Gastrointestinal Surgery Flashcards
Which section contains the majority of the small intestines?
hypogastric region
Identify the five major segments of the stomach and the purpose for each section
- Cardia– secretes mucous to ease passage of food.
- Fundus– produces hydrochloric acid.
- Corpus– produces acid & secretes pepsinogen & mucous.
- Antrum– non-acid producing secretes mucous & gastrin.
- Pylorus– food storage area before is passes in the duodenum.
What sphincter of the stomach prevents gastric reflux?
lower esophageal sphincter
What sphincter controls the exit of food from the stomach?
pyloric sphincter
What would be the consequences for the patient if the sleeve was too tight? Too loose?
Food will not be able to processed causing reflux if too tight, too lose and won’t hold structure
Identify the location and purpose of the greater and lesser omentum
The greater omentum is located at the peritoneal fold that hangs down from the stomach in front of the transverse colon. The function of the greater omentum is fat deposition, provide wound and infection isolation, and physically limit spread of intraperitoneal infections.
The lesser omentum is the double layer of the peritoneum that is extended from the liver to the lesser curvature of the stomach as well as part of the duodenum (between stomach and proximal duodenum and liver). The lesser omentum helps cover some of these organs to protect them.
Parasympathetic innervation to the stomach is provided by the vagus nerve. This nerve and the main left and right gastric arteries run primarily along the ______ of the stomach
superior portion of the lesser curvature
Name the four layers of the wall of the digestive tract
The innermost layer is the mucosa, underneath is the submucosa, then the muscularis propria, and then the outermost layer called the adventitia.
The enzyme pepsinogen (pepsin) secreted in the stomach begins digestion of the food substance _____.
proteins
The small intestine is responsible for the digestion and absorption of ______.
nutrients
The large intestine is responsible for the absorption of _____.
water
The movement of food through the intestines by the muscles of the alimentary canal is called _____.
peristalsis
What is the purpose of the mesentery?
The mesentery holds the small intestines to the back of the abdominal wall. It is a fold of tissue attaching organs to the wall.
Describe the typical location of the appendix. What is the purpose of the mesopendix?
The appendix is located generally at the lower right quadrant of the abdomen (near the right hip bone).
The mesoappendix is the part of the mesentery that connects the ileum to the appendix. It closes the appendicular artery & vein, lymphatic vessels, nerves, and a lymph node.
The Nissen fundoplication is performed to:
treat gastroesophical reflux disease (GERD) and hiatal hernia (via laparoscopic surgery)—it treats GERD
A percutaneous endoscopic gastrostomy is used to:
place a tube for feeding without having to perform an open surgery on the abdomen to help treat patients that struggle taking food in by the mouth - enteral feedings
What procedure establishes a permanent communication between the proximal jejunum and either the anterior or the posterior stomach:
gastrojejunostomy
The formation of a temporary or permanent opening into the ileum:
ileostomy
Resection of the right half of the colon, including a portion of the transverse colon, ascending colon, and cecum:
hemicolectomy
Incision and ligation of dilated veins in the anal region:
hemorrhoidectomy
A Billroth I is the resection of a diseased portion of the stomach and the establishment of an anastomosis between:
stomach and duodenum
A McBurney incision is commonly used for:
appendectomy
A Billroth II is the resection of a diseased portion of the stomach and the establishment of an anastomosis between:
stomach and jejunum
This is the main surgical treatment for esophageal cancer. The surgeon removes all the parts of the esophagus through an incision that is located in the chest, abdomen, or even both.
Esophagectomy
An operation that creates an opening at the colon or the large intestines through the abdomen that can be temporary or permanent. Transverse can be done to treat colon cancers.
Transverse colectomy
Name and describe all of the variations for large bowel anastomosis.
a. 1. end-to-end: two ends of approximately the same size structures are attached.
2. end-to-side: the end of one section of bowel is attached to the side of another section
3. Side-to-side: creation of parallel openings in two sections of bowel with anastomosis.
4. Roux-en-Y: specific technique of anastomosis that allows a variety of applications in gastric, intestinal, biliary, and pancreatic surgery.
Describe the patient position that is necessary when a thoracoabdominal approach is planned.
placed in lateral or supine position
What are the three major sections of the stomach?
Fundus (upper)
Body (middle)
Antrum (lower or distal)
What is assessed during an esophagogastroscopy?
The esophagus, stomach, and upper part of small intestines (duodenum) is assessed.
What is used to ligate the vagus nerve and how many vagus nerve branches are ligated or resected?
The nerve is ligated with metal surgical clips.
What health conditions have a Roux-en-Y procedure traditionally been used to treat?
Gastric Bypass
What stapling devices will be used to perform a Roux-en-Y procedure?
TA-90 stapler, GIA stapler, and a TA-55 stapler
protrusion of abdominal tissue through one or more abdominal layers is an
incisional hernia
in a _________ hernia, tissue protruding from the hernia may be swollen and squeezed
strangulated
A hernia in which abdominal viscera slides into the inguinal canal from the deep inguinal ring is an
indirect hernia.
protrusion of abdominal or inguinal tissue directly through the transversalis fascia is a
direct inguinal hernia
A rare hernia occurring between the transverse abdominis and rectus muscles is a
Spigelian hernia
This occurs most often as a postoperative complication or a result of pelvic or back injury and peritonitis,
paralytic ileus
Telescoping of the intestines, occurring mainly in children, and resulting in ischemia and necrosis of the bowel is
intussusception
Twisting of the bowel on itself is
volvulus
During a laparoscopic cholecystectomy, which two structures are occluded?
cystic duct and cystic artery
venous drainage from the esophagus empties into
subclavian veins, azygos vein on the right, hemiazygos vein on the left, and through the coronary vein in the portal circulation
blood supply to the esophagus
branches of the inferior thyroid arteries, bronchial arteries, thoracic aorta, and branches of the left gastric and inferior phrenic arteries
what is the omentum
omentum is a double layer of fatty peritoneum attached to the greater curvature of the stomach. it drapes loosely over the intestines, folds posteriorly on itself, sweeps upward to attach along the transverse colon
what is the landmark for the beginning of the jejunum
ligament of Treitz: supports the duodenojejunal flexure
blood supply to ascending, transverse, descending, and sigmoid colon
ascending: ileocolic and middle colic arteries
transverse: middle colic artery
descending/sigmoid: left colic and sigmoid arteries
layers of the abdominal wall
skin, camper’s fascia, scarpa’s fascia, external oblique, internal oblique, transversus, transversalis fascia, preperitoeal fat, peritoneum
what is a billroth 1
truncal vagotomy, antrectomy, and gastroduodenostomy (one limb off remnant)
what is a billroth 2?
truncal vagotomy, antrectomy, and gastro gastrojejunstomy (2 limbs off)
what is the kocher maneuver?
dissect the left lateral peritoneal attachments to the duodenum to allow visualization of posterior duodenum
most common metastasis from colorectal cancer is to
liver
