon in UC IVC
Only indication for surgery in UC pt. Duodenum (2nd-4th)
Long hx of bloody diarrhea Ascending colon
Inc abdominal pain Descending colon
Vomiting Aorta (abdominal)
Fever Suprarenal glands
Tender, guarding, rigid abdomen
‼️Note: Rectum
ACUTE DIVERTICULITIS Superior: peritoneal
Initial mngt: IV fluid, Antibiotic, drainage Middle: Retroperitoneal
+ free air=Lapcole Inferior: Extraperitoneal
Sx: LLQpain
Dehydratedvomiting xxxx TRIANGLES AND THYROIDECTOMIES:
SIMON'S TRIANGLE - used to identify RLN
MC type of Fistula in anu: Lat: Common carotid a.
Intersphincteric Med: Esophagus**
Sup: Inferior thyroid a.
COMMON BILE DUCT STONE
POC to Confirm dx: MRCP BEAHR'S - also used to identify RLN.
If sure ka masyado na may stone:ERCP- Lat/base: CCA
Gold standard Sup: ITA
B4 ERCP dpt nkta m na sa UTZ Med/lower arm: RLN**

Kalkikrein activates Brady JOLL'S: - used to identify SLN (external


ACE inactivates brady branch)
Brady:Increase vasoD, permeability,pain Lat: upper pole of the thyroid/superior
thyroid vessels
BURN: Sup: strap muscles/investing layer
MC Fatal infection:Pneumonia Med: midline of the neck
MC Infection:UTI floor: cricothyroid

BLOOD TRANSFUSION: For Palpatory BP:


MCC:Allergic rxn Caroti6 artery - >60 mmHg
MC transmitted:CMV Femora7 artery - >70 mmHg
MCC to much trans:TRALI R8dial artery - > 80 mmHg

FAST:HSPP
Hepatorenal, Splenorenal
Pelvic,Pericardial
EOMs Lethal Triad for Bloody Vicious Cycle
All are innervated by CN III except!  Coagulopathy
SO4 LR6 - SOLAR  Acidosis
‼ Superior oblique - CN IV  Hypothermia
‼ Lateral rectus - CN VI *if these conditions are met, surgery must
be stopped and resuscitation must be
Some generalities on actions: started
‼ Both of the obliques are ABDUCTORS Goal of damage control surgery:
‼ "SUPERIOR" muscles INTORT  Control surgical bleeding
‼"INFERIOR" muscles EXTORT  Limit GI spillage
*return patient to OR within 24-48 hrs
Horner syndrome once they clinically improve
Triad of MAP
1. Miosis SIRS vs qSOFA
2. Anhidrosis qSOFA (≥2 points = escalate therapy or
3. Ptosis investigats organ dysf)
‼ Also termed oculosympathetic paresis,  RR ≥ 22 cpm
occurs when the sympathetic ganglion  GCS <15
➡fibers are interrupted like from the  SBP <100 mmHg
hypothalamus (first order neurons),
cervical ganglion, etc. SIRS criteria (≥2 - sepsis)
‼ Can be acquired (iatrogenic, or due to  Temp ≥38C or ≤36C
systemic/local diseases), or congenital.  HR ≥90 bpm
 RR ≥20 cpm / mech vent / PaCO ≤32
mmHg
 WBC ≥12,000/uL or ≤4,000/uL or
≥10% bands

SEPSIS & SSI


• Target glucose control
SSI: <200 mg/dl
SEPSIS: <180 mg/dl
• Target MAP >65 mmHg

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