Chapter 14 Flashcards by Sofi Brown

what are the vertical incisions

midline
paramedian
supra umbilical (epi gastric)
infra umbilical (sub)

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what are the oblique incisions

subcostal (kocker)
mcBurney (open appy)
inguinal

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what are the transverse incisions

transverse upper + lower
lumbar/ flank
thoracoabdominal

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layers of abd wall

skin
subcuticular
subcutaneous
superficial fascia
internal + external obliques
transverse abdominus muscle
transversalis fascia
peritoneum

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what do you go through with a midline incision of laparotomy

skin, subQ, linea Alba, peritoneum

2 knives

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what do you need to do in opening during laparotomy

incision
control hemostasis
retraction for visualization
open midline incision
closing

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what is the alimentary canal

digestive tract

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what’s bad about surgery of the esophagus

easily perforated and difficult to reconstruct

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pathological conditions of surgery of the esophagus

hiatal hernia - stomach coming up
motility disorders - achalasia
neoplasm
trauma - EGD

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what is an esophagectomy with esophagogastrostomy

removal of diseased portions of esophagus and stomach

anastomos the remaining sections

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what instrument do we use for opening midline incision skin

blade

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what instruments d we need in the subQ

sponges, bovie
retractors

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what instruments do you need in the linea alba

kelly x2
deep blade

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why would you do a esophagectomy with esophagastrostomy

treatment for esophageal or stomach tumors or strictures

removal of part of stomach or eophagus

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pathology of the stomach

gastric ulcer
gastric polyp
bezoar
bariatric procedures

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surgeries for bariatric procedures

gastric bypass
sleeve gastrectomy

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tumors of the stomach

carcinoma
lymphoma
leiomyoma
leiomyosarcoma
- get gastrectomy for these

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how to do a gastrectomy

opening to gastric mucosa
give them a feeding tube to drain
three approaches
- opening (most common)
- laparoscopic
- percutaneous

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what do you do in a stamm gastrostomy

upper midline incision
catheter inserted suprapubic
stomach secured to abd wall
tube secured to skin
wound closed

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what is is a partial (subtotal) gastrectomy

antrectomy- removal of distal portion of the stomach and pylorus

billroth I
billroth II
- anastomosis to the stomach

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what is a billroth I

gastroduodenostomy

anastomosis is to the duodenum

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what is a billroth II

gastrojejunostomy

preferred when duodenum is scarred
end of duodenum is left closed
anastomosis is the the jejunum

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what is a total gastrectomy

total removal of the stomach

upper midline, subcostal or thoracoabdominal incision

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how do you do a total gastrectomy

stomach is mobilized

vessels of stomach are ligated

linear cutter transects into duodenum + across the esophagus
- freeing stomach

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what do you need to know when doing a roux-en-y esophojejunostomy

18 inches of free jejunum us needed for tension free loop to prevent GERD

what are the two anastomoses of roux-en-y esophojejunostomy

esophojejunal jejunojenjunal

pathology of the small bowel

meckels diverticulum - structures not fully absorbed neoplasms- benign or malignant obstructions crohns disease

examples of obstructions with small bowel pathology

scar tissue hernia cancer swallowed items

pathology of the colon

diverticular disease appendicitis neoplasms (polyps, carcinoma) ulcerative colitis + crohns

examples of obstructions of the colon

fecal impaction volvulus intussusception

what is a volvulus

twisting of the intestine

what is an intussusception

the bowel laps into itself tiffany

bowel anastomosis options

- end to end - end to side - side to side - roux-en-y

bowel technique

confinement and containment of dirty instruments - prevent contamination of layers during wound closure

when do things become contaminated during a bowel anastomosis

the second it is used to resection

basic principles of bowel technique

- separate Clean and dirty areas - sterile towels used to surround exposed bowel - ends once the resection and anastomosis is complete

7 principles of bowel anastomosis

bowel mobilized remove bad pathology good blood supply remains equal parts sewn together tension free leak proof mesenteric defect repaired functional anatomy maintained

colon resection consideratiosn

- prophylactic antibiotics are routine - extensive prep site

ano-rectal patholoy

fistula-in-ano anal fissure pilonidal disease hemorrhoids

what is a fistula- in- ano

chronic form of perianal abscess that fails to heal and becomes an inflamed tract

what is an anal fissure

tears in epidermis of anal canal

how do you repair fistula-in-ano

incise and marsupialize the tissue

how do you repair an anal fissure

lateral internal sphincterotomy

what is pilonidal disease

abscess in sacrococcygeal midline that suddenly ruptures - results in unhealed sinus tract with chronic drainage

how do you repaid pilonidal disease

incise, irrigate, curetagged - edges trimmed - wound left open and trimmed

what are hemorrhoids

dilation of submucosal plexus that line the anal canal (inflammed veins popping out ass)

how do you repair hemorrhoids

banding hemorrhoidectomy

how doyou do a hemorrhoidectomy

- lubricate asshoe - kelly placed on protruding components - external ones dissected - hemorrhoid clamp placed on internal - gelfoam inserted into anal canal to provide hemostasis

what suture do you use to close pedicles and mucosa on hemorrhoidectomy

3-0 chromic

pathology ofthe liver

cancer hemangioma hepatic cysts cirrhosis trauma/ laceration

what do you do if you have cirrhosis

transplant

what do you do if you have hepatic cysts

percutaneous or open drainage

what do you do if you have hemangioma

arterial ligation

what do you do if you have malignancy, hepatic adenoma, and nodular hyperplasia

hepatectomy (liver resection) - partial

pathology of the gallbladder

cholecystitis cholelithiasis- stones - cholesterol, lighter - pigmented, darker

treatment for cholelythiasis

medications to dissolve stones

two types of medication for cholelythiasis

ursodiol - reduces cholesterol MTBE (methyl tert butyl ether) - injected into gallbladder to dissolve

what isextracorporeal shock wave lithotripsy (ESWL)

electro generated shock eave to fragment gallstones

what incision for a open cholecystecomty whit cholangiogram

right subcostal

*what trocars do you do for lap cholecystectomy*

*4 trocar incisions*

what instrument do you yes for open lysis of adhesions

bovie with extended tip

*what instruments do you used for lap lysis of adhesions*

*maryland and endo grasper*

what do you do after lysis of adhesion with cholecystectomy

ampulla grasped and retracted

what instruments do you need for grasping ampulla

open: sponge stick or kelly *lap: locking endo grasper*

what do you do after grasping ampulla in cholecystetomy

lesser ommentum dissected, peritoneal incision is made

what do you do in the triangle of calot during cholecystectomy

cystic duct and artery are dissected free from surrounding tissue

*what do you need in cholangiogram during cholecystetomy*

*contrast medium catheter syringe pediatric IV Tubing drape for xray lead under gown*

what instruments do you need for open omentum dissection

metz, bovie, right angle

*what instrumetns do you need for lap dissection of omentum*

*maryland, bovie*

what do you do after you dissect the omentum in chole

cystic ducts and artery ligated

what instruments do you usef or open cystic duct ligation

clips or suture

*what instrumetns do you use for lap cystic duct ligation*

*clips and hook scissors*

what do you do after you ligate the cystic duct and artery

dissection of gallbladder from liver bed

*what instruments do you use for dissection of gallbaldder from liver bed*

open: *lap:

what do you do after the gallbladder is removed from liver bed

gallbladder removed from abdomen

*what instruments do you use for lap removal of gallbladder*

*endograsper, endocatch*

*what instruments do you use for removal of lap gallbladder with stones*

*6" pean x3 metz sponge stick yankauer*

*what instrment do you need for lap irrigation of gallbladder*

*suciton irrigator*

*what supply do you need to pass off gallbladder specimen*

*kidney basin*

what makes up the triangle of calot

lateral border: cystic duct medial border: common hepatic duct superior: inferior surface of liver

Chapter 14 Flashcards

general surgery