Surgical Complications and Management Quiz

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Questions and Answers

What is a key risk factor for developing an incisional hernia?

High tension wound closure (correct)

Low physical activity

Frequent antibiotic use

Genetic predisposition

Which symptom is typically associated with acute appendicitis?

Persistent cough

Chest pain radiating to the arm

Epigastric pain migrating to RLQ (correct)

Dull headache

Which sign is associated with acute appendicitis and indicates peritoneal irritation?

Brudzinski's sign

Bainbridge sign

Psoas sign (correct)

Murphy's sign

What laboratory finding is expected in a case of acute appendicitis?

Elevated white blood cell count Signup and view all the answers

What complication should be suspected if high fever is present with abdominal pain in the context of appendicitis?

Perforation of the appendix Signup and view all the answers

What is the primary clinical sign indicating a patient may be at risk for acute kidney injury (AKI) after surgery?

Decreased urine output Signup and view all the answers

Which of the following are concerns associated with oliguria in postoperative patients?

Outflow Obstruction Signup and view all the answers

Which condition is NOT a form of shock to be worried about in patients presenting with hypotension?

Psychogenic Shock Signup and view all the answers

What is a potential issue with administering liberal fluids in patients undergoing bowel surgery?

Increased postoperative complications Signup and view all the answers

Which of the following should NOT be excluded as a reversible cause of oliguria?

Peripheral edema Signup and view all the answers

What is the most common type of gallstone?

Mixed stones Signup and view all the answers

Which of the following is NOT a risk factor for developing gallstones?

Male gender Signup and view all the answers

What are the symptoms of biliary colic primarily related to?

Obstruction of bile flow Signup and view all the answers

Which of the following describes Charcot’s triad in the context of choledocholithiasis and cholangitis?

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

What treatment options are considered when a patient shows severe gallbladder disease but is not healthy enough for surgery?

Percutaneous drain of gallbladder Signup and view all the answers

What laboratory findings are expected in a patient with gallstone pancreatitis?

Elevated amylase and lipase Signup and view all the answers

What imaging technique is best suited for detecting gallstones?

Ultrasound Signup and view all the answers

Which condition can develop from choledocholithiasis that also involves infection?

Cholangitis Signup and view all the answers

What is the primary function of vascular cushions in the anal canal?

To aid in continence and protect the anal canal Signup and view all the answers

Which of the following is NOT a risk factor for symptomatic or enlarged hemorrhoids?

Excessive hydration Signup and view all the answers

What symptom is most commonly associated with a thrombosed external hemorrhoid?

Swelling with excruciating pain Signup and view all the answers

Which treatment is recommended for chronic anal fissure management?

Increased fiber, Sitz baths, diltiazem 2% cream Signup and view all the answers

What is the triad of characteristics associated with a chronic anal fissure?

Sentinel tag, hypertrophic anal papilla, and exposed fibers of internal sphincter Signup and view all the answers

What is the primary goal of using a Sitz bath in hemorrhoid or anal fissure management?

To alleviate pain and reduce spasm Signup and view all the answers

Which medication is NOT indicated for the treatment of anal fissures?

Antihistamines for allergic reactions Signup and view all the answers

What is a common non-surgical treatment option for recurrent thrombosed external hemorrhoids?

Increased fiber intake and NSAIDs Signup and view all the answers

What is the most common treatment for an anorectal abscess?

Incision and drainage Signup and view all the answers

Which of the following is true regarding the healing time after drainage of an anorectal abscess?

Healing typically takes 2-6 weeks. Signup and view all the answers

What is a probable cause of a fistula in ano?

Obstructed or infected anal gland Signup and view all the answers

What is a characteristic of pilonidal disease?

It is related to debris and hair in the upper natal cleft. Signup and view all the answers

Which postoperative complication would most likely occur between POD 5-10?

Wound infection Signup and view all the answers

What is the recommended immediate treatment for suspected urinary tract infection (UTI) post-surgery?

Administer Ciprofloxacin and send for culture and sensitivity. Signup and view all the answers

What is a complication associated with postoperative days 0-48?

Sepsis Signup and view all the answers

Which management strategy will NOT resolve a fistula in ano?

Observation and dietary changes Signup and view all the answers

What is the correct replacement for loss from perspiration, evaporation, and urinary output?

CRYSTALLOID Signup and view all the answers

Which fluid replacement should be used during maintenance for a patient who is NPO on POD1?

D5W + 1/2NS + 20meqKCl/L Signup and view all the answers

Which of the following body fluids has the highest primary cation content?

Small Bowel Signup and view all the answers

What happens to fluids in the third spacing after surgery?

They can cause temporary fluid overload if over-resuscitated. Signup and view all the answers

What should be used to replace acute blood loss?

BLOOD Signup and view all the answers

Study Notes

General Surgery Study Guide

Hernia: Abnormal protrusion of tissue/organs through muscle/connective tissue. Internal hernias occur through peritoneal defects; External hernias occur through abdominal wall layers; Reducible hernias can return to their original position; Irreducible hernias cannot be returned (incarcerated); Strangulated hernias are incarcerated with vascular compromise, requiring emergent surgery; Obstructed hernias cause bowel obstruction requiring surgery; Richter's hernia involves part of bowel wall but does not cause obstruction.
Hernia Risk Factors: Chronic increased abdominal pressure (obesity, ascites, peritoneal dialysis, VP shunt, pregnancy, constipation, prostatism, chronic cough, COPD, heavy lifting)
Hernia Locations: Abdominal wall is the most common site, particularly where aponeurosis and fascia are not covered by striated muscle (inguinal, femoral, umbilical, linea alba, semilunar line).
Groin Hernias (Inguinal): Hasselbach's triangle (lateral border of rectus, inguinal ligament, inferior epigastric vessels) is a location for indirect and direct inguinal hernias.
Indirect Inguinal Hernia: Congenital; protrudes through internal/superficial inguinal rings.
Direct Inguinal Hernia: Acquired; protrudes directly through inguinal wall, through Hesselbach's triangle.
Femoral Hernia: More common in females; protrusion of intestinal loop through weakened abdominal wall below inguinal ligament.
Umbilical Hernia: Most common pediatric hernia; protrudes through umbilical ring.
Epigastric Hernia: Defect in preperitoneal fat; presents with a painless lump in the upper abdomen.
Spigelian Hernia: Hernia along the semilunaris, presenting with vague lower abdominal pain.
Incisional Hernia: Hernia at the site of a previous surgical incision; risk factors include high tension closure, steroid use, and wound infections.

Acute Appendicitis

History: Epigastric/periumbilical pain migrating to RLQ (8-12 hours); nausea, vomiting, anorexia, diarrhea.
Physical Exam: RLQ tenderness, rebound and guarding, Rovsing's sign, pain at McBurney's point, internal hip rotation.
Diagnosis: Clinical diagnosis; vital signs (fever, high WBC, elevated fever) are valuable indicators elevated WBC count and fever, suggests possible perforation.
Imaging: Ultrasound, CT are helpful for confirmation, but clinical suspicion is primary.
Treatment: Broad spectrum antibiotics and prompt appendectomy (open or laparoscopic).

Small Bowel Obstruction (SBO)

Causes: Adhesions, hernia, Crohn's disease, cancer, strictures, foreign bodies.
Symptoms: Crampy, colicky abdominal pain, nausea/vomiting, obstipation, increased bowel sounds (if incomplete).
Diagnosis: Clinical suspicion, abdominal x-rays (looking for air-fluid levels, pattern of folds).

Mesenteric Ischemia

History: Older patients with severe, generalized abdominal pain, out of proportion to findings. N/V common. Underlying CAD/CHF/DM/sepsis/dehydration/AF/hypercoagulation are frequent comorbid conditions.
Causes: Acute mesenteric artery or vein embolus/thrombus or non-occlusive mesenteric ischemia.
Diagnosis: CT is the best diagnostic test, but ultrasound/ elevated lactate levels/WBC/ liver function tests/ creatinine might be suggestive to support suspicion.
Treatment: Emergency surgery.

Gallstone Disease

Symptoms: Biliary colic (episodic right upper quadrant pain, resolves within 4 hours), acute cholecystitis (right upper quadrant pain, fever, nausea/vomiting, related to stone lodge in cystic duct) .
Diagnosis: Ultrasound or CT usually confirms presence of gallstones, though elevated white blood cell count and other symptoms might be present without being definitively noted on imaging.
Treatment: Acute cholecystitis = Surgery.

Choledocholithiasis

Symptoms: RUQ pain, pale stools, dark urine, jaundice due to blockage of bile duct., related to gallstones entering the bile duct.
Diagnosis: Elevated liver function tests and ultrasound will confirm presence of gallstones.
Treatment: Endoscopic retrograde cholangiopancreatography (ERCP).

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Description

Test your knowledge on surgical complications, particularly focusing on incisional hernias, acute appendicitis, and kidney injury. This quiz covers risk factors, symptoms, laboratory findings, and management concerns related to common surgical conditions. Prepare to enhance your understanding of postoperative challenges in a clinical setting.