Bariatric Flashcards
1
Q
How many parts of the stomach are there
A
5
2
Q
name the parts of the stomach
A
- cardia
- fundus
- body
- atrum
- pylorus
3
Q
how many curvatures
A
2
4
Q
name the curvatures
A
- greater
- lesser
5
Q
which curvature is convex
A
greater
6
Q
which curvature is concave
A
lesser
7
Q
what is the angle of his
A
the acute angle created between the cardia at the entrance of the stomach from the esophagus
8
Q
sphincter of the stomach
A
pyloric sphincter = between pylorus and duodenum
9
Q
ligament of Treitz
A
suspensory muscle of the duodenum = end of upper gastrointestinal system
10
Q
omenta
A
layers of fatty connective tissue called peritoneum that attach to the stomach. provides extra support and protection by lining the abdominal cavity and surrounding organs
11
Q
greater omentum
A
attached to greater curvature of the stomach and hangs over the intestines, you must move this to access the intestines or abdominal organs
12
Q
lesser omentum
A
attached to the lesser curvature of the stomach and to the liver and forms a protective and supportive covering to the abdominal organs
13
Q
what protects the abdominal organs
A
omentum
14
Q
what is the largest vessel in the abdoment
A
abdominal aorta (extension of thoracic aorta)
15
Q
when does the abdominal aorta begin
A
when the thoracic aorta passes through the diaphragm
16
Q
abdonminal aorta is an extension of what
A
thoracic aorta
17
Q
the main unpaired branches of the abdominal aorta
A
- celiac trunk
- superior mesenteric
- inferior mesenteric
18
Q
3 branches of the celiac trunk
A
- left gastric artery
- common hepatic artery
- splenic artery
19
Q
how many branches of celiac trunk
A
3
20
Q
what organs does the celiac trunk and it’s branches supply blood to?
A
- liver
- stomach
- esophagus
- spleen
- duodenu,
- pancrease
21
Q
how many organs does the celiac trunk and its branches supply blood to?
A
6
22
Q
how many branches does the celiac trunk have
A
3
23
Q
name the branches of the celiac trunk
A
- splenic
- gastric
- common hepatic
24
Q
which artery supplies the spleen
A
splenic artery
(abdominal aorta –> celiac trunk –> splenic artery)
25
how many trunks come off the abdominal aorta
3
26
blood supply to greater curvature?
1. left gastroepiplonic
2. right gastroepiplonic
27
left gastroepiplonic extension of?
splenic artery
(ab. aorta, celiac trunk, splenic artery, left gastroepiplonic art)
28
right gastroepiplonic comes from?
gastroduodenal
(ab aorta, celiac trunk, common hepatic, gastroduodenal, right gastroepiplonic)
29
what branches supply the upper part of the greater curvature and fundas
short gastric branches
(ab aorta, celiac trunk, splenic artery, short gastric branches)
30
which branch of the celiac trunk ultimately supplies the lesser curvature?
left gastric artery (also supply the esophagus)
common hepatic
31
splenic artery has how many branches
2
32
common hepatic has how many branches
3
33
left gastric artery has how many branches
1
34
how common is gastric cancer
4th most common cancer worldwide
35
true or false obesity has tripled around the world since 1975
tru
36
how many adults worldwide are obese
1.9 billion
37
9 complications of obesity
diabetes, hypertension, hyperlipidemia, fatty liver disease, sleep apnea, GERD, arthritis, inflammatory and autoimmune disease, cancer
38
lesser curvature blood supply
1. inferior = right gastric artery off hepatic artery off the common hepatic
2. superior = left gastric artery (branch of cephalic)
39
cardia blood supply
left gastric artery
40
hypertension
high blood pressure - prolonged exposure = damage to artery walls and atherosclerosis (plaque buildup)
stroke, heart failure
41
hyperlipidemia
high cholesterol = higher than average levels of lipids(fat) in the blood stream
LDL cholesterol damage artery walls and contribute to plaque buildup
coronary artery disease, stroke, heat attack
42
stomach cancer cause
unclear. thought to be related to H pylori
age 60+
excess tobacco and alcohol
diet high in salt
prior stomach surgery for an ulcer
gender men>women
family history
race common in black hispanic and asian people
43
symptoms of stomach cancer
indigestion/heart burn
abdomen pain
nausea
diarrheaa
bloating
loss appetite
sensation of food getting stuck in the throat while eating
weakness/fatigue
vomiting blood
44
Anastomosis
join together two hallow organs usually to restore continuity after resection or the bypass an unresectable disease process
45
where/when are anastmoses performed
1. blood vessels
2. GI tract (esophagus, stomach, small bowel, large bowel, bile ducts, pancreas)
3. urinary tract
46
types of anastomeses
1. end to end
2. end to side
3. side to side
4. functional end to end
47
how many types of anastomoses are there
4
48
what is the angle of his
the acute angle created between the cardia at the entrance of the stomach and esophagus
49
how many sphincters in the stomach
2
50
what are the sphincters in the stomach
1. pyloric sphincter
2. esophageal sphincter
51
ligament of treitz
suspensory muscle of the duodenum = marks the end of the upper gastrointestinal system
52
the most common form of anastomosis
end to end
53
end to end anastomoses
most common form. the ends of the tubular structures are sutured together at the point of incision
54
this anastomosis joins the end to the side
end to side
55
end to side
this anastomosis joins the end of a tubular structure to the side of another structure.
56
when is end to side anastomosis used?
bariatric procedures (gastric bypass)
57
side to side
joins the sides of two structures.
58
when is side to side used
gastric bypass (joining of two portions of jejunum
59
functional end to end
bowel is mobilized bowel ends are approximated, a common stoma (opening) is created, and finally the common opening is closed
60
when is functional end to end used?
bowel resection
61
gastrojejunostomy
a small part of the stomach is used to create a new stomach pouch connected directly to the jejunum
62
gastric bypass access steps:
1. identify trocar sites and insert to gain access
2. mobilize the upper portion of stomach and take down adhesions
63
goals of the gastric bypass access steps
1. safe laproscopic entry w/o injury to viscera or other internal structures
2. maintain pneumoperitoneum
3. optimize visualization
4. gain exposure and mobilize the upper portion of the stomach in preparation for stapling
5. provide reliable hemostasis and minimize thermal damage to surrounding tissue
64
steps for gastric repair (7)
1. create gastric pouch
2. transect the jujunum
3. transect the jujunal mesentery and create the enterotomies in prep for the jejunojejunostomy
4. perform jejunojejunostomy and close the otomy
5. create the otomoies in the stomach pouch and jujunum
6. perform the gastrojejunostomy
7. perform a leak test
65
Jejunojejunostomy
a surgical technique used in an anastomosis between two portions of the jejunum
66
steps of gastric bypass closure
1. close mesentary defects, and place any drains
2. close trocar defects
3. apply topical skin adhesive
67
surgical goals of gastric bypass repair gastric pouch step
1. maintain compression to ensure uniform leak free hemostatic staple line
2. achieve good consistent staple lines in wide range of tissue thickness
68
surgical goals of gastric by pass transcect jujunum step
1. maintain appropriate compression to ensure uniform hemostatic staple lines
2. fully transect the jejunum
69
surgical goals of gastric by pass transect jejunal mesentary step (3)
1. transect and seal the mesenteric vessels
2. minimize trauma to surrounding tissue and structures
3. create an otomy in the small bowel to facilitate the creation of the jejunojejunostomy
70
surgical goals of gastric bypass jejunojejunostomy and close ostomy step
1. hemostatic and secure staple lines
2. secure, leak free anastomosis
3. secure, fluid-tight closure of the otomy
71
surgical goals of gastric bypass create stomach ostomies step
1. minimize thermal damage to surrounding tissues
2. hemostatic, secure, leak free anastamosis
3. achieve good consistent staple lines in a wide range of tissue thickness
72
surgical goals of gastric bypass perform leak test step
1. confirm integrity of anastomosis
2. control any bleeding oozing
73
surgical goals of gastric bypass close mesentery defects step
1. prevent postoperative intestinal herniation
2. evacuate any blood or fluid from the abdominal cavity to identify staple line issues
74
surgical goals of gastric bypass closed trocar step
1. prevent wound dehiscense while maintaining tight closure
2. address risks associated with surgical site infection, trocar site herniation
75
surgical goals of gastric bypass apply topical skin adhesive step
1. added strength and protection to incisions
2. help address risk factors for postoperative
