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1
Q

simplist abdominal incision offering good exposure

A

vertical midline

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2
Q

how is a vertical midline reinforced

A

single layer continuous absorbable suture

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3
Q

incision for appendectomy

A

McBurnery

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4
Q

describe McBurney

A

8cm oblique in RLQ

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5
Q

incision right or left under ribs

A

subcostal

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6
Q

subcostal incision structures

A

right: gallbladder, pancreas, biliary tree
left: spleen

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7
Q

incision for pelvic surgery .5 in. above symphysis pubis

A

pfannensteil

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8
Q

incision for operations on proximal stomach and distal esophagus

A

thoracoabdominal

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9
Q

2 functions of organs in alimentary canal

A

mechanical/chemical breakdown of food

Peristalsis

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10
Q

what structures does esophagus lie between in neck

A

trachea

cervical spine

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11
Q

3 parts of stomach

A

fundus

body

pylorus

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12
Q

upper margin of stomach

A

cardia

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13
Q

lower margin of stomach

A

pyloris

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14
Q

what is attached to greater curvature of stomach

A

greater omentum

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15
Q

what is attached to lesser curvature of stomach

A

lesser omentum

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16
Q

what is omentum

A

double fold of peritoneum attached to stomach and viscera

fatty, prevent friction, wall off infection

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17
Q

what attaches intestines to posterior abdominal wall?

A

mesentery

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18
Q

start and end of small intestine

A

pyloric sphincter to large intestine

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19
Q

3 sections of small intestine

A

duodenum

jejunum

ileum

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20
Q

what portion of small intestine do CBD and pancreatic duct enter

A

duodenum at ampulla of vater

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21
Q

ligament stabilizing the duodenojejunal flexure and landmark for abdominal orientation

A

Treitz

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22
Q

the ileum empties into large intestine via what valve

A

ileocecal

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23
Q

start and end of large intestine

A

cecum to anus

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24
Q

3 portions of large intestine

A

cecum

colon

rectum

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25
Q

what structure projects from the blind pouch of the cecum

A

appendix

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26
Q

4 parts the colon is divided into

A

ascending

transverse

descending

sigmoid

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27
Q

the rectum begins and ends where

A

sacrum to coccyx

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28
Q

rectum lies behind what

A

bladder

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29
Q

sphincters of anus

A

internal

external

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30
Q

what is bowel technique

A

isolation to prevent cross-contamination of wound/abdomen w/ bowel bacteria

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31
Q

non-traumatic grasping forceps used on intestine

A

DeBakey

Wagonstein

Singley

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32
Q

forceps used on skin

A

Adson

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33
Q

process by which food is moved through stomach and intestine

A

peristalsis

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34
Q

function of small intestine

A

absorb nutrients

barrier for harmful, injected substances

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35
Q

function of large intestine

A

absorb water and electrolytes

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36
Q

2 suction tips in GI

A

yankeaur

frazier

poole

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37
Q

what is bariatric surgery

A

weight loss/reduction

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38
Q

what is Barrett’s esophagus

A

lining of esophagus damaged by stomach acid and changed to lining like stomach

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39
Q

during EGD what position is used to view fundus & cardia of stomach

A

left lateral

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40
Q

what is a colonoscopy

A

visualization of large intestine with a colonoscope

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41
Q

what is a sigmoidoscopy

A

visualization of sigmoid colon and rectum

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42
Q

what preop prep is done before colonoscopy and sigmoidoscopy

A

bowel clean/enema

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43
Q

and is another name for esophageal diverticulum

A

Zenker’s diverticulum

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44
Q

what is an esophageal diverticulum

A

weakening in wall of cervical esophagus

collects small food and sensation of fullness in nexk

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45
Q

what position is used for an esophageal diverticulum

A

supine w/ shoulder roll

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46
Q

over which muscle is the incision for zenker’s diverticulum made

A

sternocleidomastoid

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47
Q

what is hiatal hernia

A

portion of stomach enters throacic cavity

congenital or accidental

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48
Q

what is hiatal hernia repaired

A

lap nissen fundoplication

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49
Q

lap nissen fundoplication were developed why?

A

hiatal hernia

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50
Q

how many trocars are used for lap nissen?

A

5

lithotomy with rev. trendelenburg (CHECK)

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51
Q

what is esophagomyotomy?

A

Incision into esophageal muscle to treat a food obstruction

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52
Q

incision for esophagomyotomy

A

abdominal midline

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53
Q

why is esophageal dilation done

A

stricture

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54
Q

dilators for esophageal dilation

A

Hurst

Malony

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55
Q

what does interrupting the parasymphathetic innervation during vagotomy do

A

reduce gastric acid generation in patients with duodenal ulcers

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56
Q

incision for vagotomy

A

midline

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57
Q

what is the more frequent reason a pyloroplasty is done?

A

peptic ulcer, midline incision

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58
Q

what is a gastrostomy and why is it done?

A

Incision into stomach to insert a feeding tube

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59
Q

instrument used to retract tissue near the surface

A

Senn

Army/Navy

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60
Q

what does PEG stand for

A

percutaneous endoscopic gastrostomy

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61
Q

what is a Billroth I and between which 2 structures is the anastomosis

A

resect diseased portion of stomach

stomach + duodenum

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62
Q

what is a Billroth II and between which 2 structures is the anastomosis

A

resect distal portion of stomach

stomach + jejunum

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63
Q

between which 2 structures is the anastomosis in a total gastrectomy

A

jejunum + esophagus

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64
Q

instrument for cross-clamp stomach

A

Payr

autosuture

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65
Q

what is a Meckel’s diverticulum

A

Congenital outpouch of sm. intestine (ileum)

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66
Q

what is appendectomy

A

removal of appendix with McBurney incision

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67
Q

surute on appendiceal base

A

nonabsorbable

68
Q

why would a drain be used on appendectomy

A

continuous drainage

69
Q

how many trocars for lap appy

70
Q

why is small bowel resection done

A

tumors, gangrene, volvulus, herniation

71
Q

2 non traumatic forceps

A

platapus, wagonstein, singley

72
Q

what is ileostomy and 2 reasons its done

A

temp or permanent opening into ileum

extensive lesions, reduce activity in colon by diversion

73
Q

can large intestine be resected laparoscopically

74
Q

what is colostomy, what 2 parts of large intestine cna be used?

A

mobilize loop of colon and externalize

transverse/descending

75
Q

why colostomy is done

A

obstruction, trauma

76
Q

what is the closure of colostomy

A

reestablishment of internal intestinal continuity and repair of abdomen

77
Q

2 reasons right hemicolectomy and ileocolostomy are done

A

remove malignant lesion or inflammatory lesion in right colon

78
Q

incision for transverse colectomy

A

transverse, upper midline

79
Q

what is abdominoperineal resection

A

mobilization and division of a diseased segmant of lower bowel

80
Q

what is done to proximal and distal bowel in APR

A

proximal: colostomy
distal: closure

81
Q

why is APR performed

82
Q

positions for APR and incision

A

supine, modified lithotomy

midline incision

83
Q

what is hemorrhoidectomy/positions

A

remove hemorrhoids

jacknife/buie

84
Q

instrument to grasp bottom of hemorrhoid

A

pennington

85
Q

suture to tie proximal end of hemorrhoid

A

2-0 synthetic absorbable

86
Q

what are J, S, and Y pouches for rectal reconstruction

87
Q

what is the excision of pilonidal cyst and sinus. Do they recur?

A

intergluteal fold on posterior surface of lower rectum

they can recur

88
Q

position for pilonidal cyst excision. how are tracts identified and marked

A

jacknife

probes and incision

89
Q

how is incision from pilonidal cyst protected

A

left open and packed with a pressure dressing

90
Q

what quadrant is liver located. what cells manufacture bile

A

RUQ

hepatocytes

91
Q

hepatic ducts join to form which common duct

A

common hepatic duct

92
Q

the cystic duct and common hepatic duct form which duct

A

common bile duct

93
Q

what is gallbladder. it ends in which duct

A

RUQ on underside of liver

cystic duct

94
Q

what is the function of the gallbladder. how does bile aid in digestion

A

store bile

emulsify fat in duodenum

95
Q

what is blood supply of gall bladder

A

cystic artery

96
Q

where is pancreas located. what structure is head of pancreas fixed to?

97
Q

an an exocrine gland, what does the pancreas secrete and through which duct

A

digestive enzyme

Wirshung

98
Q

as an endocrine gland what 2 hormones does pancreas secrete and by which cells are they produced

A

insulin, glucagon

islets of Langerhan

99
Q

where is spleen and what is its function

A

LUQ: defend body with phagocytosis

100
Q

what does ERCP stand for and what is it

A

endoscopic retrograde cholangiopancreatography

visualization of biliary tree

101
Q

during laparotomy the patient is at risk for hypothermia. how can you help prevent it with irrigation

A

warm solution for thermoregulation

102
Q

what is applied to patient to help prevent DVT

A

sequential compression device TED stocking

103
Q

train used after common duct exploration

104
Q

where do abdominal drains exit skin and why are they anchored

A

stab wounds

prevent retraction

105
Q

what is cholecystectomy

A

remove gallbladder

stones/disease

106
Q

position and 2 incisions for gallbladder

A

supine

right subcostal/upper midline`

107
Q

hand held retractors used to retract liver

A

Harrington

Deaver

108
Q

what is divided and what is left intact in cholecystectomy

A

cut artery/cystic duct

leave common bile duct

109
Q

what is intraoperative cholangiogram

A

visualize CBD, hepatic duct branches

access patency of CBD

110
Q

what is injected during cholangiogram to look for stones

A

contrast medium

remove bubbles b/c they look like stones

111
Q

what is Hasson technique

A

open insufflation w/ blunt cannula

patients w’ previous surgery or adhesions

112
Q

max pressure for insufflation unit

113
Q

trocar sites for lap chole

114
Q

what is cholecystostomy and who is it performed on

A

open incision into gallbladder to drain/remove stones

advanced medical problems

115
Q

instrument through purse-string to drain gallbladder

A

trocar

CHECK

116
Q

what is another name for pancreatoduodenectomy, why is it done

A

whipple-cancer

117
Q

pancreatic transplant is done to treat what

A

type 1 diabetes

118
Q

how does CUSA work

A

dissect tissue with ultrasonic waves with fluid and suction

119
Q

what is splenectomy done and what is the incision

A

trauma, malignancy, leukemia, jaundice

midline/subcostal

120
Q

what is danger with incarcerated hernia and what additional procedure must you be prepared to do

A

become strangulated/ischemia

resect necrotic bowel

121
Q

3 landmarks of Hasselbach’s triangle

A

rectus abdominis, inguinal ligament, inferior epigastric vessels

has direct inguinal hernias

122
Q

what hernia occurs laterally to deep epigastric vessels

A

indirect inguinal

123
Q

direct and indirect hernias represent a weakness in what

A

transverse fascia

124
Q

what hernia protrudes into inguinal canal but not into cord, rarely into scrotum

A

direct inguinal

125
Q

what hernia results from heavy lifting

A

direct inguinal

126
Q

what hernia leaves the abdominal cavity at internal ring and passes with cord structures into scrotum

A

indirect inguinal

127
Q

what hernia is congenital or acquired

128
Q

what is a pantaloon hernia

A

indirect + direct

129
Q

what incision is used for a hernia repair

130
Q

why is a moistened penrose drain used in hernia repair

A

retract spermatic cord

131
Q

2 spontaneously occuring ventral hernias

A

epigastric

umbilical

132
Q

name for a postop ventral hernia and what incisions is it found in

A

incisional hernia

vertical midline

133
Q

examples of synthetic material in hernia repairs

A

mersilene, prolene, dacron

134
Q

lobes of thyroid and what separates them

A

2, isthmus

135
Q

blood supply to thyroid gland

A

superior thypoid/external carotid

136
Q

how many parathyroid glands are there

137
Q

what preop test provides info in diagonses of cancer in thyroid

A

Fine needle biopsy/ CT/ MRI

138
Q

position for thyroidectomy, incision

A

supine, transverse

139
Q

nerve in close proximity to thyroid

140
Q

what knife handle holds a 10,11,12,15 blade

141
Q

what is the name of the most common congenital cyst in neck

A

thyroglassal duct

142
Q

why does a parathyroid gland need to stay in the body

A

prevent hypocalcemia

143
Q

what type of glands are there in the breasts, what is areola

A

mammory/pigmented area around nipple

144
Q

what lesions are fibroademonas

145
Q

incisional vs. excisional breast biopsy

A

incisional: just part of mass
excisional: take whole mass

146
Q

what are sentinal nodes

A

1st nodes along lymphatic channel from primary tumor site

147
Q

if patient has positive lymph nodes what procedure is done (breast)

A

radical mastectomy

148
Q

2 substances used in IDing sentinal nodes

A

isosulfan blue dye, radiocolloid

149
Q

what radioactive material is used what device is used to detect it

A

Geiger counter/neoprobe

150
Q

when axillary node dissection is done how is the arm positioned

A

extended on armboard less than 90 degrees

151
Q

what is subcutaneous mastectomy

A

under skin removal

overlying skin + nipple remain

152
Q

what is simple/total mastectomy

A

remove entire involved breast w/o lymph node dissection

153
Q

what is modified radical mastectomy?

154
Q

clamp used to hold breast lumps

155
Q

incision for modified radical mastectomy

A

elliptical

156
Q

drain in modified radical mastectomy

A

closed wound suction catheter

157
Q

what is Nissen Fundoplication

A

wrap fundus around esophagus

GERD/hiatal hernia

158
Q

what is pylormyotomy

159
Q

what age is pyloromyotomy done and what is the first sign of the condition

A

2-6 weeks

projectile vomiting

160
Q

what is omphalocele

A

hernia where intestines and other organs are outside of body through belly button

161
Q

what is intussusception?

162
Q

what is a frequent site for intestinal obstruction

A

ileocecal junction

163
Q

what is an imperforate anus. describe anorectoplasty

A

no hole

make an anus

164
Q

what is the most common hernia in pediatrics

165
Q

what is lumpectomy

A

remove lump for biopsy

166
Q

what anesthesia is given for liver needle biopsy

167
Q

2 needles for liver needle biopsy

A

tru-cut

silverman

franklin

Senior Rotations (8 decks)

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