General surgery

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Questions and Answers

What is the main difference between laparoscopic cholecystectomy and traditional cholecystectomy?

The type of anesthesia used

The type of hospital where the procedure is done

The type of surgeon performing the procedure

The type of incision used (correct)

What is the primary benefit of robotic surgery?

Increased precision (correct)

Reduced recovery time

Lower cost

All of the above

In what type of incision is the gallbladder extracted during laparoscopic cholecystectomy?

Pfannenstiel incision

Cesarean section incision

Right subcostal incision

Umbilical incision (correct)

What is the expected future development in robotic surgery?

Increased use of artificial intelligence Signup and view all the answers

What is the primary advantage of robotic surgery over traditional surgery?

Reduced trauma to internal organs Signup and view all the answers

What is the current limitation of robotic surgery?

Need for further research and development Signup and view all the answers

What is being researched in robotic surgery?

Use of artificial intelligence Signup and view all the answers

What is the potential future application of robotic surgery?

Automated surgical procedures Signup and view all the answers

What is the primary goal of prehabilitation in the perioperative setting?

To prepare patients for better outcomes in surgery Signup and view all the answers

What is the recommended duration of nutrition support in severely malnourished patients?

10-14 days Signup and view all the answers

What is the benefit of immunonutrition in surgical patients?

Reduces postoperative infections Signup and view all the answers

Why is it essential to address smoking cessation in prehabilitation?

To improve surgical outcomes Signup and view all the answers

What is the purpose of tele-rehabilitation in prehabilitation?

To contact patients remotely to provide prehabilitation and monitor activity and psychological aspects Signup and view all the answers

What is the ERAS protocol primarily used for?

To reduce the stress response to surgery Signup and view all the answers

When is blood transfusion considered necessary?

In case of severe anemia with risk of organ ischemia Signup and view all the answers

What is the primary focus of a surgical oncologist?

To treat cancer Signup and view all the answers

What is the first step in evaluating a patient's fitness for surgery?

Considering the type of surgery Signup and view all the answers

What is the purpose of MET evaluation in patients undergoing surgery?

To evaluate the patient's metabolic state and energy needs Signup and view all the answers

What is the significance of a MET score < 4 in a patient undergoing surgery?

The patient has a high risk of CV complications Signup and view all the answers

Why is it essential to evaluate the patient's pulmonary function before surgery?

To reduce the pulmonary impact during and after surgery Signup and view all the answers

What is the significance of a creatinine level > 2 mg/dL in a patient undergoing surgery?

The patient has a high risk of postoperative cardiac complications Signup and view all the answers

What is the primary purpose of evaluating Cardiac risk index conditions in patients undergoing surgery?

To identify potential cardiac risks during surgery Signup and view all the answers

What percentage of the adult population has some renal dysfunction?

5% Signup and view all the answers

What is the purpose of pulmonary rehabilitation after surgery?

To reduce the pulmonary impact after surgery Signup and view all the answers

What is a major complication obese people may face after surgery?

Deep vein thrombosis Signup and view all the answers

What should be done with Beta-Blockers before surgery?

Do not stop them Signup and view all the answers

Why should Antithrombotic therapy be stopped before surgery?

Because it increases the risk of bleeding Signup and view all the answers

When should Antithrombotic therapy be restarted after surgery?

A few days after surgery Signup and view all the answers

What is an online tool that can help predict patient risk factors?

American College of Surgeons' calculator Signup and view all the answers

What is a key characteristic of frailty?

It is a spectrum Signup and view all the answers

What is a consequence of frailty in surgery?

Significantly changed outcome of surgery Signup and view all the answers

What is not a factor that contributes to frailty?

Body mass index Signup and view all the answers

What is the common finding in both cases presented to the ER with acute abdominal pain?

Thickened colonic wall with no visible lumen Signup and view all the answers

What is the final diagnosis that can be given by endoscopy?

Both diverticulitis and perforated cancer Signup and view all the answers

What is the difference between the two cases presented to the ER?

One was diverticulitis and the other was perforated cancer Signup and view all the answers

Why may the prognosis be worse in emergency settings?

Because the patient may not have proper diagnostic tools Signup and view all the answers

What is the purpose of biopsy in these cases?

To get a final diagnosis Signup and view all the answers

What type of biopsy is used to collect a sample of cells?

Fine-needle aspiration Signup and view all the answers

What is the difference between fine-needle aspiration and core needle biopsy?

One is used for tissues and the other for cells Signup and view all the answers

What is the significance of black bubbles in the imaging?

It indicates air outside of the colon Signup and view all the answers

What is the purpose of the FRAIL scale?

To diagnose frailty in older adults Signup and view all the answers

What is a common consequence of frailty in surgical patients?

Increased risk of complications Signup and view all the answers

What is sarcopenia?

Age-related loss of skeletal muscle mass Signup and view all the answers

What is the purpose of evaluating a patient's physical frailty?

To identify patients at risk of complications Signup and view all the answers

What is the significance of a patient scoring >3 on the FRAIL scale?

The patient is considered frail Signup and view all the answers

What is the purpose of prehabilitation in the perioperative setting?

To prepare the patient for surgery Signup and view all the answers

What is the benefit of immunonutrition in surgical patients?

Enhances the patient's immune system Signup and view all the answers

Why is it essential to address smoking cessation in prehabilitation?

To reduce the risk of complications Signup and view all the answers

What does the c-prefix in cTNM staging stand for?

Clinical Signup and view all the answers

What is the purpose of exploratory laparoscopy?

To visualize metastases that are difficult to see with imaging Signup and view all the answers

What is the significance of the G parameter in TNM staging?

Tumor grading Signup and view all the answers

What is the goal of oncological surgery?

To remove the tumor with adequate margins of normal tissue Signup and view all the answers

What is the purpose of the multidisciplinary team?

To discuss surgery and therapeutic approaches Signup and view all the answers

What is the primary concern of the no-touch technique?

Local implantation and embolization of tumor cells Signup and view all the answers

What is the purpose of surgical margins?

To remove the cancer with adequate margins of normal tissue Signup and view all the answers

What is the significance of the yTNM staging?

Stage after chemo/radiotherapy Signup and view all the answers

What is the primary goal of prehabilitation in the perioperative setting?

To prepare the patient for surgery Signup and view all the answers

What is the recommended duration of nutrition support in severely malnourished patients?

10-14 days Signup and view all the answers

What is the benefit of immunonutrition in surgical patients?

Reduces postoperative infections Signup and view all the answers

Why is it essential to address smoking cessation in prehabilitation?

Because it has a high impact on surgical outcomes Signup and view all the answers

What is the purpose of tele-rehabilitation in prehabilitation?

To contact the patient remotely to provide prehabilitation Signup and view all the answers

What is the ERAS protocol primarily used for?

To reduce the stress response to surgery Signup and view all the answers

When is blood transfusion considered necessary?

In the event of severe anemia with risk of organ ischemia Signup and view all the answers

What is the focus of a surgical oncologist?

To treat cancer patients Signup and view all the answers

What is the recommended duration of nutrition support in severely malnourished patients?

10-14 days Signup and view all the answers

What is the primary benefit of immunonutrition in surgical patients?

Reduced postoperative infections Signup and view all the answers

What is the primary focus of a prehabilitation program in the perioperative setting?

Preparing patients for surgery Signup and view all the answers

Why is it essential to address smoking cessation in prehabilitation?

To reduce anesthesia risk Signup and view all the answers

What is the primary purpose of tele-rehabilitation in prehabilitation?

To monitor patient activity remotely Signup and view all the answers

What is the recommended duration of immunonutrition in GI oncological surgery?

About 7 days Signup and view all the answers

Why is it essential to evaluate the patient's nutritional status before surgery?

To identify malnutrition and provide support Signup and view all the answers

What is the primary goal of prehabilitation in the perioperative setting?

To prepare patients for surgery Signup and view all the answers

What is the primary reason to evaluate a patient's MET score before surgery?

To identify potential underlying cardiovascular conditions Signup and view all the answers

Which of the following is a condition that can worsen the outcome of surgery?

Smoking Signup and view all the answers

What is the significance of a creatinine level > 2 mg/dL in a patient undergoing surgery?

It increases the risk of postoperative cardiac complications Signup and view all the answers

What is the primary benefit of evaluating a patient's Cardiac risk index conditions before surgery?

To identify potential underlying cardiovascular conditions Signup and view all the answers

What is the purpose of pulmonary rehabilitation after surgery?

To reduce the risk of postoperative respiratory complications Signup and view all the answers

Why is it essential to address smoking cessation in prehabilitation?

To reduce the risk of postoperative respiratory complications Signup and view all the answers

What is the primary purpose of evaluating a patient's kidney function before surgery?

To assess the patient's risk of postoperative renal complications Signup and view all the answers

What is the benefit of immunonutrition in surgical patients?

It enhances the patient's immune function Signup and view all the answers

What should be considered before performing surgery if a patient has an active cardiac condition?

Solve the cardiac condition first Signup and view all the answers

Why is it important to evaluate a patient's cardiac condition before surgery?

To address any potential cardiac complications Signup and view all the answers

What should be done for patients with cancer before performing surgery?

Solve the cancer problem before performing surgery Signup and view all the answers

What is the primary focus of evaluating a patient's cardiac condition before surgery?

To identify potential cardiac complications Signup and view all the answers

Why is it important to evaluate a patient's cardiac risk index before surgery?

To identify potential cardiac complications Signup and view all the answers

What should be considered when evaluating a patient's fitness for surgery?

The patient's overall health and underlying conditions Signup and view all the answers

What is the primary purpose of evaluating a patient's cardiac condition before surgery?

To identify potential cardiac complications Signup and view all the answers

What should be done before performing surgery on a patient with an active cardiac condition?

Solve the cardiac condition first Signup and view all the answers

Study Notes

Minimally Invasive Surgery

Laparoscopic cholecystectomy: a 1-centimeter incision at the umbilicus and two or three other 5-millimeter incisions to extract the gallbladder
Advantages: strong cosmetic advantage, less adhesions, faster recovery, and less postoperative pain

Robotic Surgery

Similar to laparoscopy, but uses a robotic platform to remotely control instruments
Advantages: improved vision, precision, and quality of movements
Potential for integration with artificial intelligence and protocols for automatic identification of anatomical structures and anastomosis

Preoperative Evaluation

Step 3: evaluate the type of surgery and determine if it is low risk
Step 4: evaluate the patient's cardiovascular function using the MET score
Step 5: investigate underlying cardiac risk index conditions

Cardiac Risk Index Conditions

Pulmonary evaluation: consider smoking, COPD, preoperative sputum production, pneumonia, dyspnoea, and obstructive sleep apnoea
Kidney evaluation: consider creatinine level >2 mg/dL and renal dysfunction
Medications: beta-blockers, metformin, antithrombotic therapy, and acetylsalicylic acid

Global Risk Assessment

American College of Surgeons' online calculator considers 20 clinical parameters and the type of procedure
Predicts patient risk factors, but not perfect due to complexity of parameters

Frailty

A state of reduced physiological capacity and increased susceptibility to disability caused by age-related loss of physical, cognitive, social, and psychological function
A multi-factorial event considering age, chronic comorbidity, disability, and social and psychological function

Prehabilitation

Prepares patients in the perioperative setting for better outcomes
Includes nutritional assessment and supplementation, smoking cessation, physical exercise programs, and care for cognitive function and stress
ERAS protocol reduces the stress response to surgery, while prehabilitation occurs before

Nutritional Support

Improves surgical outcomes
Supplementation can be oral, enteral, or parental
Immunonutrition reduces postoperative infections
10-14 days of nutrition support recommended for severely malnourished patients

Prehabilitation

Prepares patients in the perioperative setting to have better outcomes in surgery
Includes:
- Nutritional assessment and supplementation
- Smoking cessation
- Physical exercise programs
- Cognitive function and stress management
Improving nutritional status can improve surgery outcomes
Malnutrition can be solved by giving supplementation (orally, enterally, or parenterally)

ERAS Protocol

Reduces the stress response to surgery
Occurs before surgery (preoperative)

Nutritional Support

10-14 days of nutrition support recommended for severely malnourished patients
7 days of immunonutrition (nutritional formulas aimed to regulate the immune system) recommended for all patients undergoing GI oncological surgery
Immunonutrition reduces postoperative infections

Smoking Cessation

High impact on patient outcomes
Additional measures for COPD patients: breathing techniques, medications

Anemia Correction

Iron supplementation or erythropoiesis stimulation (if it doesn't interfere with cancer treatment)
Blood transfusions only in severe anemia with risk of organ ischemia

Telehabilitation

Used to contact patients remotely to provide prehabilitation and monitor activity and psychological aspects

Principles of Surgical Oncology

Distinction between surgeon and surgical oncologist
Grading frailty:
- Physical frailty (based on S&S: weight loss, exhaustion, weakness, slow walking speed, decreased physical activity)
- Index frailty (considering cumulative comorbidities and illnesses)

Frailty Scale (FRAIL)

Each affirmative answer to questions is worth 1:
- Fatigue
- Resistance
- Ambulation
- Illnesses
- Loss of weight
Patient is defined as frail when score is >3

Index Frailty

Consider all comorbidities using a comprehensive geriatric assessment
Takes into account functional status, diabetes, history of COPD, history of congestive heart failure and hypertension requiring medication

Sarcopenia

Age-related loss of skeletal muscle mass, muscle strength, and muscle function
More than 50% of patients > 80 years old are affected
Large percentage of patients of any age with oncological diseases are also affected
Associated with more complications, higher mortality, and longer hospital stay

TNM Staging

Prefixes specify characteristics of staging:
- cTNM: clinical, based on preoperative evaluation
- pTNM: based on pathology data
- yTNM: stage after chemo/radiotherapy
- rTNM: stage for a recurrent tumor
- aTNM: stage determined at autopsy
- uTNM: stage based on ultrasound or endoscopic ultrasound
- mTNM: in case of multiple tumors

Additional Parameters in TNM

G (1-4): tumor grading
S (0-3): elevation of serum tumor markers
Pn (0-1): perineural invasion
L (0-1): lymphatic vessel invasion
V (0-2): venous invasion

Surgery in Diagnosis and Staging

Role in diagnosis and staging:
- Incisional and excisional biopsy
- Exploratory laparoscopy to find metastases difficult to visualize with imaging

Prehabilitation

Prepares patients in the perioperative setting for better surgical outcomes
Includes:
- Nutritional assessment and supplementation
- Smoking cessation
- Physical exercise programs
- Cognitive function and stress management

Nutrition and Surgery Outcomes

Improving nutritional status can enhance surgery outcomes
Malnutrition can be solved by supplementation (orally, enterally, or parenterally)
10-14 days of nutrition support recommended for severely malnourished patients
7 days of immunonutrition recommended for all patients undergoing GI oncological surgery
Immunonutrition reduces postoperative infections

Smoking Cessation and Respiratory Care

Smoking cessation has a high impact on surgery outcomes
COPD patients may require breathing techniques and medication
Telerehabilitation can be used for remote prehabilitation and monitoring

Anemia and Blood Transfusions

Correct anemia with iron supplementation or erythropoiesis stimulation
Blood transfusions only considered in severe anemia with risk of organ ischemia

Surgical Oncology Principles

Distinction between surgeon and surgical oncologist
Evaluation of surgical risk involves assessing CV function and cardiac risk index conditions

Cardiovascular Evaluation

MET score evaluates metabolic state and energy needed for daily tasks
MET score < 4 indicates underlying CV condition
Cardiac risk index conditions include unstable coronary disease, decompensated heart failure, and more

Pulmonary Evaluation

Conditions that worsen surgery outcomes include smoking, COPD, and pneumonia
Pulmonary rehabilitation reduces pulmonary impact during and after surgery

Kidney Evaluation

Renal dysfunction affects approximately 5% of the adult population
Creatinine level >2 mg/dL increases risk of postoperative cardiac complications

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Description

This quiz covers the laparoscopic cholecystectomy surgical procedure, including the removal of the gallbladder through small incisions. It also compares the traditional open surgery method with the laparoscopic approach.