Alimentary Tract Flashcards
Layer of GI tract organs?
Serosa - outside layer
Muscle layer
Submucosal layer
Mucosal layer - inside
Layers of the abdominal wall.
Skin Subcutaneous fat Anterior fascia Muscle Post fascia Peritoneum
When is the McBurney’s incision done?
Appendectomy
Pfannestiel incision is made when?
Gyne
Positives of a vertical (midline) line incision?
Good primary incision
Hemostasis easily achieved
Fewer layers traversed
Where are postoperative hernias more common?
Above umbilicus
What are facts to know about the McBurney’s incision?
Muscle splitting incision Goes through McBurney's point on right lower quadrant Chance of post of hernia Does not permit good exposure Difficult to extend
The pfannenstiel Incision does not alter blood supply to _______________.
Abdominal wall
When is the thoracoabdominal incision used?
Proximal stomach
Distal esophagus
Anterior spine
Where is the thoracoabdominal incision made?
Begins at midpoint between xyphoid and umbilicus and extends posteriorly across 7&8 interspace of mid scapular line into chest
What size and type of needle is typically used in general surgery for intestinal tissues?
3-0 & 4-0 on taper needle
What is typically used for abdominal closure?
0 or #1 braided monofilament
When are retention sutures indicated?
With potential for compromised wound healing
How long do you have decreased peristalsis after laparotomy and intestinal resection?
2-5 days
What are some incisional complications of general surgery?
Dehiscence - separation if unsealed incision
Evisceration - bowel and abdominal structures may protrude
When is dehiscence and eviscerationg most common?
With vertical incisions
What are some risk factors for dehiscence and evisceration?
Obesity Nut deficiencies Steroid use Infection Improper closure.
Blood supply to esophagus?
Branches of inferior thyroid arteries
Bronchial arteries
Thoracic aorta
Branches of left gastric and inferior phrenic arteries
What are the types of esophagectomies?
Esophagectomy - distal
Transhiatal esophagectomy - two thirds
Transthoracic esophagectomy - middle third
What is esophageal diverticulum?
Aka zenker’s diverticulum
Weakness in wall of cervical portion of esophagus which collects small amount of food
Causes sensation of fullness
What does a hiatal surgery fix? Why was the problem there in the first place?
Restores cardioesophageal junction to proper position in abdomen. (Corrects GERD)
From hiatal hernias
What are the two types of hiatal hernias?
Sliding and para esophageal
What are the symptoms for a hiatal hernia?
Heart burn
Reflux
Regurgitation
Dysphagia
What does the surgery for a hiatal hernia involve?
Wrapping fundus of stomach around lower 4-6 cm of esophagus and suturing into place.
What is esophagomyotomy?
Aka Hellers procedure
Myotomy of esophagogastric junction
Correct obstruction from achalasia (muscles of the lower part of the esophagus fail to relax)
May have pyloroplasty to prevent reflux
What position would you put a pt for an esophagomyotomy?
Transthoracic or transabdominal approach
What is esophageal dilation?
Procedure to dilate esophagus when pt has stricture. Pt usually has moderate sedation. Dilation done with bougies in graduating sizes.
Why would a pt have a stricture that needed to be dilated?
From previous sx.
Anatomical anomalies
What are the three parts o f the stomach?
Fundus
Body
Antrum
What is the blood supply to the stomach?
Left gastric artery
Splenic artery
Common hepatic arteries
Explain the omentum
Double fold of peritoneum containing fat
Convex or greater curvature of the stomach in the lower margin contains the greater omentum it covers the intestines loosely and some blood vessels run through.
Concave or lesser curvature of the stomach in the upper margin contains the lesser omentum
What is a vagotomy?
Division of vagus nerves to decrease gastric acid secretion. Can be done laparoscopically
What types of vagotomies are there?
Truncal - all
Selective - some
Parietal cell - certain ones on proximal edges
What is a pyloroplasty?
Formation of larger opening between prepyloric region and duodenum. Used in the treatment of peptic ulcers. Remove fibrous bands in pyloric ring. Usually have a vagotomy
What is a gastrotomy?
Opening into stomach to retrieve a object or look around inside
What is a gastrostomy?
Temporary or permanent channel
Why would a gastrojejunostomy be done?
Tx of obstructions at pylorus
Inoperable lesions
Why would a partial gastrectomy be done? What are the two types of connections made after?
Malignant lesions
Ulcers
Bilroth1- stomach to duodenum
Bilroth2- stomach to jejunum
What do they do for a total gastrectomy?
Remove whole stomach
Anastomosis between esophagus and jejunum
Remove adjacent lymph nodes
What are the three types of bariatric surgery?
Restrictive (lap band)
Malabsorptive (roux en y)
Combination of both (biliopancrestic diversion, duodenal switch)
Explain the roux en y procedure.
Small part of to p of stomach cut and both ends sealed off. A portion of the small intestine is attached to the esophagus and the other part of the small intestine with the stomach still connected is attached to the small intestine connected to the esophagus a short distance from the connection. The food that is able to be eaten is smaller and then travels along the esophagus small intestine line. The stomach still produces gastric acids which travels through its small portion of small intestine until it meets up with food in other small intestine.
What is biliopancreatic diversion? With duodenal switch?
Transect stomach
Anastomosis of duodenum to distal ileum
Largely malabsorptive and mildly restrictive, pylorus remains intact.
Blood supply to small intestine?
Branches of celiac artery
Superior mesenteric arteries
What is mesentery?
Double fold peritoneum found on Jejunum Ileum Appendix Colon
Anchors bowel to body
What is meckle’s diverticulectomy?
Diverticuli removed to prevent obstruction
There is a congenital duct at umbilicus attached to distal ileum
May ulcerate, bleed, or perforate
Two types of excision (just cut off nub or cut off segment)
What are some causes of small bowel obstruction that require a small bowel resection?
Tumor
Adhesions
Intussusception (kinks on/goes into oneself)
What can occur with disruption of absorption in small bowel obstruction?
Ileitis
How is intussusception fixed?
If barium enema fails Try to milk it back out or do a resection.
Where is an ileostomy placed?
Right lower quadrant
What aRe the divided segments of the large intestine?
Cecum, colon (acscending, transverse, descending, sigmoid), rectum.
Blood supply to the large intestine?
Superior and inferior mesenteric arteries
What are Tenia Coli?
Incomplete muscle bands that try to gather up large intestine causing the sac like appearance.
What is the name of the outpouchings caused by the Tenia Coli?
Haustra sacculations
What is the name of the globes of fat on the large intestines?
Globs of fat
What is removed in a right hemicolectomy?
Terminal ileum Cecum Appendix Ascending colon Transverse colon (half)
What is removed in a left hemicolectomy?
Transverse colon (half) Descending colon
What is removed in a low anterior resection?
Sigmoid and portion of rectum
What is an abdominal perineal resection?
Removal of lg intestine and rectum, and anus for rectal tumors and IBD of lower sigmoid and rectum.
What is an ileoanal endorectal pull through?
Removal of entire colon and proximal two thirds of rectum.
Creation of pouch from distal small bowel and anastomosis of pouch to anus.
When would an ileoanal endorectal pull through be done?
To relieve symptoms of ulcerative colitis and familial polyposis
What is the benefit of having an ileoanal endorectal pull through?
Saves anal sphincter which avoids an ileostomy.
What is a sigmoidoscopy?
Visual inspection of sigmoid and rectum
Remove polyps, tumors, or for dx. purposes
Used to check anastomosis during sigmoid resection.
