Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Surgery > ex lap and biopsy > Flashcards

ex lap and biopsy Flashcards

1
Q

when doing an abdominal exploration, what should we always have?!

A

Make a plan and stick to it!

  • If done methodically – you will remember to look everywhere
    – Examine organs in the same order each time
    – Don’t interrupt unless you have to do so!
    – Cover organs with moist towels and try not to exteriorize them unless you need to
  • Prevent contact of organs with the skin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what to look for in organs in an exlap?

A
  • Position
  • Thickening
  • Enlargement
  • Irregularity
  • Mass
  • Discolouration * Etc.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what should we do if we find free fluid upon entry into the abdomen?

A

-take a sample for culture +/- cytology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

how should we examine the liver during an exlap?

A

visually inspect and palpate all lobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what do we do with the gall bladder during an exlap

A

express to confirm patency of the bile duct

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is normal to find on the spleen during an exlap?

A

siderotic plaques

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what do we see in an acute vs chronic splenic torsion?

A

acute - red
chronic - white, pale

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

how do we “explore the gutters” in an exlap? what are we looking for?

A

Use the mesoduodenum to retract the intestines to the left and examine the right gutter
– Kidney, adrenal gland, ureter +/- ovary / horn / testis/ etc.
Use the descending colon (mesocolon) to achieve the same on the left

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

how do we limit tissue trauma during and exlap?

A
  • Keep organs moist
  • Prevent contact with skin
  • Use less traumatic instruments (Debakey)
  • Use stay sutures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

how do we lavage?

A
  • Warm sterile saline
  • Until clear
  • Ideally suction…
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what should we change before closing if its a contaminated surgery?

A

gloves, instruments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

should we administer antibiotic therapy for an exlap?

A
  • Depends on:
    – Underlying disease / surgical procedure – Duration of procedure
    – Type of procedure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what type of surgical procedures do not warrant antibiotics?

A
  • Surgeries <1.5–2hrs with no entry into a hollow viscus or contamination do not warrant prophylactic antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what do perioperative antibiotics entail?

A
  • Perioperative means to start1⁄2 hour before cutting the skin and to stop once the procedure is finished
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what type of antibiotics are usually used in antibiotic therapy for surgery? when do we administer it? when do we stop?

A
  • Cefazolin (cefoxitin if lower jejunum or colon)
  • First dose at induction (22mg/kg) &q90min during surgery
  • Without contamination, stop antibiotics immediately post-op
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

how do we do a liver biopsy? where should we take it from and what techniques are available to use? should we use antbiotics?

A
  • Edge of the most accessible lobe(s)
  • Representative sample for focal lesion
  • Guillotine/loop biopsy
  • Skin punch biopsy
  • Assistant or stay suture in stomach and laparotomy sponges cranial to liver (don’t forget to remove it)
  • Cefazolin*
17
Q

how do we perform a guillotine biopsy? what type of suture should we use and what is the technique?

A
  • 3-0 or 2-0 PDS or Monocryl
  • Single throw better than surgeon’s throw
  • ~1 cm of tissue
  • Crush through capsule and parenchyma – Crush all the way!
  • 3 or 4 throws
  • Leave a small stump (ischemic)
  • Oozing vs hemorrhage (Gelfoam or suture)
18
Q

when would we use a liver punch biopsy? how? what are the advantages and disadvantages? what type of tool should we use?

A
  • Focal mass lesions of diaphragmatic surface
    – More risky for visceral surface > bleeding
  • 4-6 mm Keyes punch biopsy
  • Invade less than 50% thickness
  • Pressure to control bleeding
  • +/- Gelfoam
19
Q

how to we isolate a region for gastric biopsy? what is a good region?

A

use laparotomy sponges
* Use stay sutures (include submucosa)
* Less vascular region b/w lesser & greater curvature

20
Q

what is the technique we use to take a gastric biopsy?

A
  • Stab & extend scissors ~2cm
  • Ellipse/edge of cut surface – *full thickness
  • 2-layer closure (simple continuous & Cushing or Lembert)
  • No chromic gut
  • No need to ligate / cauterize bleeders - they will stop when you suture
21
Q

what is the technique for taking an intestinal biopsy?

A
  • Isolate with moist laparotomy sponges
  • Stop intestinal flow!
  • Stab anti-mesenteric border with a blade
  • Extend with Metzembaum scissors ~1cm
  • Remove 2-3mm full thickness edge
  • Do not cauterize or ligate bleeders
22
Q

what is the purpose of a transverse closure for the intestine?

A
  • Prevent luminal stricture if small lumen (pediatric patient, rabbit, ferret)
23
Q

how do we close an intestinal biopsy? what suture material and size? what pattern?

A

Absorbable monofilament (3-0 or 4-0)
* No Chromic gut
* Single layer closure – simple interrupted (2-4 mm bites)
* Continuous pattern (Weisman 1999)
* Some mucosal eversion is normal
* Longitudinal vs transverse closure

24
Q

what techniques can we use to take an intestinal biopsy?

A

punch or wedge

25
Q

what should we do when closing an intestinal biopsy in partcular?

A

-leak test
-omentalize

26
Q

what techniques can we use for a lymph node biopsy? what are their advantages and disadvantages?

A
  • Wedge
    – Hemorrhage
    – Can be difficult to suture
  • Guillotine* (4-0 or 3-0)
    – No hemorrhage but might explode!
  • Whole node resection
    – Ligate or cauterize vessels
    – Beware of the mesenteric root vasculature
27
Q

prior to abdominal closure, we must:

A
  • Know your anatomy
    – Intestines
    – Spleen
    – Omentum
  • Return all organs to their anatomic location
  • Don’t twist the mesenteric root
  • Ask for gauze count
28
Q

how do we close the linea alba wth continuous pattern? how many throws, what material and why, what size? what do we include wth bites? how large are bites?

A
  • One extra throw at start (6) and two at the end(7)
  • Polydioxanone – PDS
  • No Catgut or Monocryl
    – Quick loss of tensile strength
    – Fascia heals slowly
  • 3-0, 2-0 or 0
  • Include the external rectus fascia in all bites
  • 5-10 mm bites
29
Q

how do we close the subcutaneous layer? what pattern and what material? what material should we not use and why?

A
  • Close using a simple continuous pattern
  • Monocryl ,Vicryl

(PDS, Maxon & Biosyn last longer than you need)

Surgery (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions