Having An Operation CPC

2.2.07

Pre-op work-up
• Haematology.
• Biochemistry.
• CXR/ECG.
• Special cases.
-Drug history, especially steroids.
-DM.

Anaemia
• Haemorrhage.
• Iron deficiency.
• Megaloblastic (including pernicious anaemia).

Blood transfusion
• When to give it.
• Group and save.
• Emergency situation.
• Cross-match.
• Risks.
-Reactions.
-Infections.
• Auto-transfusion.

Wound infections
• Cellulitis (Strep.)
• Abscess (Staph.)
• Commonest organisms.

Bacterial damage
• Virulence increased with population density.
-Adherence.

Adherence
• Adhesins.
-Fimbriae/pili on Gram negative bacteria.

Invasion
• M. tuberculosis.
-Opsonised with C3.
-Invades macrophages via C36 receptor.
-Phagosome/lysosome fusion blocked.
• Gram-negative bacteria.
-Inject "transmitter" proteins into cell that rearrange structure and facilitate entry.

Toxins
• Exotoxins.
-Enzymes.
§Protease.
§Hyaluronidase.
§Coagulase.
-Signal blockers.
§Receptor binding part + enzyme.
-Neurotoxins.
§Botulinum, tetanus.
-Superantigens.
§Toxic shock syndrome.
~Stimulate many T cells → cytokines.
• Endotoxins.
-Lipopolysaccharides.
§Constant part and variable ("O") part (O157).
§Small doses enhance immune response.
§Large doses overwhelm it e.g. sepsis.
~DIC.
~ARDS.
~Cytokine release (IL-1, IL-2, TNF-α).

Lung infections
• Pneumonia.
• Organisms.
-Pneumococcus.
-Haemophilus.
-Klebsiella.
-Legionella.
-Opportunists.
-Fungi.
-Viral.