Exam case studies

Question 1

54 year old lady who underwent elective L hemi-colectomy

Answer 1

• Removes the left-hand portion of the colon (large intestine)
• altered diet/drinks prior to surgery- dehydration
• can be performed via a laparotomy

Question 2

55 year old gentleman with oesophageal carcinoma undergoing an oesophagogastrostomy

Answer 2

• removal of the lower portion of the oesophagus and the stomach
• if thoracic extension for oesophagogastrostomy is involved a left thoracotomy is performed
• undernourished preoperatively- affect anastomotic healing and postoperative progress
• head-down position is avoided to prevent gastric reflux and potential aspiration

Question 3

23 year old woman with asthma who yesterday delivered a baby via C-section

Answer 3

• spinal block: access limb sensation and motor

* Pubic incision

Question 4

Mr C admitted to hospital with a diagnosis of acute pneumonia affected left lower lobe

Answer 4

• lung inflammation caused by a bacterial/viral infection, in which alveoli fill with sputum and may consolidate
• sputum sample- indicate antibiotics
• positioning- (lateral) side lying on R, 30 degrees tilted and arm lifted above head

Question 5

62 year old gentleman who underwent an emergency laparotomy for a burst duodenal ulcer

Answer 5

• duodenal ulcer: peptic ulcer that develops in the small intestine
• open sore occurs when protective mucus lining of the wall of the intestine breaks down
• caused by a bacterium called helicobacter pylon
• or long-term NSAIDS e.g. aspirin- increases risk
• Laparotomy: one large incision in the abdomen
• Midline (incision runs down the middle of the abdomen) standard incision for laparotomy.

Question 6

21 year old with CF in hospital awaiting a heart lung transplant

Answer 6

• thoracic organ transplantation is indicated in patients with end-stage diseases where survival is limited and quality of life poor
• performed via a median sternotomy or a clamshell incision (transverse sternotomy)
• preoperative management- optimise physical and functional performance and quality of life. Addressing the deconditioning results for CF
• exercise training, psychosocial support

Question 7

A 68 year old man following a CABG x3 yesterday

Answer 7

• A coronary artery bypass graft is a surgical procedure used to treat coronary heart disease: triple bypass
• Diverts blood around severely narrowed/blocked arteries to improve blood flow and O2 supply to the heart
• blood vessel from another part of the body (chest, internal mammary artery) attached above and below coronary artery blockage.
• number of grafts needed depend on how severe the disease is and number of coronary arteries narrowed
• usually takes between 3-6 hours

treatment-

• education on lifestyle changes- healthy diet and regular exercise
• cardiac rehabilitation- incorporate thoracic exercises as they reduce sternal pain
• patients with sternal instability should be prescribed bilateral upper limb exercises
• treadmill training

Question 8

A 62 year old female with diabetes has undergone a R below knee amputation

Answer 8

85% Type II diabetes

• factors lead to amputation- neuropathy, circulation problems, foot ulcers, other damage to foot
• look out for any signs of damage to the foot
• metabolic disease that causes hypo/hyper blood glucose levels. insufficient production/use of insulin

Question 9

A 40 year old women with alpha 1-antirypsin deficiency emphysema has had lung volume reduction surgery and is 4 days post operation

Answer 9

LVR

• approach which removes most damaged areas of the lung. Removing the enlarged lung air sacs that occur in emphysema. less air is trapped so breathing is more efficiency
• improvements in dyspnoea and lung function for around 3.5 years
• reduction in hyperventilation, allows increase in inspiratory muscle strength and decreases elastic load imposed by chest wall

Alpha 1-antitryspin deficiency-

• rare, inherited condition
• lack of the enzyme inhibitor AAT
• increased risk of lung disease. more likely to develop COPD at a younger age and may progress more rapidly
• enzymes break down surrounding healthy lung (alveoli)- as lack of AAT to prevent this
• education on stopping smoking?