1. If someone comes in with acute cholecystitis, don't operate on them immediately-- IVF, watch them; percutaneous cholecystostomy if a fluid collection collects and you need to drain. Go through liver to have something between the gallbladder and abdomen wall so you dont leak bile into your peritoneal cavity.
2. Distal pancreatectomy-- options for spleen management:
-Take spleen and pancreas together. Will need pneumovax/meningococcal every 5 years, annual flu shot.
-Take pancreas tail, take splenic aa/vv, leave spleen supplied by short gastrics: if the tumor is integrated with splenic aa/vv, it's hard to save those vessels. to save the short gastrics though you have to be very careful of cutting on the greater curve of the stomach or manipulating that area (i.e. flipping up the spleen), since if you damage those vessels the spleen wont have any blood supply. There is a low chance of splenic infarction, esp in the inferior part of the spleen. If it goes necrotic, they will have bad LUQ pain and you will have to go back in 8-10 days out from surgery.
-Take pancreas tail, leave splenic aa/vv. This is hard, technically, and adds ~1 hour; you have to dissect the pancreas off the splenic vessels. You may get unacceptable bleeding
3. If you're doing a re-anastomosis after a hartmann, if the anastamosis is <6 cm from the anal verge, you may have to do a diverting ileostomy to take pressure off the new anastamosis.
4. For DVT prophylaxis, some people like to do subQ heparin in the first 24 hours after surgery and lovenox after that-- lovenox can't be reversed, and in the first 24 hrs postop the risk of bleeding is higher. People without a CI (bleeding) should be anticoagulated while they're in the hospital. Some people may need prolonged DVT prophylaxis-- up to 28 days, notably people with cancer, with big incisions (big laparotomy), obese, history of DVT. Lovenox is renally cleared so is dose-adjusted to 30mg/day (rather than 40 mg/day) in people with GFR <30, although small studies have shown that it does not increase major bleeding events, though it may increase minor bleeding events. {Chest} Lovenox has been shown to be slightly more effective than heparin, although with proportionally increased bleeding risk. The main benefit is lovenox is once daily subQ injections, while heparin is usually administered as TID subQ injections. The main disadvantage of lovenox is that it's more $$$$, so if your patients can't afford it, they'll have to inject themselves TID.
5. Things to do to speed up recovery of bowel motility:
-exercise, mobility
-chewing gum stimulates bowel "Sham feedings and the action of chewing stimulate bowel motility by a cephalic-vagal mechanism and have been shown to increase levels of neural and humoral factors that subsequently increase function in several different segments of the gastrointestinal tract." - {JAMA surgery} From the same article, speculation on the origins/cause of postoperative ileus: "The etiology of postoperative ileus remains controversial. Bowel motility is suppressed postoperatively owing to sympathetic hyperactivity and increased concentrations of circulating catecholamines.6 Pacemaker dysfunction owing to bowel manipulation is another postulated mechanism of postoperative ileus.7 In addition, electrolyte abnormalities, peritoneal and/or retroperitoneal irritation, and narcotic analgesia effects may contribute to postoperative ileus.8 The focus of more recent studies has been on neural and humoral factors. Vasoactive intestinal peptide directly inhibits smooth muscle contraction in the intestine, and levels of it are increased after operation.9 In addition, pain increases the release of substance P, which is also known to inhibit bowel motility.10,11 Operations also inhibit the promotility hormones gastrin, neurotensin, and pancreatic polypeptide.8"
6. Pneumonia definitions: 
-community-acquired: clinical or radiographic findings within first 48 hours of admission.
-healthcare-associated: CAP patients with recent contact with healthcare system.
-hospital-acquired: findings 48-72 hours after admission.
-ventilator-acquired: 48-72 hours after getting ET tube.
{source}
7. Most common pathogens of pneumonia... 
-CAP: s.pneumo, h.flu, atypicals, viruses
-Hospital-acquired: s.pneumo, h.flu, atypicals, legionella, aspiration, viruses
-ICU: s.pneumo, staph aureus/MRSA, gram negatives, legionella, h.flu
8. Criteria to admit someone with CAP: CURB-65
-Confusion
-BUN>20
-Resp rate>30
-BP systolic <90, diastolic <60
-Age>65
If they have 0-1 criteria, they are low risk and should be treated as an outpatient, 2 criteria they should be admitted, 3+ criteria should go to ICU (esp if 4 or 5 criteria)
9. Treatment for CAP in 
-outpatient setting: z-pack, 500 mg qd for 3 days. or clarithro, 500mg BID for 5 days. Or doxy 100mg BID for 7-10 days.
-inpatient setting: respiratory quinolone (moxi/levo) or b-lactam (ceftri, ceftax, unasyn) PLUS macrolide, since macrolides have limited gram-neg coverage.
-ICU setting: b-lactam (see above) PLUS either azithro or a resp quinolone. If you're worried about pseudomonas, double cover with an anti-pseudomonal b-lactam (zosyn, cefepime, mero, imipenem) and an anti-pseudomonal quinolone (cipro-- make sure not resistant in your hospital). If you're worried about MRSA, add vanc or linezolid to your cocktail.
10. Surgical patients do not all need H2-blocker/PPI prophylaxis for stress ulcer/chemical aspiration. Risk factors for chemical aspiration: post-op ileus (esp not NPO), opiate narcotics that worsen ileus, plus sedation in the form of an anxiolytic or sleep aid = bad cocktail for chemical aspiration. Keep the head of the bed elevated 30-45 degrees. If someone doesn't have GERD/didn't come in on a PPI/H2 blocker, it's not necessarily good policy to reflexively put everyone on one. Changing the acidity of the stomach may encourage increased and/or worse type bacterial overgrowth; increasing likelihood of GI infections or lung infections from microaspiration.