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exam 3 > Alimentary Tract > Flashcards

Alimentary Tract Flashcards

1
Q

Layer of GI tract organs?

A

Serosa - outside layer
Muscle layer
Submucosal layer
Mucosal layer - inside

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2
Q

Layers of the abdominal wall.

A 
Skin
Subcutaneous fat
Anterior fascia
Muscle
Post fascia
Peritoneum
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3
Q

When is the McBurney’s incision done?

A

Appendectomy

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4
Q

Pfannestiel incision is made when?

A

Gyne

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5
Q

Positives of a vertical (midline) line incision?

A

Good primary incision
Hemostasis easily achieved
Fewer layers traversed

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6
Q

Where are postoperative hernias more common?

A

Above umbilicus

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7
Q

What are facts to know about the McBurney’s incision?

A 
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
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8
Q

The pfannenstiel Incision does not alter blood supply to _______________.

A

Abdominal wall

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9
Q

When is the thoracoabdominal incision used?

A

Proximal stomach
Distal esophagus
Anterior spine

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10
Q

Where is the thoracoabdominal incision made?

A

Begins at midpoint between xyphoid and umbilicus and extends posteriorly across 7&8 interspace of mid scapular line into chest

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11
Q

What size and type of needle is typically used in general surgery for intestinal tissues?

A

3-0 & 4-0 on taper needle

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12
Q

What is typically used for abdominal closure?

A

0 or #1 braided monofilament

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13
Q

When are retention sutures indicated?

A

With potential for compromised wound healing

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14
Q

How long do you have decreased peristalsis after laparotomy and intestinal resection?

A

2-5 days

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15
Q

What are some incisional complications of general surgery?

A

Dehiscence - separation if unsealed incision

Evisceration - bowel and abdominal structures may protrude

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16
Q

When is dehiscence and eviscerationg most common?

A

With vertical incisions

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17
Q

What are some risk factors for dehiscence and evisceration?

A 
Obesity
Nut deficiencies
Steroid use
Infection
Improper closure.
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18
Q

Blood supply to esophagus?

A

Branches of inferior thyroid arteries
Bronchial arteries
Thoracic aorta
Branches of left gastric and inferior phrenic arteries

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19
Q

What are the types of esophagectomies?

A

Esophagectomy - distal
Transhiatal esophagectomy - two thirds
Transthoracic esophagectomy - middle third

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20
Q

What is esophageal diverticulum?

A

Aka zenker’s diverticulum

Weakness in wall of cervical portion of esophagus which collects small amount of food
Causes sensation of fullness

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21
Q

What does a hiatal surgery fix? Why was the problem there in the first place?

A

Restores cardioesophageal junction to proper position in abdomen. (Corrects GERD)

From hiatal hernias

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22
Q

What are the two types of hiatal hernias?

A

Sliding and para esophageal

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23
Q

What are the symptoms for a hiatal hernia?

A

Heart burn
Reflux
Regurgitation
Dysphagia

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24
Q

What does the surgery for a hiatal hernia involve?

A

Wrapping fundus of stomach around lower 4-6 cm of esophagus and suturing into place.

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25
Q

What is esophagomyotomy?

A

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

26
Q

What position would you put a pt for an esophagomyotomy?

A

Transthoracic or transabdominal approach

27
Q

What is esophageal dilation?

A

Procedure to dilate esophagus when pt has stricture. Pt usually has moderate sedation. Dilation done with bougies in graduating sizes.

28
Q

Why would a pt have a stricture that needed to be dilated?

A

From previous sx.

Anatomical anomalies

29
Q

What are the three parts o f the stomach?

A

Fundus
Body
Antrum

30
Q

What is the blood supply to the stomach?

A

Left gastric artery
Splenic artery
Common hepatic arteries

31
Q

Explain the omentum

A

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

32
Q

What is a vagotomy?

A

Division of vagus nerves to decrease gastric acid secretion. Can be done laparoscopically

33
Q

What types of vagotomies are there?

A

Truncal - all
Selective - some
Parietal cell - certain ones on proximal edges

34
Q

What is a pyloroplasty?

A

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

35
Q

What is a gastrotomy?

A

Opening into stomach to retrieve a object or look around inside

36
Q

What is a gastrostomy?

A

Temporary or permanent channel

37
Q

Why would a gastrojejunostomy be done?

A

Tx of obstructions at pylorus

Inoperable lesions

38
Q

Why would a partial gastrectomy be done? What are the two types of connections made after?

A

Malignant lesions
Ulcers

Bilroth1- stomach to duodenum
Bilroth2- stomach to jejunum

39
Q

What do they do for a total gastrectomy?

A

Remove whole stomach
Anastomosis between esophagus and jejunum
Remove adjacent lymph nodes

40
Q

What are the three types of bariatric surgery?

A

Restrictive (lap band)
Malabsorptive (roux en y)
Combination of both (biliopancrestic diversion, duodenal switch)

41
Q

Explain the roux en y procedure.

A

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.

42
Q

What is biliopancreatic diversion? With duodenal switch?

A

Transect stomach
Anastomosis of duodenum to distal ileum

Largely malabsorptive and mildly restrictive, pylorus remains intact.

43
Q

Blood supply to small intestine?

A

Branches of celiac artery

Superior mesenteric arteries

44
Q

What is mesentery?

A 
Double fold peritoneum found on 
Jejunum
Ileum
Appendix 
Colon

Anchors bowel to body

45
Q

What is meckle’s diverticulectomy?

A

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)

46
Q

What are some causes of small bowel obstruction that require a small bowel resection?

A

Tumor
Adhesions
Intussusception (kinks on/goes into oneself)

47
Q

What can occur with disruption of absorption in small bowel obstruction?

A

Ileitis

48
Q

How is intussusception fixed?

A

If barium enema fails Try to milk it back out or do a resection.

49
Q

Where is an ileostomy placed?

A

Right lower quadrant

50
Q

What aRe the divided segments of the large intestine?

A

Cecum, colon (acscending, transverse, descending, sigmoid), rectum.

51
Q

Blood supply to the large intestine?

A

Superior and inferior mesenteric arteries

52
Q

What are Tenia Coli?

A

Incomplete muscle bands that try to gather up large intestine causing the sac like appearance.

53
Q

What is the name of the outpouchings caused by the Tenia Coli?

A

Haustra sacculations

54
Q

What is the name of the globes of fat on the large intestines?

A

Globs of fat

55
Q

What is removed in a right hemicolectomy?

A 
Terminal ileum
Cecum
Appendix
Ascending colon
Transverse colon (half)
56
Q

What is removed in a left hemicolectomy?

A 
Transverse colon (half)
Descending colon
57
Q

What is removed in a low anterior resection?

A

Sigmoid and portion of rectum

58
Q

What is an abdominal perineal resection?

A

Removal of lg intestine and rectum, and anus for rectal tumors and IBD of lower sigmoid and rectum.

59
Q

What is an ileoanal endorectal pull through?

A

Removal of entire colon and proximal two thirds of rectum.

Creation of pouch from distal small bowel and anastomosis of pouch to anus.

60
Q

When would an ileoanal endorectal pull through be done?

A

To relieve symptoms of ulcerative colitis and familial polyposis

61
Q

What is the benefit of having an ileoanal endorectal pull through?

A

Saves anal sphincter which avoids an ileostomy.

62
Q

What is a sigmoidoscopy?

A

Visual inspection of sigmoid and rectum
Remove polyps, tumors, or for dx. purposes
Used to check anastomosis during sigmoid resection.

exam 3 (8 decks)

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