Deck 2 Flashcards
Differentiate the three chambers of a pleur-evac
- Collection chamber
- Water seal chamber = one-way valve, ensures no backwards flow back into the chest
- Suction control chamber- ensures a max limit on the negative suction pressure applied to the chest
Name and differentiate the 4 classifications of hip fractures
Hip fractures classified by anatomic location and fracture type- split into
Intracapsular: at the femoral neck or femoral head
Extracapsular: intertrochanteric or subtrochanteric
Differentiate fusiform vs. saccular aneurysm
Fusiform = symmetric enlargement
Saccular = asymmetric enlargement
-associated w/ infection and trauma
Identify
Keloid- scar formation where tissue extends beyond the border of the original wound
Name the 4 boundaries of the inguinal canal
Anterior wall = aponeurosis of the external oblique (contains the superficial inguinal ring)
Posterior wall = transversalis fascia (contains the deep inguinal ring)
Roof -=internal oblique and transversus abdominis
Floor = inguinal ligament, medial ligament on end
Artery most commonly injured in pelvic fracture
Superior gluteal artery
Give brief overview of steps of thyrodectomy
- Incision 2cm above sternal notch
- Dissect around strap muscles (sternothyroid), reflect sternothyroid laterally and reflect thyroid lobe medially
- See carotid artery laterally, locate recurrent laryngeal coursing under inferior thyroid artery. Preserve nerve, ligate vessels (both inferior and superior arteries) then resect lobes
- Ligate inferior thyroid artery branches distal to where parathyroid supply comes off to preserve (or attempt to preserve) parathyroid arteries)
- Interupted sutures to reapproximate midline fasia, close skin incision
Name the three nerves in the groin region susceptible to injury during hernia repair
- Genital branch of the genitofemoral nerve = most common nerve damaged in hernia repair
- goes thru internal ring - ilioinguinal nerve
- iliohypogastric nerve
Describe the two grafts used in CABG and where they go
- Saphenos vein (harvested from leg) used to connect aortic arch to distal RCA (distal to the blockage)
- Internal mammary/thoracic artery (coming from subclavian artery) is relocated off the chest wall and connects distally to the LAD (distal to the blockage)
- so leave internal mammary connected to subclavian proximally, then relocate from chest wall and reconnect to distal LAD
Swan-Ganz catheter
(a) Function
(b) Location
Swan Ganz catheter- thread thru right heart to terminate (balloon) in the pulmonary artery
(a) measures pulmonary capillary wedge pressure = indirect measure of left atrial pressure
Name the 4 layers of the colon
Lumen
Mucosa
Submucosa
Muscularis propria
Serosa
Differentiate appearance of small vs. large bowel on abdominal Xray
Large bowel:
haustra: markings don’t extend from wall to wall
peripherally located
Small bowel:
valvulae conniventes extend across the lumen and are spaced closer together
centrally located
GIve overview of steps of exploratory laparotomy for operative SBO
- midline incision
- start exploration at cecum and work backwards towards Ligament of Trites (want to start distally and move proximally, b/c want to minimize manipulation of dilated loops of bowel)
- full exploration includes SI from lig of Treitz to the ileocecal jxn - lyse (cut/bluntly dissect) all adhesions along the way
2 nerves you have to watch out for during mastectomy
long thoracic nerve
thoracodorsal nerve
Percent of body surface area by areas of the body
Aka how much body surface area is affected if both legs are burned? the font?
in a child?
Rule of 9’s for adults: 9 for head, each arm. 18 for each leg, front, and back
For kids (head is bigger): 18 for head, 9 for each arm, 18 for each leg, front/back, each leg is 14
How to differentiate upper vs. lower GI tract
Split by the ligament of Treitz = suspensatory ligamnet of the duodenum
Boundaries of Hasselbach’s triangle
Medially- border of the rectus abdmoinis
Laterally- ilioinguinal ligament
Inferior epigastric blood vessels
Statistically most common type of hernia
Indirect inguinal hernia
Name the layers of the abdominal wall from superficial to deep
- Skin
- Subcuntaeous tissue made of
(a) Camper’s fascia = superficial fatty layer
(b) Scarpa’s fascia = deep membranous layer - Investing (deep) fascia
- Muscles w/ their aponeuroses (also can be considered additional layers of investing fasia)
- external obliques
- internal obliques
- transversus abdominis - traversalis fascia
- parietal peritoneum
Where is McBurney’s point?
2/3 of the way from the umbilicus to the ASIS
What is a Hartmann’s procedure
Hartmann’s = proctosigmoidectomy = segmental colonic resection w/ end colostomy
done in emergency to remove the perf/sepsis, then can come back later and do curative surgery
resection of rectosigmoid colon w/ closure of rectal stump and formation of end colostomy
During hernia repair the external oblique aponeurosis is opened, what should be found right beneath the external oblique?
Spermatic cord
Dividing the external oblique will expose the internal oblique layer everywhere except the groin, where it exposes the spermatic cord
Maneuver to limit hepatic inflow during trauma laparotomy
Pringle maneuver- basically compress the portal triad (hepatic artery, portal vein, CBD) to prevent inflow/outflow
Differentiate the two types of ileostomy
End ileostomy = opening in the end of colon to the outside
Loop ileostomy = opening connects back to more colon
Benefit of using mesh in hernia repair
(a) What is the alternative to using mesh
Benefit of using mesh = reduced recurrence rates 2/2 tension-free
(a) Alternative is Shouldice repair = 4 layer repair in which you directly sew tissue together
- higher recurrence rate
When do inguinal hernias get repaired?
(a) When do femoral hernias get repaired?
Repair inguinal hernias when they’re symptomatic
(a) ALWAYS repair femoral hernias b/c of the 30% complication risk (strangulation) even if asymptomatic
- higher baseline risk => repair
Define carcinoma in situ
Carcinoma in situ means the full thickness of the epithelium is involved, but the basement membrane has not been invaded
Calot’s triangle
Calot’s triangle = 3 C’s- anatomic structures important in view during lap choley
cystic duct laterally
cystic artery superiorly
common bile duct medially
Which stones would we attempt to medically break up?
Kidney stones, NOT gall stones
if you break up a kidney stone you’re just putting pieces into the bladder/urine
but if you were to break up gallstones you’d just shoot tiny pieces out into more tiny ducts
