514 Section II / General Surgery

How is the diagnosis made?

What is the risk factor for rupture?

What are the indications for splenic artery aneurysm removal?

What is the treatment for splenic aneurysm?

Usually by abdominal pain S U/S or CT scan, in the O.R. after rupture, or incidentally by eggshell calcifications seen on AXR

Pregnancy

Pregnancy, 2 cm in diameter, symptoms, and in women of childbearing age

Resection or percutaneous catheter embolization in high-risk (e.g., portal hypertension) patients

What is it?

How is the diagnosis made?

Why examine the contralateral popliteal artery?

What are the indications for elective surgical repair of a popliteal aneurysm?

Why examine the rest of the arterial tree (especially the abdominal aorta)?

What size of the following aneurysms are usually considered indications for surgical repair:

Thoracic aorta?

Aneurysm of the popliteal artery caused by atherosclerosis and, rarely, bacterial infection

Usually by physical exam S A-gram, U/S

50% of all patients with a popliteal artery aneurysm have a popliteal artery aneurysm in the contralateral popliteal artery

1.2 cm in diameter

2.Intraluminal thrombus

3.Artery deformation

75% of all patients with popliteal aneurysms have additional aneurysms elsewhere; 50% of these are located in the abdominal aorta/iliacs

6.5 cm

Takayasu’s arteritis

Buerger’s disease

What is the treatment for Buerger’s disease?

What is blue toe syndrome?

Arteritis of the aorta and aortic branches, resulting in stenosis/occlusion/ aneurysms

Seen mostly in women

A.k.a. thromboangiitis obliterans: occlusion of the small vessels of the hands and feet; seen in young men who smoke; often results in digital gangrene S amputations

Smoking cessation, /– sympathectomy

Microembolization from proximal atherosclerotic disease of the aorta resulting in blue, painful, ischemic toes

What is the motto of pediatric surgery?

What is a simple way to distract a pediatric patient when examining the abdomen for tenderness?

“Children are NOT little adults!”

Listen to the abdomen with the stethoscope and then push down on the abdomen with the stethoscope to check for tenderness

What is the estimated blood volume of infants and children?

What is the maintenance IV fluid for children?

Why 1/4 NS?

8% of body weight or 80 cc/kg

D5 1/4 NS 20 mEq KCl

Children (especially those younger than 4 years of age) cannot concentrate their urine and cannot clear excess sodium

How are maintenance fluid rates calculated in children?

4, 2, 1 per hour:

4 cc/kg for the first 10 kg of body weight

2 cc/kg for the second 10 kg of body weight

1 cc/kg for every kilogram over the first 20 (e.g., the rate for a child weighing 25 kg is 4 10 40 plus 2 10 20 plus 1 5 5, for an IVF rate of 65 cc/hr)