Smoking Cessation Prior to Surgery

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Questions and Answers

What is the recommended time frame for a patient to stop smoking prior to surgery to minimize the risk of pulmonary complications?

At least 12 weeks

At least 6 weeks

At least 8 weeks (correct)

At least 4 weeks

Which of the following is NOT a perioperative benefit of short-term smoking cessation?

Increased hospital stay (correct)

Improved pulmonary function tests (PFTs)

Decreased risk of blood clot

Less vasoconstriction

Which condition is associated with fever occurring immediately after surgery due to possible bowel perforation?

Malignant hyperthermia

Wonder Drugs

Bacteremia (correct)

Atelectasis

What is the first-line treatment for malignant hyperthermia experienced during surgery?

Dantrolene and cold IV fluids Signup and view all the answers

What is an effective nicotine replacement therapy that can be used on the morning of surgery?

Nicotine gum or lozenge Signup and view all the answers

What is the primary preventive measure suggested to reduce the risk of pneumonia postoperatively on day 2?

Incentive spirometry and getting the patient out of bed Signup and view all the answers

Which diagnostic test is considered the gold standard for diagnosing deep vein thrombosis?

DVT Venography Signup and view all the answers

What is the most common organism responsible for cellulitis in postoperative patients?

Staphylococcus Signup and view all the answers

What symptom is typically the first sign of wound infection occurring 5-10 weeks after surgery?

Fever Signup and view all the answers

What is the recommended empirical treatment approach for a urinary tract infection on postoperative day 3?

Broad-spectrum antibiotics and catheter removal Signup and view all the answers

How much maintenance fluid is calculated for a patient weighing 80 kg using the 4/2/1 rule?

130 mL/hr Signup and view all the answers

What is the minimum urine output for a patient receiving maintenance fluids?

30 mL/hr Signup and view all the answers

Which crystalloid fluid contains the highest concentration of sodium?

Normal Saline Signup and view all the answers

In managing perioperative hyperglycemia, which blood glucose range does not require insulin treatment?

90-100 Signup and view all the answers

Which of the following is NOT a risk factor for pulmonary complications in the perioperative setting?

Body mass index under 25 Signup and view all the answers

Which fluid is contraindicated due to the risk of coagulopathy caused by platelet deactivation?

Albumin Signup and view all the answers

What is the target Peak Expiratory Flow Rate (PEFR) for patients with asthma before elective surgery?

<blockquote> 80% of predicted </blockquote> Signup and view all the answers

Which of the following actions should NOT be taken for a patient with COPD one week before undergoing surgery?

Initiate long-term steroid therapy Signup and view all the answers

What is a potential result of insufficient cerebral blood flow as stated in the content?

Sense of impending faint Signup and view all the answers

Which red flag symptom is NOT associated with syncope according to the information provided?

Feeling fatigued after prolonged sitting Signup and view all the answers

Which risk factor is commonly associated with the development of varicose veins?

Family history Signup and view all the answers

What underlying condition can lead to the development of varicose veins?

Valvular incompetence Signup and view all the answers

Which of the following is NOT a symptom associated with varicose veins?

Improved blood circulation Signup and view all the answers

What is the expected finding in pulmonary function tests (PFTs) for a patient with asthma?

FEV1/FVC is less than 70% and reversible with bronchodilator Signup and view all the answers

Which indication suggests that preoperative pulmonary function tests (PFTs) are necessary?

A patient with a history of asthma and exertional dyspnea Signup and view all the answers

What should a patient on methadone be advised regarding its use on the day of surgery?

To continue methadone to avoid withdrawal symptoms Signup and view all the answers

Which of the following indicates a high risk of postoperative complications based on pulmonary function tests?

FEV1 < 50% Signup and view all the answers

What common laboratory test is used to evaluate alcohol use in patients?

Blood ETOH concentration Signup and view all the answers

What is the role of naltrexone in the treatment of substance use disorder?

It is an opioid antagonist used for overdose reversal Signup and view all the answers

Which factor is NOT a part of the CAGE screening tool for substance use disorder?

Severe withdrawal symptoms Signup and view all the answers

How might sympathomimetic drug use affect anesthetic needs during surgery?

Increase pressor response leading to higher anesthetic requirements Signup and view all the answers

Which condition is characterized by the twisting of bowel, often leading to abdominal pain and distention?

Volvulus Signup and view all the answers

What is the primary treatment for primary sclerosing cholangitis that significantly reduces the risk of additional complications such as cholangiocarcinoma?

Liver transplant Signup and view all the answers

What physiological change occurs due to NG decompression post-operative care?

Increased HCO3- levels Signup and view all the answers

In ascending cholangitis, what triad of symptoms is classically observed?

RUQ pain, jaundice, fever Signup and view all the answers

What complication is commonly associated with choledocholithiasis?

Acute pancreatitis Signup and view all the answers

What is the common symptom experienced by patients with cholelithiasis?

Asymptomatic episodes Signup and view all the answers

Which laboratory finding is typical for primary sclerosing cholangitis?

Increased alkaline phosphatase (3-5 times normal) Signup and view all the answers

What is a known risk factor for developing primary sclerosing cholangitis?

Inflammatory bowel disease (IBD) Signup and view all the answers

Which condition is most likely to be complicated by gastric fluid loss during NG suctioning?

HypoCl- metabolic alkalosis Signup and view all the answers

What is the typical age range for men most affected by primary sclerosing cholangitis?

20-40 years Signup and view all the answers

Which diagnostic procedure is considered the gold standard for evaluating primary sclerosing cholangitis?

ERCP Signup and view all the answers

What clinical finding is included in Reynold’s pentad, which is associated with severe cholangitis?

Altered mental status Signup and view all the answers

How is the pain associated with biliary colic typically described?

Episodic and gradual onset Signup and view all the answers

Which type of gallstones are most commonly found in patients with cholelithiasis?

Cholesterol stones Signup and view all the answers

Study Notes

Cholecystitis

Gallbladder (cystic duct) obstruction by gallstones → inflammation/infection
Majority are caused by Escherichia coli (E. coli).
Acute acalculous cholecystitis: Usually in critically ill patients, due to biliary stasis and absence of cholecystokinin (decreased gallbladder contraction).
Chronic cholecystitis: Associated with gallstones, a "strawberry" gallbladder (secondary to cholesterol submucosal aggregation) or porcelain gallbladder (premalignant condition).
Primary cause: gallstones; chronic alcohol abuse.

Pancreatitis

Inflammation of the pancreas
From trauma, hyperlipidemia, drugs, hypercalcemia, penetrating peptic ulcer disease (PUD), certain medications.
Acute: Sudden, severe, constant upper abdominal pain that may radiate to the back, better with forward leaning or sitting in fetal position. Nausea, vomiting, fever.
Chronic: Steatorrhea, calcifications, diabetes; recurrent acute pancreatitis episodes
Labs: Elevated amylase (may be normal after 48-72 hrs) and lipase (more sensitive); mild hyperbilirubinemia/bilirubinuria. Hypocalcemia.
Imaging: CT is the diagnostic test of choice.
Treatment: NPO (nothing by mouth), IV fluid resuscitation; pain management (demerol); use abx if needed. ERCP for biliary sepsis suspicion (effective in obstructive jaundice).

Anal Fissure

Painful linear lesions in the distal anal canal.
Mostly found in the posterior midline.
Can involve the entire thickness of the mucosa if untreated.
Painful bowel movements, leading to constipation and bleeding. Skin tags if chronic.

Anorectal Abscess/Fistula

Bacterial infection of anal ducts/glands
Throbbing rectal pain, worse with sitting, coughing, or bowel movements.
MC posterior midline
Treatment: I&D (with or without antibiotics); high fiber diet; topical nitroglycerin, silver nitrate or Nifedipine ointment; BoTox.

Appendicitis

Obstruction of the appendix (MC cause is a fecalith; could be from inflammation, malignancy, foreign body or collagen vascular disease).
MC in 10-30 year olds
Initial symptoms: anorexia, periumbilical/epigastric pain transitioning to constant RLQ (McBurney's point) pain; nausea, vomiting, low-grade fever.
Complications: Perforation/peritonitis (high fever, generalized abdominal pain, increased leukocyte count).
Imaging: US or CT.
Treatment: Urgent appendectomy.

Bariatric Surgery

Maintaining weight loss and reducing obesity-related medical problems (BMI > 40 or > 35 with medical problems; failed other non-surgical programs; must be psychologically stable and able to follow post-op instructions).
Variety of procedures (e.g., adjustable gastric banding, sleeve gastrectomy or Roux-en-Y gastric bypass)
Post-op complications: band slippage or erosion; dumping syndrome (from rapid movement of simple sugars from stomach to bowel, leading to fullness, cramping, pain, nausea, vomiting, and diarrhea).

Bowel Obstruction

Mechanical or functional blockage of the small or large intestine
Mechanical: Adhesions, hernias, neoplasms, inflammatory bowel disease (IBD), volvulus, fecal impaction, strictures; intussusception.
Symptoms: Vomiting (follows pain), obstipation (severe); crampy abdominal pain, vomiting, diarrhea (early). Mild pain → severe.
Imaging: XR (air-fluid levels, dilated bowel loops); CT with contrast if XR inconclusive
Treatment: NPO; NG suctioning; IVF; if mechanical obstruction likely → urgent surgical consult.
Volvulus: Twisting of a portion of the bowel, potentially causing necrosis & perforation.

Cholelithiasis

Asymptomatic formation of gallstones (90% cholesterol)
Risk factors: Female, fertile, forty, fair, fat, oral contraceptives.
Causes: Bile stasis, chronic hemolysis, cirrhosis, infection, rapid weight loss, inflammatory bowel disease (IBD), total parenteral nutrition (TPN), or some medications (e.g. fibrates).
Complications: Biliary colic (episodic upper abdominal or epigastric pain beginning abruptly and resolving slowly, often lasting 30 min-hours after a meal), jaundice, possible cholecystitis or choledocholithiasis.

Diverticular Disease

Diverticulosis: Non-inflamed diverticula; often associated with a low-fiber diet, constipation, and obesity. Asymptomatic but can cause lower GI bleeding
Diverticulitis: Inflamed diverticula, secondary to obstruction or fecalith; associated with infection. LLQ pain; Fever; n/v/d/c.
Diagnosis: CT scan—shows bowel wall thickening, fat stranding and inflamed diverticula.
Treatment: Diverticulosis: High fiber diet; diverticulitis: oral antibiotics; avoid low fiber diets

Esophageal Neoplasms

Cancerous growth and development in the esophagus
Squamous cell carcinoma: Most common in the upper esophagus and associated with tobacco use and alcohol consumption
Adenocarcinoma: Most common in the lower esophagus, associated with Barrett's esophagus, obesity.
Symptoms: Progressive dysphagia to solids, weight loss, odynophagia, heartburn, vomiting, hoarseness.

Esophageal Strictures

Narrowing of the esophagus, mostly caused by GERD or Barrett's esophagus.

Gastric Carcinoma

Cancer of the stomach
Risk factors include H. pylori infection, salted, cured, smoked or processed/cured foods.
Symptoms: Dysphagia (difficulty swallowing), indigestion, weight loss, early satiety, abdominal distention, pain, Nausea
Treatment: Endoscopy with biopsy; surgical resection; radiotherapy; chemotherapy

Constipation

Inability to pass stools regularly
Caused by various factors including low fiber intake, medications and other underlying diseases
Diagnosis: Physical exam; medical history

Diarrhea

Frequent loose, liquid or semi-solid stools for at least 2 to 3 consecutive days
Etiology: Infection, toxic, diet, Gl dz
Possible indications: infection (bacterial or viral), medication reactions, inflammatory bowel disease (IBD) or pancreatic insufficiency.
Diagnosis: Based on symptoms or hx of recent food/ drinks consumed, meds

Hernia

Protrusion of an organ or body part through an abnormal opening in the muscle or connective tissue that surrounded it
Hiatal Hernia: protrusion of the stomach through the diaphragm via the esophageal hiatus usually worsened by GERD.
Sliding hiatal hernia: GE junction and stomach slide into mediastinum
Rolling/paraesophageal hernia: fundus of stomach protrudes through diaphragm, GE junction remains in anatomic location.
Inguinal Hernia: Protrusion of abdominal contents through the inguinal canal.
Direct Inguinal Hernia: intestines pass medially to epigastric artery into inguinal canal
Indirect Inguinal Hernia: intestines pass laterally to epigastric artery through internal inguinal ring into inguinal canal.
Femoral Hernia: contents pass through the femoral canal
Diagnosis: Physical exam and imaging to determine the type and location of the hernia

Hepatic Carcinoma

Cancer of the liver
Risk factors include chronic liver diseases and cirrhosis (especially viral hepatitis and alcohol abuse), some medications.
Treatment: surgery (if tumors are small or limited in number or size); transplant; chemotherapy or radiation therapy depending on the severity of the dz and if distant metastasis is present.

Hematemesis/GI bleed

Vomiting of blood
Causes: PUD, esophageal ulcer, Mallory-Weiss tear, variceal hemorrhage, portal hypertensive gastropathy, malignancy.
Diagnosis: Physical examination, lab investigation to determine if there are any associated causes

Hemorrhoids

Inflammation or swelling of veins in the rectum and anus
Can bleed, cause pain, cause itchiness and discomfort, or prolapse out of the anus.

Jaundice

Yellowing of the skin, sclera and mucus membranes; caused by abnormal levels of bilirubin in the blood.
ETI: Extravascular hemolysis / ineffective erythropoiesis, Gilbert syndrome, Crigler-Najjar syndrome, Dubin-Johnson, biliary tract obstruction, viral hepatitis, physiologic jaundice of newborn; hepatocellular, obstructive.

Melena/Hematochezia

Melena: Black, tarry stool indicating an upper GI bleed
Hematochezia: Bright red blood per rectum (mostly lower GI).

Pilonidal Cysts

Infection or inflammation in the hair follicles near the natal cleft of the buttocks. -Diagnosis: physical exam.
Treatment: initial treatment is incision and drainage; definitive treatment requires surgical excision.

Pyloric Stenosis

Narrowing of the pyloric sphincter, a muscle at the end of the stomach
Presents with projectile vomiting in infants/young children

Small Bowel Carcinoma/Large bowel Carcinoma

Cancer in the small/large intestines
Symptoms: abdominal pain, intermittent and crampy; anemia; overt Gl bleeding; jaundice; weight loss.

Toxic Megacolon

Severe dilation of the colon, usually secondary to a condition like IBD, and/or some infections
Signs: fever, distended abdomen, peritonitis, and shock.
Treatment: Colon decompression; in some cases even complete colonic resection is necessary

Ulcers

Open sores in the lining of the stomach or duodenum
Types: Gastric ulcers, Duodenal ulcers
Risk factors: H. pylori; NSAIDS and Zollinger-Ellison Syndrome
Treatment: Medications (Acid suppression)

Volvulus

Twisting of a portion of the intestine, potentially causing necrosis and perforation.
MC sigmoid and cecum

Portal Hypertension

Elevated blood pressure in the portal vein - causes: hepatic cirrhosis; portal vein thrombosis
CM: ascites and GI hemorrhage

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Description

This quiz explores the recommended time frame for patients to stop smoking before undergoing surgery. Understanding this critical timeline is essential for minimizing the risk of pulmonary complications during surgical procedures. Test your knowledge on this important aspect of patient care.