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Surgery - Surgical Terms
Allen’s Test
Allen’s test is used to assess the adequacy of blood flow to the hand via the radial and ulnar arteries. The patient is asked to clench their fist to expel blood while both arteries are compressed. After opening the blanched hand, one artery is released to observe if normal color returns, indicating patency. The process is then repeated for the other artery.
Argyll Robertson Pupil
Argyll Robertson pupil is characterized by pupils that constrict during accommodation (focusing on near objects) but do not respond to light. This dissociation is remembered by the mnemonic: Accommodation Reflex Present, Pupillary Response Absent.
Barton’s Fracture
Barton’s fracture is a fracture-dislocation of the distal radius involving the articular surface, typically affecting the volar lip. The distal fragment and hand are displaced proximally and volarly, and it can sometimes be mistaken for a Colles’ fracture.
Battle’s Sign
Battle’s sign refers to bruising over the mastoid region (behind the ear) and is a clinical indicator of a basal skull fracture.
Beck’s Triad
Beck’s triad is a set of three clinical signs seen in cardiac tamponade: raised jugular venous pressure, muffled heart sounds, and hypotension.
Bell’s Palsy
Bell’s palsy is an acute lower motor neuron facial nerve paralysis of unknown cause. It presents with unilateral facial weakness and is diagnosed after excluding other causes.
Chvostek’s Sign
Chvostek’s sign is a clinical sign of hypocalcaemia. Tapping over the facial nerve triggers twitching of the facial muscles.
Colles’ Fracture
Colles’ fracture is a fracture of the distal radius, typically within 2 cm of the wrist joint, with dorsal displacement of the distal fragment, producing a characteristic “dinner fork” deformity.
Compartment Syndrome
Compartment syndrome occurs when pressure within a closed anatomical space rises to a level that compromises circulation and tissue viability, potentially leading to permanent damage if untreated.
Cushing’s Triad
Cushing’s triad is associated with raised intracranial pressure and consists of hypertension, bradycardia, and irregular respirations.
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is inflammation of the extensor pollicis brevis and abductor pollicis longus tendons due to repetitive use, causing pain on thumb movement.
Finkelstein’s Test
Finkelstein’s test is used to diagnose De Quervain’s tenosynovitis. The patient makes a fist with the thumb inside, and ulnar deviation of the wrist causes pain due to tendon stretching.
Frey’s Syndrome
Frey’s syndrome is characterized by sweating and flushing over the cheek when eating or thinking about food. It occurs due to misdirected regeneration of autonomic fibers after parotid gland injury.
Galeazzi Fracture
Galeazzi fracture involves a fracture of the radial shaft with dislocation of the distal radioulnar joint, disrupting the forearm axis.
Gradenigo’s Syndrome
Gradenigo’s syndrome is associated with complications of otitis media and includes ear infection signs, ipsilateral abducens nerve palsy, and trigeminal nerve pain.
Hitselberger’s Sign
Hitselberger’s sign involves increased sensitivity of the posterior external auditory canal along with hearing loss, often seen in acoustic neuroma.
Horner’s Syndrome
Horner’s syndrome results from disruption of sympathetic innervation to the eye, causing ptosis, miosis, anhidrosis, and enophthalmos on the affected side.
Monteggia Fracture
Monteggia fracture consists of a fracture of the proximal ulna with dislocation of the radial head.
Osler–Rendu–Weber Syndrome
Osler–Rendu–Weber syndrome, or hereditary haemorrhagic telangiectasia, causes abnormal blood vessel formation leading to frequent nosebleeds and mucosal telangiectasia.
Pendred’s Syndrome
Pendred’s syndrome is an autosomal recessive condition characterized by congenital sensorineural hearing loss and the development of a thyroid goitre.
Pierre Robin Sequence
Pierre Robin sequence includes a small mandible, cleft palate, and displacement of the tongue, often causing airway obstruction and feeding difficulties.
Raccoon Eyes
Raccoon eyes refer to bilateral periorbital bruising, commonly seen in basal skull fractures.
Refsum Disease
Refsum disease is a metabolic disorder presenting with retinitis pigmentosa, cerebellar ataxia, peripheral neuropathy, and hearing loss.
Ramsay Hunt Syndrome
Ramsay Hunt syndrome is caused by herpes zoster infection of the facial nerve and presents with facial paralysis and painful vesicles in the ear.
Smith’s Fracture
Smith’s fracture is a distal radius fracture with volar displacement of the distal fragment, usually resulting from a fall onto a flexed wrist.
Superior Vena Cava Syndrome
Superior vena cava syndrome occurs when there is obstruction of the SVC, leading to swelling and venous congestion of the face, neck, and upper chest.
Thoracic Outlet Syndrome
Thoracic outlet syndrome involves compression of nerves or blood vessels at the thoracic outlet, leading to upper limb symptoms.
Thornwaldt’s Cyst
Thornwaldt’s cyst is a benign cyst in the nasopharynx arising from the pharyngeal bursa and may cause nasal obstruction.
Treacher Collins Syndrome
Treacher Collins syndrome is a genetic disorder causing underdevelopment of facial bones, particularly the jaw and ears, often with hearing impairment.
Trousseau’s Sign
Trousseau’s sign is seen in hypocalcaemia, where inflation of a blood pressure cuff induces carpopedal spasm.
Waardenburg Syndrome
Waardenburg syndrome is a genetic condition characterized by wide-set eyes, pigment abnormalities such as a white forelock, and sensorineural hearing loss.
If you want, I can convert this into exam flashcards, OSCE notes, or ultra-short one-liners for quick recall.
Allen’s Test
Allen’s test is used to assess the adequacy of blood flow to the hand via the radial and ulnar arteries. The patient is asked to clench their fist to expel blood while both arteries are compressed. After opening the blanched hand, one artery is released to observe if normal color returns, indicating patency. The process is then repeated for the other artery.
Argyll Robertson Pupil
Argyll Robertson pupil is characterized by pupils that constrict during accommodation (focusing on near objects) but do not respond to light. This dissociation is remembered by the mnemonic: Accommodation Reflex Present, Pupillary Response Absent.
Barton’s Fracture
Barton’s fracture is a fracture-dislocation of the distal radius involving the articular surface, typically affecting the volar lip. The distal fragment and hand are displaced proximally and volarly, and it can sometimes be mistaken for a Colles’ fracture.
Battle’s Sign
Battle’s sign refers to bruising over the mastoid region (behind the ear) and is a clinical indicator of a basal skull fracture.
Beck’s Triad
Beck’s triad is a set of three clinical signs seen in cardiac tamponade: raised jugular venous pressure, muffled heart sounds, and hypotension.
Bell’s Palsy
Bell’s palsy is an acute lower motor neuron facial nerve paralysis of unknown cause. It presents with unilateral facial weakness and is diagnosed after excluding other causes.
Chvostek’s Sign
Chvostek’s sign is a clinical sign of hypocalcaemia. Tapping over the facial nerve triggers twitching of the facial muscles.
Colles’ Fracture
Colles’ fracture is a fracture of the distal radius, typically within 2 cm of the wrist joint, with dorsal displacement of the distal fragment, producing a characteristic “dinner fork” deformity.
Compartment Syndrome
Compartment syndrome occurs when pressure within a closed anatomical space rises to a level that compromises circulation and tissue viability, potentially leading to permanent damage if untreated.
Cushing’s Triad
Cushing’s triad is associated with raised intracranial pressure and consists of hypertension, bradycardia, and irregular respirations.
De Quervain’s Tenosynovitis
De Quervain’s tenosynovitis is inflammation of the extensor pollicis brevis and abductor pollicis longus tendons due to repetitive use, causing pain on thumb movement.
Finkelstein’s Test
Finkelstein’s test is used to diagnose De Quervain’s tenosynovitis. The patient makes a fist with the thumb inside, and ulnar deviation of the wrist causes pain due to tendon stretching.
Frey’s Syndrome
Frey’s syndrome is characterized by sweating and flushing over the cheek when eating or thinking about food. It occurs due to misdirected regeneration of autonomic fibers after parotid gland injury.
Galeazzi Fracture
Galeazzi fracture involves a fracture of the radial shaft with dislocation of the distal radioulnar joint, disrupting the forearm axis.
Gradenigo’s Syndrome
Gradenigo’s syndrome is associated with complications of otitis media and includes ear infection signs, ipsilateral abducens nerve palsy, and trigeminal nerve pain.
Hitselberger’s Sign
Hitselberger’s sign involves increased sensitivity of the posterior external auditory canal along with hearing loss, often seen in acoustic neuroma.
Horner’s Syndrome
Horner’s syndrome results from disruption of sympathetic innervation to the eye, causing ptosis, miosis, anhidrosis, and enophthalmos on the affected side.
Monteggia Fracture
Monteggia fracture consists of a fracture of the proximal ulna with dislocation of the radial head.
Osler–Rendu–Weber Syndrome
Osler–Rendu–Weber syndrome, or hereditary haemorrhagic telangiectasia, causes abnormal blood vessel formation leading to frequent nosebleeds and mucosal telangiectasia.
Pendred’s Syndrome
Pendred’s syndrome is an autosomal recessive condition characterized by congenital sensorineural hearing loss and the development of a thyroid goitre.
Pierre Robin Sequence
Pierre Robin sequence includes a small mandible, cleft palate, and displacement of the tongue, often causing airway obstruction and feeding difficulties.
Raccoon Eyes
Raccoon eyes refer to bilateral periorbital bruising, commonly seen in basal skull fractures.
Refsum Disease
Refsum disease is a metabolic disorder presenting with retinitis pigmentosa, cerebellar ataxia, peripheral neuropathy, and hearing loss.
Ramsay Hunt Syndrome
Ramsay Hunt syndrome is caused by herpes zoster infection of the facial nerve and presents with facial paralysis and painful vesicles in the ear.
Smith’s Fracture
Smith’s fracture is a distal radius fracture with volar displacement of the distal fragment, usually resulting from a fall onto a flexed wrist.
Superior Vena Cava Syndrome
Superior vena cava syndrome occurs when there is obstruction of the SVC, leading to swelling and venous congestion of the face, neck, and upper chest.
Thoracic Outlet Syndrome
Thoracic outlet syndrome involves compression of nerves or blood vessels at the thoracic outlet, leading to upper limb symptoms.
Thornwaldt’s Cyst
Thornwaldt’s cyst is a benign cyst in the nasopharynx arising from the pharyngeal bursa and may cause nasal obstruction.
Treacher Collins Syndrome
Treacher Collins syndrome is a genetic disorder causing underdevelopment of facial bones, particularly the jaw and ears, often with hearing impairment.
Trousseau’s Sign
Trousseau’s sign is seen in hypocalcaemia, where inflation of a blood pressure cuff induces carpopedal spasm.
Waardenburg Syndrome
Waardenburg syndrome is a genetic condition characterized by wide-set eyes, pigment abnormalities such as a white forelock, and sensorineural hearing loss.
If you want, I can convert this into exam flashcards, OSCE notes, or ultra-short one-liners for quick recall.
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Pathology - Membranous nephropathy
Definition: A glomerulopathy characterized by widespread subepithelial immunological deposits within the glomeruli. Epidemiology: Rare occurrence.
Etiology • The majority of cases are idiopathic, with the immune complexes believed to form in situ. The antigen in these instances remains unidentified. Some cases are due to other illnesses, such as malignancies, pharmaceuticals, infections, and systemic lupus erythematosus (SLE). In these instances, the immune complexes likely originate elsewhere and flow to the kidneys, where they are deposited in the glomeruli.
Pathogenesis Immune complexes in the glomerulus compromise the normal filtration barrier, resulting in significant proteinuria. Presentation of nephrotic syndrome.
Light microscopy • All glomeruli exhibit thickened, rigid capillary loops. • Silver staining reveals 'holes' in the glomerular basement membrane, indicative of immune deposits, and 'spikes' that signify the glomerular basement membrane's response to these deposits. • More advanced cases may additionally demonstrate tubulointerstitial fibrosis. Immunofluorescence Granular deposits of IgG and C3 are, by definition, diffusely present along the capillary loops.
• The presence of deposits of IgA, IgM, and C1q necessitates consideration of membranous nephropathy secondary to systemic lupus erythematosus (SLE). Electron microscopy • Subepithelial electron-dense immune deposits are observed, accompanied by a variable response in the surrounding basement membrane. • Podocytes exhibit diffuse effacement of foot processes. Prognosis: Approximately one-third of patients have illness progression.
Definition: A glomerulopathy characterized by widespread subepithelial immunological deposits within the glomeruli. Epidemiology: Rare occurrence.
Etiology • The majority of cases are idiopathic, with the immune complexes believed to form in situ. The antigen in these instances remains unidentified. Some cases are due to other illnesses, such as malignancies, pharmaceuticals, infections, and systemic lupus erythematosus (SLE). In these instances, the immune complexes likely originate elsewhere and flow to the kidneys, where they are deposited in the glomeruli.
Pathogenesis Immune complexes in the glomerulus compromise the normal filtration barrier, resulting in significant proteinuria. Presentation of nephrotic syndrome.
Light microscopy • All glomeruli exhibit thickened, rigid capillary loops. • Silver staining reveals 'holes' in the glomerular basement membrane, indicative of immune deposits, and 'spikes' that signify the glomerular basement membrane's response to these deposits. • More advanced cases may additionally demonstrate tubulointerstitial fibrosis. Immunofluorescence Granular deposits of IgG and C3 are, by definition, diffusely present along the capillary loops.
• The presence of deposits of IgA, IgM, and C1q necessitates consideration of membranous nephropathy secondary to systemic lupus erythematosus (SLE). Electron microscopy • Subepithelial electron-dense immune deposits are observed, accompanied by a variable response in the surrounding basement membrane. • Podocytes exhibit diffuse effacement of foot processes. Prognosis: Approximately one-third of patients have illness progression.
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Surgery – Scrubbing up
Scrubbing up helps lessen the chance of infection from the surgeon to the patient. Using bactericidal soaps can lower the amount of organisms that can be cultured from skin swabs, but sterilizing the skin (especially sweat glands and hair follicles) is impossible. Surgical gloves can cause considerable bacterial development within 2 hours due to moisture and heat, even with contemporary cleaning solutions. Bactericidal soaps include chlorhexidine and povidone-iodine.
Protocol
When entering the theatre for the first time, introduce yourself to the senior scrub nurses. It is respectful and safe. It's important to understand the purpose and identity of those in the theatre.
How To Scrub
• Wet your hands and arms first. • Apply disinfecting soap and wash well. • Scrub under nails and excessively filthy areas with a sterile brush and disinfecting soap. Scrubbing too forcefully might cause irritation and have little bactericidal effect. • Use soap to thoroughly clean between fingers, back of hands, beneath fingernails, and base of thumbs. • Rinse well to eliminate soap and prevent skin irritation. • Rinse off, ensuring water runs off elbows. Dry your hands well before moving on to your arms.
How to Gown and Glove
: • Open the gown without touching the exterior 'face'. Do not put your hands through the cuffs. Pick up the right glove with your right hand still in the gown's cuff—palm side down, fingers pointing up towards your forearm. • Fold the other side of the glove's edge 'over' your right hand. • Insert your right hand into the glove. • Grab the left glove by the edge and pull it over the left hand's cuff. • Slide your left hand into the glove and adjust its position. Wearing eye protection and two pairs of gloves is a standard practice to prevent exposure to infectious pathogens. % Infection control strategies include hand hygiene and personal protective equipment (PPE).
Scrubbing up helps lessen the chance of infection from the surgeon to the patient. Using bactericidal soaps can lower the amount of organisms that can be cultured from skin swabs, but sterilizing the skin (especially sweat glands and hair follicles) is impossible. Surgical gloves can cause considerable bacterial development within 2 hours due to moisture and heat, even with contemporary cleaning solutions. Bactericidal soaps include chlorhexidine and povidone-iodine.
Protocol
When entering the theatre for the first time, introduce yourself to the senior scrub nurses. It is respectful and safe. It's important to understand the purpose and identity of those in the theatre.
How To Scrub
• Wet your hands and arms first. • Apply disinfecting soap and wash well. • Scrub under nails and excessively filthy areas with a sterile brush and disinfecting soap. Scrubbing too forcefully might cause irritation and have little bactericidal effect. • Use soap to thoroughly clean between fingers, back of hands, beneath fingernails, and base of thumbs. • Rinse well to eliminate soap and prevent skin irritation. • Rinse off, ensuring water runs off elbows. Dry your hands well before moving on to your arms.
How to Gown and Glove
: • Open the gown without touching the exterior 'face'. Do not put your hands through the cuffs. Pick up the right glove with your right hand still in the gown's cuff—palm side down, fingers pointing up towards your forearm. • Fold the other side of the glove's edge 'over' your right hand. • Insert your right hand into the glove. • Grab the left glove by the edge and pull it over the left hand's cuff. • Slide your left hand into the glove and adjust its position. Wearing eye protection and two pairs of gloves is a standard practice to prevent exposure to infectious pathogens. % Infection control strategies include hand hygiene and personal protective equipment (PPE).
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Surgery - Surgical Instruments
'Sharps' • Scalps. There are two sizes of handles (4 and 6). Blade types and usage include no. 11 (stab incisions), no. 10 (most skin incisions), no. 15 (fine incisions), and no. 22 (adhesiolysis). • Scissors. It could be dissection or stitch cutting. Dissecting scissors can be straight or curved, such as Mayo, McIndoe, Metzenbaum, and Nelson's.
Forceps • Non-toothed. DeBakey and Adson's forceps are fine, non-toothed instruments used to handle delicate tissues like arteries and bowels. This heavy, non-toothed tool is ideal for general handling, including specimens and sutures. • Toothed. Fine-toothed forceps, such as Gillies' and McIndoe's, are commonly used to handle skin and fascia, as well as to grip delicate tissues precisely. thick-toothed forceps, such as Lane's, are used to grip thick tissues like fascia and scars. • Ring-tipped and microforceps. Used for vascular anastomoses.
Clips and Clamps • Artery clips, such as Spencer-Wells, Robert's (big), and Dunhill's, Mosquito (little), feature serrated jaws. Suitable for vascular clamps, tissue/suture holding. • Tissue clamps, including the Lahey clamp. Clamp with curved tip is commonly used for dissecting vessels. • • Doyen bowel clamp. Non-crushing atraumatic. Babcock/Duval clamp. This non-toothed, semi-atraumatic tissue-holding clamp is commonly employed for holding the bowel. • Use Lane's, Allis, or 'Littlewood' clamps. Tissue clamps with heavy teeth for traumatic use.
Retractors • Self-retaining retractor: • Examples of large retractors include the Goligher retractor for abdominal incisions and the Finichetto retractor for thoracic procedures. • Travers (superficial) and Norfolk and Norwich (deeper) retractors are suitable for minor cutaneous and abdominal incisions. • • • Large handheld retractors, such as Deaver, Kelly, and Morris. Small (e.g. Langenbeck, Kilner/'Catspaw').
'Sharps' • Scalps. There are two sizes of handles (4 and 6). Blade types and usage include no. 11 (stab incisions), no. 10 (most skin incisions), no. 15 (fine incisions), and no. 22 (adhesiolysis). • Scissors. It could be dissection or stitch cutting. Dissecting scissors can be straight or curved, such as Mayo, McIndoe, Metzenbaum, and Nelson's.
Forceps • Non-toothed. DeBakey and Adson's forceps are fine, non-toothed instruments used to handle delicate tissues like arteries and bowels. This heavy, non-toothed tool is ideal for general handling, including specimens and sutures. • Toothed. Fine-toothed forceps, such as Gillies' and McIndoe's, are commonly used to handle skin and fascia, as well as to grip delicate tissues precisely. thick-toothed forceps, such as Lane's, are used to grip thick tissues like fascia and scars. • Ring-tipped and microforceps. Used for vascular anastomoses.
Clips and Clamps • Artery clips, such as Spencer-Wells, Robert's (big), and Dunhill's, Mosquito (little), feature serrated jaws. Suitable for vascular clamps, tissue/suture holding. • Tissue clamps, including the Lahey clamp. Clamp with curved tip is commonly used for dissecting vessels. • • Doyen bowel clamp. Non-crushing atraumatic. Babcock/Duval clamp. This non-toothed, semi-atraumatic tissue-holding clamp is commonly employed for holding the bowel. • Use Lane's, Allis, or 'Littlewood' clamps. Tissue clamps with heavy teeth for traumatic use.
Retractors • Self-retaining retractor: • Examples of large retractors include the Goligher retractor for abdominal incisions and the Finichetto retractor for thoracic procedures. • Travers (superficial) and Norfolk and Norwich (deeper) retractors are suitable for minor cutaneous and abdominal incisions. • • • Large handheld retractors, such as Deaver, Kelly, and Morris. Small (e.g. Langenbeck, Kilner/'Catspaw').
Clamps
Scapel
Forceps
Retractor
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Pathology. - Minimal change disease
Definition: A glomerulopathy with clinical symptoms of nephrotic syndrome and histologically normal glomeruli under light microscopy.
Epidemiology • Uncommon. • Most commonly seen in children aged 2-6 years, but can also affect adults. The exact reason is unknown, however recent data shows it may be due to immunological malfunction. • Research has shown that minimal change disease (MCD) can occur after exposure to drugs, bee stings, or venom.
Pathogenesis: • The podocyte is assumed to be the primary cell involved in MCD. • Normal podocyte activity is compromised, making the glomerular filtration barrier abnormally permeable to proteins.
Presentation: • Nephrotic syndrome. Light microscopy shows typical glomeruli. immune fluorescence • No specific immune deposition is present.
Electron microscopy reveals that podocyte foot processes are highly simplified and lack immune complexes.
Prognosis: • MCD typically results in full recovery, especially in youngsters. Adults with steroid-resistant disease should be closely watched as they may have FSGS (b p. 148) that was not detected during biopsy due to its focused character.
Definition: A glomerulopathy with clinical symptoms of nephrotic syndrome and histologically normal glomeruli under light microscopy.
Epidemiology • Uncommon. • Most commonly seen in children aged 2-6 years, but can also affect adults. The exact reason is unknown, however recent data shows it may be due to immunological malfunction. • Research has shown that minimal change disease (MCD) can occur after exposure to drugs, bee stings, or venom.
Pathogenesis: • The podocyte is assumed to be the primary cell involved in MCD. • Normal podocyte activity is compromised, making the glomerular filtration barrier abnormally permeable to proteins.
Presentation: • Nephrotic syndrome. Light microscopy shows typical glomeruli. immune fluorescence • No specific immune deposition is present.
Electron microscopy reveals that podocyte foot processes are highly simplified and lack immune complexes.
Prognosis: • MCD typically results in full recovery, especially in youngsters. Adults with steroid-resistant disease should be closely watched as they may have FSGS (b p. 148) that was not detected during biopsy due to its focused character.
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Surgery - Incisions and Closures
Body cavity incisions Incisions that allow access to each bodily cavity are referred to in general terms.
• Laparotomy. An incision into the peritoneal cavity or retroperitoneal region. Laparotomies are classified based on their location in the abdomen, the tissues they traverse, or the individual who performed them
• Thoracotomy. Accessing the chest cavity, usually in the pleural space or posterior mediastinum. A median sternotomy is a form of thoracotomy that allows access to the anterior and middle mediastinum
. • Craniotomy. Accessing the skull's chambers. Incision closures Incisions are closed using certain basic ideas. • Fascial layers are ideal for supporting apposition and forming the primary abdominal closure. Heavy, non-permanent sutures are commonly used to close wounds. • When performing a craniotomy, bone flaws should be minimized to prevent movement. • Replace defects in fascial or bony structures with transposed or inserted tissues, such as skin, muscle, or polypropylene mesh. • Avoid large cavities and crevices between tissues to prevent infection-causing fluid accumulation.
Body cavity incisions Incisions that allow access to each bodily cavity are referred to in general terms.
• Laparotomy. An incision into the peritoneal cavity or retroperitoneal region. Laparotomies are classified based on their location in the abdomen, the tissues they traverse, or the individual who performed them
• Thoracotomy. Accessing the chest cavity, usually in the pleural space or posterior mediastinum. A median sternotomy is a form of thoracotomy that allows access to the anterior and middle mediastinum
. • Craniotomy. Accessing the skull's chambers. Incision closures Incisions are closed using certain basic ideas. • Fascial layers are ideal for supporting apposition and forming the primary abdominal closure. Heavy, non-permanent sutures are commonly used to close wounds. • When performing a craniotomy, bone flaws should be minimized to prevent movement. • Replace defects in fascial or bony structures with transposed or inserted tissues, such as skin, muscle, or polypropylene mesh. • Avoid large cavities and crevices between tissues to prevent infection-causing fluid accumulation.
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Surgery – Surgery in Neurological Disease
Surgery for neurological illness.
Cerebrovascular accidents (strokes) Anaesthetic drugs can disrupt cerebrovascular autoregulation, increasing the risk of re-infarction or infarction extension during ischemic episodes. Autoregulation is restored after around 6 weeks. • Haemorrhagic infarctions have a low risk of continued bleeding, especially with thromboprophylaxis. Strategies for reducing risk • Postpone all non-essential surgeries for 6 weeks after infarctions, particularly ischemic ones. • Patients with recent hemorrhagic events may not require thromboprophylaxis. • Control blood pressure throughout perioperative period to prevent hypotension and hypertension and stabilize cerebral blood flow. • Avoid placing the patient's head down on the operating table, as this can increase cerebral venous pressure.
Epilepsy
Paroxysmal neuronal discharge in different parts of the brain can disrupt awareness, movement, and sensory perception. Cerebral space-occupying lesions, uraemia, cerebral oedema, medication toxicity, and hypercalcaemia can all elicit symptoms similar to epilepsy. For patients with known epilepsy, the following measures are recommended. • Determine normal seizure frequency, severity, and prodrome characteristics. • Continue anticonvulsant medication during NBM and immediately after surgery. • If not possible, consult with an anesthetist or neurologist to determine the best bridging regime. • 0 Phenytoin interacts with several medicines used during the perioperative period. • Increase elimination of prednisone, warfarin, and lidocaine. Increase Phenytoin absoption orally through amiodarone, fluconazole, omeprazole, and paroxetine but reduced through antacids with magnesium, calcium, and aluminum and enteral feeding.
Myasthenia gravis
This autoimmune disease causes muscle weakness due to inadequate acetylcholine (ACh) receptors. The disease typically affects young adults and causes symptoms such as ptosis and diplopia, as well as weakness in the neck, limbs, and trunk. Patients may seek thymectomy as a treatment or as an unplanned procedure. Management involves the following: • Continue regular medication. Consider elective post-operative breathing for significant thoracic or upper abdominal surgery, or if the patient has a vital capacity of less than 2L. Consult with an anaesthetist and the ICU. If ventilation is extended after surgery, a tracheostomy may be necessary. Discuss this with the patient during the consent process. • Monitor for respiratory failure after surgery, which could be caused by muscle weakness. Precipitants include hypokalemia, infection, over- or under-treatment, and emotional or physical exertion.
Surgery for neurological illness.
Cerebrovascular accidents (strokes) Anaesthetic drugs can disrupt cerebrovascular autoregulation, increasing the risk of re-infarction or infarction extension during ischemic episodes. Autoregulation is restored after around 6 weeks. • Haemorrhagic infarctions have a low risk of continued bleeding, especially with thromboprophylaxis. Strategies for reducing risk • Postpone all non-essential surgeries for 6 weeks after infarctions, particularly ischemic ones. • Patients with recent hemorrhagic events may not require thromboprophylaxis. • Control blood pressure throughout perioperative period to prevent hypotension and hypertension and stabilize cerebral blood flow. • Avoid placing the patient's head down on the operating table, as this can increase cerebral venous pressure.
Epilepsy
Paroxysmal neuronal discharge in different parts of the brain can disrupt awareness, movement, and sensory perception. Cerebral space-occupying lesions, uraemia, cerebral oedema, medication toxicity, and hypercalcaemia can all elicit symptoms similar to epilepsy. For patients with known epilepsy, the following measures are recommended. • Determine normal seizure frequency, severity, and prodrome characteristics. • Continue anticonvulsant medication during NBM and immediately after surgery. • If not possible, consult with an anesthetist or neurologist to determine the best bridging regime. • 0 Phenytoin interacts with several medicines used during the perioperative period. • Increase elimination of prednisone, warfarin, and lidocaine. Increase Phenytoin absoption orally through amiodarone, fluconazole, omeprazole, and paroxetine but reduced through antacids with magnesium, calcium, and aluminum and enteral feeding.
Myasthenia gravis
This autoimmune disease causes muscle weakness due to inadequate acetylcholine (ACh) receptors. The disease typically affects young adults and causes symptoms such as ptosis and diplopia, as well as weakness in the neck, limbs, and trunk. Patients may seek thymectomy as a treatment or as an unplanned procedure. Management involves the following: • Continue regular medication. Consider elective post-operative breathing for significant thoracic or upper abdominal surgery, or if the patient has a vital capacity of less than 2L. Consult with an anaesthetist and the ICU. If ventilation is extended after surgery, a tracheostomy may be necessary. Discuss this with the patient during the consent process. • Monitor for respiratory failure after surgery, which could be caused by muscle weakness. Precipitants include hypokalemia, infection, over- or under-treatment, and emotional or physical exertion.
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Surgery - Nutrition for surgery patients
Nutrition is crucial to the health of surgery patients. Providing timely nutritional support can minimize acute catabolism and skeletal muscle weakness caused by metabolic loads. This is a prevalent element that impacts the outcome of surgery patients. The incidence of pre-existing malnutrition is high and increases with age. Patients with high nutritional needs, such as those with severe burns, sepsis, intestinal fistulae, advanced cancer, or immunosuppression, may require additional support to prevent excessive acute catabolism due to metabolic demands. Assessment of nutritional status.
All patients should be evaluated for nutritional status. Various methods can be used: • BMI (weight/height in kg/m²). Relatively insensitive to all but major malnutrition. A BMI of 18-25 is considered normal, while <18 indicates underweight and>30 indicates obesity.
• Thickness of the triceps skinfolds. This test is simple and effective for measuring body fat, which can indicate chronic nutritional condition. • Strong grip. Simple, repeatable index of lean skeletal muscle. Serum albumin. Poor predictor of acute nutritional status. Responds slowly to dietary supplementation and is influenced by several circumstances.
• Serum transferrin. A reliable indicator of acute state and response to treatment. Not widely used. Effects of protein-calorie deficiency.
Decreased neutrophil and lymphocyte function. Albumin production is impaired. Impaired wound healing and collagen deposition. Skeletal muscle weakness, known as 'critical illness myopathy,' can lead to respiratory and gastrointestinal problems.
• Micronutrient deficits can cause particular clinical symptoms.
Types of Nutritional Support
• Oral supplements. Examples of high-calorie, high-protein supplements are Fortisip®, Calshakes®, and Ensures®/Enlives®. For nutritional supplementation, oral administration is always the preferable method. It promotes healthy GI flora and reduces the chance of problems following surgery. • Nasogastric (NG) or nasojejunal feeding. Often used in conjunction with oral supplements. Sometimes administered overnight to reduce appetite suppression during the day.
• Surgically implanted feeding tube (gastrostomy or jejunostomy). Not commonly used. This is reserved for people who have a functioning GI tract but cannot take via the oropharyngeal route.
• \tParenteral nutrition. It may be central or peripheral.
Nutrition is crucial to the health of surgery patients. Providing timely nutritional support can minimize acute catabolism and skeletal muscle weakness caused by metabolic loads. This is a prevalent element that impacts the outcome of surgery patients. The incidence of pre-existing malnutrition is high and increases with age. Patients with high nutritional needs, such as those with severe burns, sepsis, intestinal fistulae, advanced cancer, or immunosuppression, may require additional support to prevent excessive acute catabolism due to metabolic demands. Assessment of nutritional status.
All patients should be evaluated for nutritional status. Various methods can be used: • BMI (weight/height in kg/m²). Relatively insensitive to all but major malnutrition. A BMI of 18-25 is considered normal, while <18 indicates underweight and>30 indicates obesity.
• Thickness of the triceps skinfolds. This test is simple and effective for measuring body fat, which can indicate chronic nutritional condition. • Strong grip. Simple, repeatable index of lean skeletal muscle. Serum albumin. Poor predictor of acute nutritional status. Responds slowly to dietary supplementation and is influenced by several circumstances.
• Serum transferrin. A reliable indicator of acute state and response to treatment. Not widely used. Effects of protein-calorie deficiency.
Decreased neutrophil and lymphocyte function. Albumin production is impaired. Impaired wound healing and collagen deposition. Skeletal muscle weakness, known as 'critical illness myopathy,' can lead to respiratory and gastrointestinal problems.
• Micronutrient deficits can cause particular clinical symptoms.
Types of Nutritional Support
• Oral supplements. Examples of high-calorie, high-protein supplements are Fortisip®, Calshakes®, and Ensures®/Enlives®. For nutritional supplementation, oral administration is always the preferable method. It promotes healthy GI flora and reduces the chance of problems following surgery. • Nasogastric (NG) or nasojejunal feeding. Often used in conjunction with oral supplements. Sometimes administered overnight to reduce appetite suppression during the day.
• Surgically implanted feeding tube (gastrostomy or jejunostomy). Not commonly used. This is reserved for people who have a functioning GI tract but cannot take via the oropharyngeal route.
• \tParenteral nutrition. It may be central or peripheral.
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Surgery - Improved recuperation after surgery
Enhanced recovery after surgery (ERAS) aims to minimize perioperative physiological and stress responses, optimize recovery pace, and limit complications. It is typically used for healthy patients who do not require specific preoperative corrections.
The following are the important areas to consider.
Nutrition • Oral carbohydrate loading 24 hours before surgery, including up to 4 hours before anesthesia, is believed to minimize the early catabolic reaction to major surgery.
• Early reintroduction of full nutrition, including carbohydrate-rich drinks from 6 hours post-surgery, nutritional supplements, and a light food from 48 hours post-surgery, to promote immediate GI tract function. Anaesthetic Technique • Avoiding opiate use, such as morphine in PCA and epidurals, to minimize nausea and reduced GI motility.
• Avoiding epidurals to facilitate early mobilization and minimize the effects of autonomic spinal blocking on the heart, lungs, and gastrointestinal system. • Using regional LA-based treatments, such as transversus abdominis plane (TAP) block, regional LA infiltration, or infusional catheters, can reduce central nociceptor input and improve systemic stress response during surgery.
Surgical method
• Minimally invasive procedures, such as laparoscopic surgery, aim to lessen metabolic reaction, improve early mobilization, and minimize GI tract exposure during abdominal surgery. Avoiding bowel preparation during abdominal surgery minimizes the risk of fluid and electrolyte imbalances, disrupts GI tract flora, and leads to fewer GI problems (e.g., anastomotic leaks). Physiotherapy involves early mobilization with particular exercises, sitting out within 12 hours, and walking within 48 hours of surgery.
Perioperative respiratory exercises. Nursing:
• Intensive patient preparation, including preoperative teaching on expected outcomes. Intensive perioperative and post-operative nursing include promoting early re-establishment of food, movement, and self-care. Although intense and demanding, ERAS-type treatments are equally successful in the elderly and young. They are not recommended for insulin-dependent diabetics, people with pre-existing nutritional issues, or those with cognitive impairment.
Enhanced recovery after surgery (ERAS) aims to minimize perioperative physiological and stress responses, optimize recovery pace, and limit complications. It is typically used for healthy patients who do not require specific preoperative corrections.
The following are the important areas to consider.
Nutrition • Oral carbohydrate loading 24 hours before surgery, including up to 4 hours before anesthesia, is believed to minimize the early catabolic reaction to major surgery.
• Early reintroduction of full nutrition, including carbohydrate-rich drinks from 6 hours post-surgery, nutritional supplements, and a light food from 48 hours post-surgery, to promote immediate GI tract function. Anaesthetic Technique • Avoiding opiate use, such as morphine in PCA and epidurals, to minimize nausea and reduced GI motility.
• Avoiding epidurals to facilitate early mobilization and minimize the effects of autonomic spinal blocking on the heart, lungs, and gastrointestinal system. • Using regional LA-based treatments, such as transversus abdominis plane (TAP) block, regional LA infiltration, or infusional catheters, can reduce central nociceptor input and improve systemic stress response during surgery.
Surgical method
• Minimally invasive procedures, such as laparoscopic surgery, aim to lessen metabolic reaction, improve early mobilization, and minimize GI tract exposure during abdominal surgery. Avoiding bowel preparation during abdominal surgery minimizes the risk of fluid and electrolyte imbalances, disrupts GI tract flora, and leads to fewer GI problems (e.g., anastomotic leaks). Physiotherapy involves early mobilization with particular exercises, sitting out within 12 hours, and walking within 48 hours of surgery.
Perioperative respiratory exercises. Nursing:
• Intensive patient preparation, including preoperative teaching on expected outcomes. Intensive perioperative and post-operative nursing include promoting early re-establishment of food, movement, and self-care. Although intense and demanding, ERAS-type treatments are equally successful in the elderly and young. They are not recommended for insulin-dependent diabetics, people with pre-existing nutritional issues, or those with cognitive impairment.
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Pathology - Prophylaxis: antibiotics and thromboprophylaxis.
Preventive antibiotics
• Prophylactic antibiotics lower the incidence of SSI and are often administered in a short term (1- 3 doses). • Antibiotic treatment for existing infections following surgery may last 5 days or more. • Prophylaxis is typically used to avoid infection of surgical wounds or to prevent the spread of organisms from colonized organs like the gut after opening.
Thromboprophylaxis VTE is a widespread, preventable cause of mortality. Patients, like the general population, are 'at risk' of getting DVT. Evaluating the risk of venous thromboembolism To meet national VTE prophylaxis criteria, all patients must be screened for risk factors upon admission and again after 24 hours in the hospital.
Risk is assessed based on:
• Procedure considerations. Prolonged anaesthesia for lower limb or pelvic surgery.
• Patient factors. Immobility, malignancy, aging, and inflammatory diseases Balanced against potential bleeding concerns. Active bleeding, stroke, invasive operations, and bleeding disorders (e.g. liver disease, thrombocytopenia, hereditary illnesses).
Record the risks on the patient's drug chart or VTE documentation. Consider using mechanical (e.g., TEDS) or chemical (e.g., LMWH) thromboprophylaxis as per local guidelines. Patients who are fully anticoagulated do not require VTE prophylaxis. Extended VTE prophylaxis is required for some patient groups following surgery, such as lower limb joint replacement or pelvic surgery.
Surgical and trauma patients are at risk of VTE if they meet any of the following criteria: • A surgical procedure lasting more than 90 minutes, or 60 minutes for pelvic or lower limb surgery.
• Acute surgical admission for inflammatory or intra-abdominal conditions. • Expected reduced mobility.
• One or more of the risk factors listed below.
Treatment with mechanical instruments.
• TEDS. Continuous direct compression helps reduce stasis in infrapopliteal veins. Not suited for those with PVD or cracked skin.
• Pneumatic compression boots. Intermittent compression of the foot and lower leg veins promotes venous flow and reduces infrapopliteal vein stasis
Risk factors for VTE include active or ongoing cancer therapy.
• Over 60 years old (DVT tends to increase with age).
• Admission for critical care.
• Dehydration.
• Known thrombophilias and polycythemia.
• Obesity (BMI over 30 kg/m2).
• Significant medical comorbidities, such as heart disease, diabetes, metabolic, endocrine, or respiratory pathologies, as well as acute infectious infections and inflammatory disorders.
• A personal or first-degree relative with a history of VTE.
• Use of hormone replacement therapy.
• Use of estrogen-containing contraception.
• Varicose veins with phlebitis.
Women who are pregnant or have given birth within the last 6 weeks should seek guidance from specialists.
Treatment:
pharmaceutical • LMWH stimulates antithrombin III. • Given SC. Longer half-life than unfractionated heparin (UFH). • Examples are enoxaparin, dalteparin, and tinzaparin
. • For renal failure, lower the dose or use UFH. Alternatively, titrate doses with anti-Xa monitoring. • UFH activates antithrombin III. • Given SC. Short half-life; reversible with protamine.
• Fondaparinux inhibits factor Xa via antithrombin III
. • Low risk of heparin-induced thrombocytopenia (HIT). There may be a lesser risk of bleeding compared to LMWH. Caution in cases of renal insufficiency.
• Non-vitamin K antagonist oral anticoagulants (NOACs). • Advantages of daily PO dosage. • Examples: dabigatran, rivaroxaban, and apixaban. • Conventional clotting assays may not accurately evaluate the effect. • Most lack a direct antidote.
Preventive antibiotics
• Prophylactic antibiotics lower the incidence of SSI and are often administered in a short term (1- 3 doses). • Antibiotic treatment for existing infections following surgery may last 5 days or more. • Prophylaxis is typically used to avoid infection of surgical wounds or to prevent the spread of organisms from colonized organs like the gut after opening.
Thromboprophylaxis VTE is a widespread, preventable cause of mortality. Patients, like the general population, are 'at risk' of getting DVT. Evaluating the risk of venous thromboembolism To meet national VTE prophylaxis criteria, all patients must be screened for risk factors upon admission and again after 24 hours in the hospital.
Risk is assessed based on:
• Procedure considerations. Prolonged anaesthesia for lower limb or pelvic surgery.
• Patient factors. Immobility, malignancy, aging, and inflammatory diseases Balanced against potential bleeding concerns. Active bleeding, stroke, invasive operations, and bleeding disorders (e.g. liver disease, thrombocytopenia, hereditary illnesses).
Record the risks on the patient's drug chart or VTE documentation. Consider using mechanical (e.g., TEDS) or chemical (e.g., LMWH) thromboprophylaxis as per local guidelines. Patients who are fully anticoagulated do not require VTE prophylaxis. Extended VTE prophylaxis is required for some patient groups following surgery, such as lower limb joint replacement or pelvic surgery.
Surgical and trauma patients are at risk of VTE if they meet any of the following criteria: • A surgical procedure lasting more than 90 minutes, or 60 minutes for pelvic or lower limb surgery.
• Acute surgical admission for inflammatory or intra-abdominal conditions. • Expected reduced mobility.
• One or more of the risk factors listed below.
Treatment with mechanical instruments.
• TEDS. Continuous direct compression helps reduce stasis in infrapopliteal veins. Not suited for those with PVD or cracked skin.
• Pneumatic compression boots. Intermittent compression of the foot and lower leg veins promotes venous flow and reduces infrapopliteal vein stasis
Risk factors for VTE include active or ongoing cancer therapy.
• Over 60 years old (DVT tends to increase with age).
• Admission for critical care.
• Dehydration.
• Known thrombophilias and polycythemia.
• Obesity (BMI over 30 kg/m2).
• Significant medical comorbidities, such as heart disease, diabetes, metabolic, endocrine, or respiratory pathologies, as well as acute infectious infections and inflammatory disorders.
• A personal or first-degree relative with a history of VTE.
• Use of hormone replacement therapy.
• Use of estrogen-containing contraception.
• Varicose veins with phlebitis.
Women who are pregnant or have given birth within the last 6 weeks should seek guidance from specialists.
Treatment:
pharmaceutical • LMWH stimulates antithrombin III. • Given SC. Longer half-life than unfractionated heparin (UFH). • Examples are enoxaparin, dalteparin, and tinzaparin
. • For renal failure, lower the dose or use UFH. Alternatively, titrate doses with anti-Xa monitoring. • UFH activates antithrombin III. • Given SC. Short half-life; reversible with protamine.
• Fondaparinux inhibits factor Xa via antithrombin III
. • Low risk of heparin-induced thrombocytopenia (HIT). There may be a lesser risk of bleeding compared to LMWH. Caution in cases of renal insufficiency.
• Non-vitamin K antagonist oral anticoagulants (NOACs). • Advantages of daily PO dosage. • Examples: dabigatran, rivaroxaban, and apixaban. • Conventional clotting assays may not accurately evaluate the effect. • Most lack a direct antidote.
