Chapter 14 Flashcards
general surgery
what are the vertical incisions
midline
paramedian
supra umbilical (epi gastric)
infra umbilical (sub)
what are the oblique incisions
subcostal (kocker)
mcBurney (open appy)
inguinal
what are the transverse incisions
transverse upper + lower
lumbar/ flank
thoracoabdominal
layers of abd wall
skin
subcuticular
subcutaneous
superficial fascia
internal + external obliques
transverse abdominus muscle
transversalis fascia
peritoneum
what do you go through with a midline incision of laparotomy
skin, subQ, linea Alba, peritoneum
2 knives
what do you need to do in opening during laparotomy
incision
control hemostasis
retraction for visualization
open midline incision
closing
what is the alimentary canal
digestive tract
what’s bad about surgery of the esophagus
easily perforated and difficult to reconstruct
pathological conditions of surgery of the esophagus
hiatal hernia - stomach coming up
motility disorders - achalasia
neoplasm
trauma - EGD
what is an esophagectomy with esophagogastrostomy
removal of diseased portions of esophagus and stomach
anastomos the remaining sections
what instrument do we use for opening midline incision skin
blade
what instruments d we need in the subQ
sponges, bovie
retractors
what instruments do you need in the linea alba
kelly x2
deep blade
why would you do a esophagectomy with esophagastrostomy
treatment for esophageal or stomach tumors or strictures
removal of part of stomach or eophagus
pathology of the stomach
gastric ulcer
gastric polyp
bezoar
bariatric procedures
surgeries for bariatric procedures
gastric bypass
sleeve gastrectomy
tumors of the stomach
carcinoma
lymphoma
leiomyoma
leiomyosarcoma
- get gastrectomy for these
how to do a gastrectomy
opening to gastric mucosa
give them a feeding tube to drain
three approaches
- opening (most common)
- laparoscopic
- percutaneous
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
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
what is a billroth I
gastroduodenostomy
anastomosis is to the duodenum
what is a billroth II
gastrojejunostomy
preferred when duodenum is scarred
end of duodenum is left closed
anastomosis is the the jejunum
what is a total gastrectomy
total removal of the stomach
upper midline, subcostal or thoracoabdominal incision
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
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 instruments do you do for lap cholecystectomy
4 trocar incisions
what do you do 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
mother in law, 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
