Pre/Postoperative Care & Surgical Oncology Flashcards

Which ASA classification describes a patient with a known systemic disease that causes moderate functional limitation (e.g., COPD requiring bronchodilators, controlled DM, mild heart failure)?

Answer: ASA III

ASA III describes a patient with a severe systemic disease causing substantial functional limitation but that is not immediately life-threatening. Examples include COPD, poorly controlled DM or hypertension, morbid obesity (BMI >40), active hepatitis, or alcohol dependence. ASA II is mild systemic disease with no functional limitation.

What is the most common electrolyte abnormality following prolonged nasogastric suction?

Answer: Hypokalaemia with metabolic alkalosis

Prolonged nasogastric suction removes gastric fluid rich in HCl and KCl. This causes hypochloraemic, hypokalaemic metabolic alkalosis. Potassium is lost both directly in gastric juice and via secondary renal wasting (increased aldosterone secretion in response to hypovolaemia further promotes K+ loss).

What is the risk of venous thromboembolism prophylaxis failure, and which method significantly reduces it when combined with LMWHs?

Answer: Graduated compression stockings combined with LMWH reduce VTE risk more than LMWH alone

The combination of mechanical prophylaxis (TED stockings and/or intermittent pneumatic compression) with pharmacological prophylaxis (LMWH) is more effective than either alone in reducing post-operative VTE. NICE guidelines recommend combined prophylaxis for moderate-to-high risk surgical patients.

A patient develops a swinging fever, right upper quadrant pain, and an elevated alkaline phosphatase on day 7 post-cholecystectomy. What is the most likely diagnosis?

Answer: Subphrenic abscess or intra-abdominal abscess

Swinging fever (characteristic of abscess), RUQ pain, and elevated ALP developing 5–10 days post-operatively suggests an intra-abdominal abscess (subhepatic or subphrenic). CT abdomen confirms the diagnosis and guides drainage. A bile duct injury typically presents with jaundice and/or peritonism.

Which scoring system is used to predict the severity of acute pancreatitis at 48 hours?

Answer: Glasgow (Imrie) criteria

The Glasgow (Imrie) criteria use 8 parameters at 48 hours (PO2 55, WBC >15, calcium 16, LDH >600, albumin 10). A score of ≥3 indicates severe pancreatitis. The Ranson criteria are similar but use 5 admission and 5 at-48-hour factors.

What is the most important preoperative investigation before major elective surgery in a patient with known ischaemic heart disease?

Answer: Resting 12-lead ECG and cardiology review with functional assessment

Perioperative cardiac assessment requires determining the patient's functional capacity (METs), current cardiac status, and any reversible ischaemia. ACC/AHA and UK guidelines recommend cardiology review, resting ECG, and if intermediate or high risk, further evaluation with stress testing or cardiac imaging to guide optimisation and anaesthetic planning.