GENERAL #2 Flashcards
hemorrhoidectomy
excision of either external or internal hemorrhoids or both, dilated anal veins
excision of anal fistula
excision of tissue surrounding a draining sinus tract in anal area
excision of pilonidal cyst
in the sacrococcygeal region, congenital defect causing tissue to be trapped below the skin
pediatric atresia
congenital condition where there is a problem with the development in the rectum/anus
trauma to the rectum
insertion of foreign body, sexual assault or accidents
two accessory organs of the GI tract
spleen, gallbladder
muscular ring located between the stomach and small intestine
pyloric sphincter
when the gallbladder contracts, bile is ejected into what
cystic duct
union of the cystic duct and the hepatic duct form what?
common bile duct
where is bile produced?
liver
where is bile stored?
gallbladder
bile and pancreatic enzymes are released through this opening into the duodenum
ampulla of vater
incision for cholecystectomy
right subcostal
xray performed during a cholecystectomy to identify any stones in the common bile duct
intra op cholangiogram
dye used during cholangiogram
hypaque
why is it important to expel the air from the saline syringes prior to cholangiogram?
air looks like stone on xray
can a cholangiogram be performed if it is a lap chole?
yes
oschner trocar
open chole to deflate the gallbladder
forceps used to remove stones during biliary surgery
randall stone forceps
choledochotomy
incision of the common bile duct to get stones out
largest organ in the abd cavity?
liver
main digestive function of the livver?
produce bile
glissons capsule covers what organ?
liver
2 functions of the spleen
filter for blood, fight bacteria
operation where the spleen is removed
splenectomy
incision for splenectomy
midline
why is a splenectomy performed?
trauma, tumors, cysts
what must be readily available when the peritoneum is entered?
suction, laps, cell saver
wher are the islets of langerhans located and what are their functions?
pancreas, blood sugar levels
pancreaticojejunostomy is performed for?
early pancreatic cancers
a whipple procedure includes surgery on what organs?
pancreas, stomach, duodenum, jejunum, common bile duct ***en bloc
technical name for whipple
pancreaticoduodenectomy
procedure done to correct intrahepatic obstruction
portacaval shunt
biopsy need used for a liver biopsy
tru-cut, silverman
what type of suture is used on liver? type of needle?
chromic, blunt
cholelithiasis
hardened deposit within the fluid in the gallbladder
insturment used to grasp the mass/tumor during a breast biopsy?
allis
how is a frzoen section sent to the lab during a breast biopsy?
dry container
needle localization
doing in radiology prior to biopsy, fine wire placed
type of breast surgery which could be performed for a benign breast tumor
lumpectomy
removal of the entired breast and axillary contents, but preserves the pectoral muscles
modified radical mastectomy
why is it important to perform the surgical prep gently for a mastectomy?
avoids dislodging cancer cells
prep parameters for a modified radical mastectomy
neck to umbilicus to midline, circumferiental upper arm to mid forearm
type of irrigation used during a mastectomy
sterile water
2 nerves which must be identified and preerved
thorocodorsal, long thoracic
type of drain used after a mastectomy
JP
pathological enlargement of the male breast
gynemastia
type of set up pack for vein stripping for adequate draping?
universal drape pack
large vein that is often removed during a vein stripping?
greater saphenous vein
why are legs wrapped with elastic wrap after vein stripping?
compression dressing
how many lobes does the thyroid gland have?
2
vocal cords are located?
larynx
what is the larynx located between?
pharynx and trachea
item used in positioning a patient for a thyroidectomy
shoulder roll
why is a shoulder roll used?
hyper extends neck for better exposure
what drainage system is preferred for a radical neck dissection?
jackson pratt
how many parathyroid glands does a person have?
4
instrument used during a tracheostomy used to pull the trachea close to the surface before inserting the trach tube
jacson tracheal hook
what must be sent with the patient to the PACU following a tracheostomy?
obturator
where are the parotid glands located?
in front of ear
laryngoscopy
visualization of larynx using laryngoscope
microlaryngoscopy
more precise visualization
you would find osteotomes, mallet, rongeurs and elevators on a set up for a total laryngectomy?
true
tracheostomy incision
below the cricoid cartilage
how is the trach tube held in place?
suture, cloth tape
when would a nerve stimulator be found?
parotidectomy, thyroidectomy
3 structures that would be resected during a radical neck dissection
sternoclidomastoid muscle, internal jugular vein, submandibular gland
what nerve is identified and preserved during a thyoidectomy?
recurrent laryngeal nerve
possible post op complication following a thyroidectomy?
swelling- end up having a trach
normal bowel fuction
open lumen for intestinal contents, adequate circulation
bowel obstruction
any that interrupts normal flow of contents
where are 80% of intestinal obstructions found?
small bowel
pathophysiology of bowel surgery
inflammatory, vascular, celiac disease, pseudomembranous
bowel technqiue
used on any GI surgery where the bowel is entered, any contact with the GI mucosa can’t be used on any other tissue
diagnostic interventions
chest xray, barium enema, CT scan
bowel prep/intestinal antisepsis
must be done to cleanse inside of bwel, antibiotics
complications of bowel surgery?
DVT, short gut syndrome
class II
controlled spillage
class III
non controlled spillage
class IV
frank pus/infection
meckels diverticulectomy
surgery/purpose/instruments
excision of congenital duct occurring at the umbilicus
PURPOSE: prevent inflammation from intussusception of diverticulum
INSTRU: kochers, bookwalter
small bowel resection
surgery/purpose
excise segment of small intestine
PURPOSE: remove an obstruction
3 anastomosing techniques
end to end, side to side, end to side
posterior serosal layer
3-0 silk SH CR interrupted
mucosal layer
3-0 chromic/vicryl SH continuous
anterior serosal layer
3-0 silk SH cr
what does the 3-0 silk prevent?
post op obstruction
appendectomy
surgery/purpose/instruments
excision of appendix
PURPOSE: remove inflamed appendix to prevent rupture
INSTRU: babcocks
lap appendectomy
surgery/instruments
endoscopic excision of appendix
INSTRU: endo GIA to cut off appendix
reducation of intussusception
telescopic invagination of a portion of intestine into an adjacent part
most common site for intussusception
ileocecal junction
resection and pull through for hirschsprung diease
lack of paristalsis due to absence of ganglion cells in distal bowel
repair of imperforate anus
surgery indicated within 24-48 hours after birth
colostomy
surgery/purpose
mobilization of a loop of colon through a right rectus incision to expose the transverse colon
PURPOSE: obstruction in the sigmoid colon from cancer
temporary colostomy
rest bowel following colon resection-gives suture line time to heal
transverse loop colostomy
most frequently used for a temporary colostomy
sigmoid colostmy
most common type of permanent colostomy
colostomy closure
surgery/purpose
reestablish internal intestinal continuity with repair of abd wall
PURPOSE: when temp. colostomy is no long necessary
when is stoma prepped?
last
right hemicolectomy and ileocolostomy
surgery/purpose
resection of the right half of the colon with creation of an ileostomy
PURPOSE: remove malignant lesion of the right colon
what will right hemicolectomy and ileocolostomy result in?
permanent ileostomy
transverse colectomy
surgery/purpose
excision of the transverse colon though an upper midline or transverse incision
PURPOSE: malignancy
low anterior resection of sigmoid colon and rectosigmoidostomy
surgery/purpose
removal of lower sigmoid colon and proximal 2/3 of rectum
PURPOSE: benign conditions or cancer
abdominoperineal resection- miles resection
surgery/purpose
excision of rectum and portion of sigmoid colon through both an abd and perineal approach
PURPOSE: treat rectal malignancy
abdominoperineal resection- miles resection incisions
vertical or transverse abd incision, elliptical perineal incision, colostomy incision
lap assisted colon resection
excision of large colon segment combining endoscopy and mini laparotomy or large bore lap port
excision of anal fissure and sphincterotomy
involves anal sphincter dilatation and removal of anal fissure/lesion/ulcer
anal fissue
benign lesions of the anal wall
open chole
surgery/purpose
excision of the gallbladder
PURPOSE: acute cholecystitis
how many steps in intra op cholangiogram?
5
what is done before cholangiogram to check for leaks?
saline injected into catheter to check for patency
exploration of common bile duct
purpose/instruments
PURPOSE: remove stones causing obstruction
INSTRU: randall stone forceps
chole
bile
choledoch
common bile duct
cholecyst
gallbladder
ostomy
forming a permanent opening
otomy
making an incision into
oscopy
viewing using a lighted scope
types of pancreatic cysts
pseudocyst
neoplasms
simple
pseudocyst
localized collections of pancreatic secretions in a cystic structure-most common
pancreatic transplatation
implantation of a donor pancreas for patients with type 1 diabetes
pancreas-kidney transplant
renal failure
gaol of pancreatic transplant
stave off debilitating side effects of diabetes
splenectomy
surgery/purpose
excision of spleen
PURPOSE: trauma
lap splenectomy
not done for trauma!!!!
liver biopsy
evaluating suspected liver disease
repair of liver laceration
blunt or penetrating abd trauma
what should you have for liver laceration repair?
hemostatic agents, blunt needle
liver resection
trauma
portal hypertension
high blood pressure in the portal vein system
liver transplantation
done for end stage liver disease
breast biopsy
determine presence of cancer-frozen section
breast biopsy when cancer is diagnosed?
mastectomy performed immediately or later after consulting with patient
breast biopsy with needle localization rule
pt remains on or table with sterile field until confirmation given that lesion has been excised
sentinal node biopsy
determine if cancer has spread to any axillary lymph nodes, if need for additional surgery or tx
radioactive isotope sentinal node biopsy
injected 1 hour prior in radiology, concentrates in tumor
isosulfan sentinal node biopsy
injected in the operating room nodes are stained blue
axillary node dissection
removal of axillary nodes though incision in axilla, allows for staging
lumpectomy-segmental
removal of mass with 1 in margin of surrounding tissue, done to control spread of breast cancer
subq mastectomy
removal of all breast tissue only, leaving overlying skin and nipple intact
simple total mastectomy
removal of entire breast, no lymph node dissection
what is a simple total mastectomy done for?
cancer confined to breast only
modified radical mastectomy
removal of breast and all axillary contents including axillary lymph nodels
what is left intact during modified radical mastectomy?
pectoral muscle
irrigating with warm water during mastectomy?
decrease cancer cell survival
radical mastectomy
removal of entire breast, pectoralis major and minor, facia, axillary nodes and adjacent tissue
parathyroidectomy
removal of 1 or more of the glands
PURPOSE: hyperplasia/hyperparathyroidism
what does the parathyroid do?
regulates calcium and phosphorous concentrations
can you remove all 4 parathyroid glands?
no!!! will die from tetany
where is the incision for parathyroidectomy?
transverse incision in natural neck fold
new technique for parathyroidectomy
1 gland is transplanted to other accessible area for later removal depending on blood levels
partial thyroidectomy
1 lobe removed
subtotal thyroidectomy
most of gland removed
total thyroidectomy
entire gland removed
what does thyroidectomy treat?
hyperthyroidism
anatomy of thyroid
2 lobes connected by an isthmus
thyroid function
regulates energy production
instruments for thyroidectomy
lahey tenaculum
parotidectomy
surgery/purpose
excision of parotid gland
PURPOSE: inflammatory disease
structures identified and preserved during parotidectomy
facial nerve, auricular nerve
excision of submandibular gland
remove gland-tumors
nerves for submandibular gland excision
hypoglossal and facial lingual nerve
most common congential cyst found in neck
thyroglossal duct cystectomy
thyroglossal duct cystectomy
excise all portions of cyst, duct and hyoid bone to avoid cyst re occurrance
tracheostomy
surgery/purpose/instruments
opening made into trachea with insertion of cannula to facilitate breathing
PURPOSE: treats upper respiratory tract obstruction
INSTRU: jackson tracheal hook
incision for trach
between 3rd and 4th tracheal rings with 15 blade
larynx function
air passageway
laryngectomy
surgery/purpose/instruments
excision of larynx, hyoid bone, strap muscles, epiglottis
PURPOSE: neoplasms
INSTRU: trach set and trach tubes,
what would be done first beofre laryngectomy to manage airway?
tracheostomy
ST job for laryngoscopy
keep all specimens separate and labeled correctly
radical neck dissection
resection of cancerous tumor and surrounding structures
when is radical neck dissection done?
only if there is a reasonable chance of controlling the cancer
modified neck dissection
removes tumor and lymph nodes suspected of cancer but allows patient minimal defect
main function of large intestine
reabsorb water and elctrolytes
mesoappendix suture
3-0 chromic
appendix base suture
2-0 chromic tie
appendix stump suture
2-0 chromic pursestring
breast biopsy anesthesia
local with IV sedation