Chapter 14 pt 2 Flashcards
pathology of the pancreas
cysts
transplant (w/ kidney)
tumors of surrounding structures
cancer- worst cancer
- 80% die
surgical considerations with pancreas
must be done as a combination procedure
removal depends on location of tumor
what blood supply does the head and tail of the pancreas share
head shares with duodenum
tail shares with spleen
what is a whipple
removes head of pancreas, duodenum, and sometimes gallbladder
steps of a distal pancreatectomy
- left subcostal/ upper midline
- retractors for exposure
- lesser omentum opened
- colon mobilized- exposes pancreas
- ultrasound to outline pancreatic duct
part 2 of distal pancreatectomy
- vascular clamp placed
- parenchyma divided sharply
- posterior vessels divided
- pancreas dissected from spleen
- tail and body removed
- retaining pancreatic stump is closed
what type of anastomosis do you use for pancreaticojejunostomy
roux en y
when do you sue a roux en y with a pancreatectomy
chronic pancreatitis
what is the real name of the whipple
pancreaticoduodenectomy
in a whipple you en bloc remove the:
- head of pancreas
- distal ⅓ of stomach
- duodenum
- proximal 10 cm of jejunum
- CBD or cystic duct
- gallbladder
- peripancreatic + hepatoduodenal lymph nodes
three anastomosis of whipple
stomach
pancreas
liver
difference between classic whipple and pyloric sparing whipple
classic- distal ⅓
pyloric- starts at duodenum
pathology of the spleen
trauma
intraop injury
thrombocytopenia
splenomegaly
splenic abscess
parasitic cysts
tumors
what is a hernia orifice
defect in the abdominal wall
what is a hernia sac
outpouching of the peritoneum
5 hernia types
umbilical
R+L inguinal
R+L femoral
inguinal hernia
above the abdomincaocrural crease
>95% male
direct inguinal hernia
acquired- weak fascia
within hasselbachs triangle
indirect inguinal hernia
congenital
follows spermatic cord
femoral hernia
below the abdominaocrural crease
>97% female
originates form the femoral canal
muscle layers of the scrotum
external oblique aponeurosa
internal oblique muscle
trasnversalis muscle fascia
peritoneum
three ways to repair inguinal hernia
open: mesh
lap: mesh
open: suture
mesh (patch) inguinal hernia repairs- lichtenstein
mesh placed over the transversalis fascia and wrapped around spermatic cord
mesh (patch) inguinal hernia repairs-rutkow
plug placed below the transversalis fascia in addition to a mesh wrapped around spermatic cord
two types of lap inguinal hernia mesh repairs
TEP
TAPP
suture inguinal hernia repairs- bassini
unite the triple layer to the inguinal ligament
triple layer closure
suture inguinal hernia repairs- shouldice (modified bassini)
4 layer closure
two types of open mesh inguinal hernia repairs
lichtenstein
rutkow
types of inguinal hernia suture reapairs
bassini
shouldice
mcvay
suture inguinal hernia repairs: Mcvay
unite triple layer to the coopers ligament
how to expose the hernia structures
incise
- skin
- subQ
- scarpas fascia
when expesing the hernia strucutrs, what instrument do you use to incise the skin
blade
when expesing the hernia strucutrs, what instrument do you use to incise the subQ
bovie
when expesing the hernia strucutrs, what instrument do you use to incise the scarpas fascia
goulet/ army navy x2
what instruments do you use to incise to expose the inguinal canal
kelly (allis) x2, metz, gelpi, goulet/ army navy
what instrumetns do you use in preserving nerves
debakey x2
what are the two nerves you need to identify and protect in inguinal hernia
ilioinguinal + iliohypogastric nerves
what muscle do you encounter for a male inguinal hernia
cremaster muscle
- fibers separated
- dont need to close
what do you do for IH after spermatic cord is identified
dissect free of attachemtns
what instruments do you use to dissect spermatic cord free of attachemtns
metz/ bovie
what do you do in IH after the spermatic cord is freed
retract it
what instruments do you use to retract he spermatic cord
moistened penrose w/ pean
what do you do in IH once the spermatic cord is retracted
identify if its direct (medial) or indirect (lateral)
if the IH is indirect, what do you do first
dissected away from spermatic cord and cremaster muscle
after the spermatic cord is dissected away for indirect IH, whats next
sac contents are pushed back into the abd cavity
what instrument do you use to push the sac contents back into the abd cavity for IH
sponge stick
what comes after sac is pushed back into abd cavity for indirect IH
purse string suture may be used to reduce sac and excess sac trimmed off
what is the next step of IH reapir after purse string is tied
suture repair of transversalis fascia defect, interrupted
- into coopers ligament
how do you do the large defect of IH
mesh repair
what layers do you close with IH
external oblique aponeurosa
scarpa fascia
subQ
skin
pathology of the breasts
neoplasms
cancer
gynecomastia
what incision is used for a modified radical mastectomy
elliptical transverse incision into axilla
how many setups does a modified radical mastectomy require
may require 2
thyroid pathology
hyperthyroidism
thyrotoxicosis
hypothyroidism
4 counts of thyroidectomy
initial
prior to fascia
prior to skin close
final count
steps of thyroidectomy
transverse incision
retract
muscles seperated
tissue dissected
find arteries for preservation
dissect thyroid from trachea
hemostasis+ close
what type of hemostat for thyroidectomy
fine tipped, lots of them
stage i breast cancer
less than 2 cm
stage ii breast cancer
gerater than 2 cm, less than 5 cm
stage iii a breast cancer
up to 5 cm, may not be fixed
stage iii b breast cancer
tumor of any dimension
what preservative can you not put breast BX in
formalin, makes it permanent
what is the CST biggest precaution when prepping for a breast BX
do not dislodge the needle
what will the surgeon ask the tech to facilitate during the breast BX
place traction on the skin to facilitate skin incision
what type of incision is made for breast BX
curvilinear- follows skin line directly
what is the tech responsible for grasping during breast bx
grabbing the mass to provide visualization to surgeon
how should the tech pass off the specimen of breast Bx
not 4x4, place in specimen cup with debakey
rule of 5s breast BX
5ml of dye, 5 sites, 5 cm of diameter, massage into tissue for 5 mins
