General Surgery Flashcards
What is the simplest abdominal incision offering good exposure to any part of the abdominal cavity?
-vertical midline incision
The vertical midline incision can be reinforced in its closure by means of what?
-closure reinforced with retention sutures sutures to prevent postoperative wound dehiscence/evisceration
What incision is used for an open appendectomy?
-McBurney incision
Is a McBurney incision oblique, vertical or transverse? Which quadrant is it located in?
- Oblique incision
- RLQ
Name the incision that can be made on either the right or left side under the ribs.
-right or left subcostal
If the incision in Ques. 5 is done on the right, what structures can be operated on?
If done on the left?
- Right: gallbladder, biliary system, pancreas
- Left: spleen
What incision is used frequently for pelvic surgery 3-5cm above the symphysis pubis?
-Pffanastiel incision
What incision is used for operations on the proximal stomach & distal esophagus?
-Left throaco abdominal
Name 2 of the many functions that the organs of the alimentary canal responsible for?
- digestion
- elimination
As the esophagus passes thru the neck, between which 2 structures does it lie?
- trachea
- vertebral column
Fundus
-superior most portion for temporary storage/mixing area
Cardiac portion
-superior opening of stomach, surrounds cardiac sphincter (entrance to stomach)
Body
-largest, dilated central-most, main region
Antrim
-funnel shaped connecting main body to narrow pyloric canal
Pylorus
-terminus of of pyloric region and stomach itself
What is attached to the greater curvature of the stomach?
-greater omentum
The blood supply to the stomach comes from?
celiac trunk of the aorta
What is the omentum?
- fold of peritoneum connecting stomach with other abdominal organs
- fat that covers intestines
What attaches the intestines to the posterior abdominal wall?
- mesentery
- The mesentery is a continuous set of tissues which is formed by the double fold of peritoneum that attaches the intestines to the wall of the abdomen
Where does the small intestine begin and end?
- pyloric sphincter
- ileocecal valve
Name the 3 sections of the small intestine.
- duodenum
- jejunum
- ileum
What portion of the small intestine do the common bile duct and pancreatic duct enter & what is the name of that area?
- duodenum
- Ampula of Vader
What is the name of a ligament which stabilizes the duodenojejunal flexure & serves as a landmark for abdominal orientation?
-ligament of treitz
The ileum empties into the large intestine where?
-cecum
Where is the hepatic flexure?
- RUQ
- first turn of large intestine
Name the 3 portions of the large intestine?
- cecum
- colon
- rectum
What structure projects from the posterior medial wall?
-appendix
Name the 6 parts the colon is divided into.
- ascending
- hepatic flexure
- transverse
- splenic flexure
- descending
- sigmoid
The rectum lies behind which structures in the male and female?
- male: prostate, bladder, seminal ducts and glands
- female: uterus
The rectum begins where?
-end of the sigmoid
Name the sphincters of the anus
- internal
- external
What is “bowel technique”?
-preventing cross contamination between the dirty bowel and other clean tissue
From the instrument list, name the non-traumatic grasping clamp that is used on the intestine. (Clinical Practice)
-babcock forcep
From the instrument list, name the forceps generally used on the skin.
-adsons forceps
What is the process by which food is moved through the stomach and intestines?
-peristalsis
What is the function of the plicae circulares of Kerckring in the small intestine?
-to provide greater mucosal surface area for nutrient absorption
What is the Haustra?
-sacculations that are out pouching of the bowel wall
Name common sutures used in GI procedures?
- 3-0, 4-0 absorbable suture
- polyglycolic acid
- polyglactin 910 (vicryl)
What is Bariatric Surgery?
- weight loss surgery
- weight reduction surgery
What is a Barrett’s Esophagus?
-metaplastic changes to esophageal cells from continuous exposure to gastric acid
During EGD, what is the position that may be utilized to view the fundus & cardia of the stomach?
-sims or lateral
What is a Colonoscopy and the instrument used?
- direct visualization of rectum
- colonoscope
What is another name for an esophageal diverticulum?
- zenkers diverticulum
- diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle
What position is used for an esophageal diverticulum?
-supine position using shoulder roll to extend neck
Which muscle is the incision made through for a Zenker’s diverticulum?
-sternocleidomastoid
What is a hiatal hernia?
- stomach moves into chest cavity
- portion of stomach
How can a Hiatal Hernia be repaired?
-nissen fundoplication
The laparoscopic Nissen Fundoplication & other procedures similar to it were developed for the management of what condition?
-GERD
What instruments might be used for a Laparoscopic Nissen?
- esophageal dilators: Hurst, Maloney
- prevent stricture maintain esophageal potency during wrapping
- graspers, cautery, suture cut, passers
What is Esophagomyotomy (or Heller cardiomyotomy) and why is it done?
- lap. esophagomyotomy is superior to all other forms of TX for achalasia (muscles of lower esophagus don’t relax)
- esophageal muscle incised w/ insulated laparoscopic instrument.
- portion of up. stomach wrapped around lower portion of esophagus prevent reflux.
- patients discharged first post-operative day after swallow study
Name some dilators used for an esophageal dilation.
- hurst
- maloney
What is a PEG tube?
-tube that provides enteral feeding for someone who can’t orally eat but has a normal GI tract
What is the more frequent reason a Pyloroplasty is done? Which incision is used?
- peptic ulcer disease
- midline, paramediaan, high transverse
What is a gastrojejunostomy and why is it done?
-anastamosis between stomach and jejunum (small intestine) to bypass obstruction
instrument used to retract tissue near the surface.
- senn
- rake
What is a Billroth I and between which 2 structures is the anastomosis?
- distal gastrectomy
- stomach to duodenum
What is a Billroth II and between which 2 structures is the anastomosis?
- distal gastrectomy
- stomach to jejunum
From the instrument list, this is an instrument used to cross-clamp the stomach.
-payer clamp
What is a Meckel’s diverticulum?
- congenital slight bulge in the DISTAL ILEUM of small intestine
- small pouch or sac
What type of suture is used on the appendiceal base, absorbable or nonabsorbable?
-non absorbable suture
-absorbable
Why might a drain be used on an appendectomy?
-if the appendix has ruptured
Name some reasons a small bowel resection is done?
-diseased, necrotic, obstructed bowel
From the instrument list, 2 other non-traumatic forceps.
- debakey
- gerald
What is an end ileostomy and 2 reasons why it’s done?
- stoma created with ileum for bowel resection
- for diversion of fecal matter
Can the large intestine be resected laparoscopically?
-yes
What is a colostomy & which 2 parts of the large intestine can be utilized?
- surgical opening of the bowel and suturing it to the skin to create an orifice
- TRANSVERSE OR DESCENDING colon
Name some reasons a colostomy is done. Are they temporary, permanent or either?
.
What is the closure of a colostomy?
.
What is an abdominoperineal resection?
-complete excision of sigmoid colon, rectum, anus
What positions can be used for an abdominoperineal resection?
- prone
- lithotomy
- kraske (jackknife)
What two incisions are used for abdomenoperineal resection?
- midline incision for abdomen
- perianal incision for rectum
What is a hemorrhoidectomy?
-removal of hemorrhoid: congestion and dilation of the submucosal and subcutaneous venous plexus
An instrument that can be used to grasp the base of the hemorrhoid?
- allis
- pennington (Duval) clamp
What are “J” , “S”, and “Y” pouches as used for rectal reconstruction?
-ileanal pull through
What is the excision of a pilonidal cyst and sinus?
-hair that tracts through the skin causing a cyst to form
Can the above reoccur?
-cyst and tract must be removed entirely to prevent reoccurrence
Which position is used for the excision of a pilonidal cyst?
-prone
Which position is used for the excision of a pilonidal cyst?
-prone
How are the tracts identified and marked for pilonidal cyst?
-methylene blue dye is injected
In which quadrant is the liver located? Which cells in the liver manufacture bile?
- RUQ right upper quadrant
- hepatocytes
Hepatic ducts within the liver join to form what?
common hepatic duct
Hepatic ducts within the liver join to form what?
common hepatic duct
What is Glisson’s capsule?
- capsule surrounding layer
- ensheathes artery, portal vein, bile ducts in liver
The cystic duct and the common hepatic duct merges to form which duct?
-common bile duct
Where does the gall bladder lie?
- RUQ
- beneath right lobe of liver
What is the function of the gall bladder?
-stores and concentrates bile
The sphincter of Oddi is where?
- ampulla of vater
- controls release bile/digestive enzymes to duodenum
What is the blood supply of the gall bladder?
-cystic artery
What structure is the head of the pancreas fixed to?
duodenum of small intestines
Where is the pancreas located?
- abdominal cavity behind stomach
- LUQ
What 2 hormones does the pancreas secrete and by which cells are those hormones produced?
- insulin
- glycogin
- islets of langerhans
As an digestive gland, what does the pancreas secrete and through which duct?
- digestive enzymes in pancreatic juice
- duct of wursung
Where is the spleen located?
- LUQ
- under ribcage & above stomach
What is the function of the spleen?
- filter for blood
- red blood cells recycled
- platelets/white blood cells stored
- fights bacteria causing meningitis/pneumonia
What does ERCP stand for and what is the procedure?
- Endoscopic Retrograde CholangioPancreatography
- direct visualization of biliary system
- cystic duct, common bile duct, hepatic ducts
What is Gelfoam?
-hemostatic agent made of absorbable gelatin
What is Surgicel?
-hemnostatic agent, oxidized cellulose polymer, control post surgical bleeding
During a laparotomy, the patient is at risk for hypothermia. What is one way in which
-make sure irrigation solution is warm
What can the circulator apply to the patient to prevent deep venous thrombosis?
-venodyne leg compression stockings
What type of drain might be used after a common duct exploration?
t-tube drain
Where do abdominal drains usually exit the patient’s skin and why are they anchored (or sutured)?
.
What is a cholecystectomy and why is it performed?
- TX for diseased gallbladder
- removal of gallbladder
What 2 incisions that can be used for a cholecystectomy?
- RIGHT SUBCOSTAL (kocher)*
- right paramedian
- midline (?)
What hand held retractors might be used to retract the liver?
- deaver retractor
- harrington retractor
Of the cystic artery, cystic duct and common bile duct, which is ligated & divided and which is left intact?
- cystic artery: divided and ligated
- cystic duct: divided
intraoperative cholangiogram?
-small catheter placed into cystic duct to drain bile from gallbladder into common bile duct
Why is it important to remove air bubbles from the syringe before injecting?
-prevent air embolus
What is the Hasson technique and why is it done?
- open method of tracer insertion for lap. Procedures
- verres needle & first trocar significant cause of complication
What is the maximum pressure setting for the insufflation unit?
-15MMHG
What is the saline drop test?
- used to confirm verres needle position
- needle flushed with saline to ensure integrity
What does the term NOTES stand for?
-Natural Orifice Transluminal Endoscopic Surgery (scarless abd operations)
What instrument is inserted thru the purse-string suture to drain the gall bladder
contents?
-endoscopic needle aspirator
What is another name for pancreatoduodenectomy where the head of the pancreas, the entire duodenum and a portion of the jejunum, stomach & common bile duct are removed/ why is it done?
-Whipple procedure TX for cancer of head of pancreass
A pancreatic transplant is done to treat which condition?
diabetes
During a hepatic resection, the surgeon may use a CUSA. How does the CUSA work?
-to fragment/aspirate liver parenchyma tissue, exposing vascular/ductal structures to be ligated and clipped
What are some reasons a splenectomy is done? Which incision is used?
- cancer, hereditary spherocytosis, ITP, trauma, ruptures splenic artery, Hodgkins
- LEFT SUBCOSTAL incision
Which 3 landmarks form Hesselbach’s triangle? Which hernia occurs here?
- inguinal
- inferior epigastric vessels
- lateral border of rectus abdominus
- direct inguinal hernia**
Which hernia occurs laterally to the deep epigastric vessels?
-indirect inguinal hernia
Direct & indirect hernias represent a weakness in what?
-fascia
Which hernia protrudes into the inguinal canal but not into the cord, rarely into the scrotum?
-direct hernia (inguinal)
Which hernia results from heavy lifting?
-direct hernia (inguinal)
Which hernia leaves the abdominal cavity at the internal ring, passes with the cord down the inguinal canal and may be found in the scrotum?
pantaloon hernia
Which hernia may be either congenital or acquired?
pantaloon hernia
What is a pantaloon hernia?
-both direct and indirect hernia are present
What type of incision is used for a hernia repair?
-oblique or transverse incision
Why is a moistened penrose drain used in a hernia repair?
-retract the spermatic cord
Name 2 spontaneously occurring ventral hernias.
-epigastric and umbilical hernias occur spontaneously
What is another name for a postoperative ventral hernia and what type of incisions does it appear in?
-incisional hernia, occurs near/along prior abdominal surgical incision
Give some examples of synthetic material used as reinforcement in hernia repairs?
- polypropylene
- polyester
- dexon/vicryl (absorbable)
How many lobes does the thyroid gland have and name the structure that unites the lobes.
-two lobes connected by thyroid isthmus
What is the blood supply to the thyroid gland?
-right/left, superior/inferior thyroid arteries
How many parathyroid glands are there?
-4 to 5
Which preoperative test provides the most useful information in the diagnosis of cancer of the thyroid?
-needle biopsy
What position is used for a thyroidectomy?
- supine w/ sandbag or roll towel to hyperextend the neck
- reverse trendelenberg
Which nerves lie in close proximity during a thyroidectomy and must be identified and preserved?
- upper laryngeal nerve
- recurrent laryngeal nerve (branch of vagus)
What type of incision is used for a thyroidectomy?
-symmetrical transverse incision
What is the name of the most common congenital cyst found in the neck?
-thyroglossal duct cysts (TGDCs)q
A portion of one parathyroid gland must remain in order to prevent what condition?
-hypocalcimia
What type of glands are the breasts?
-mammary glands = modified sweat glands
What is the areola?
-surrounds nipple, conceals sebaceous glands
What type of lesions are fibroadenomas?
-benign lesions of the breast
What is the difference between and incisional & excisional breast biopsy?
incisional: smaller area of tissue is taken
Excision: entire abnormality or area of interest is removed
What are the sentinel nodes?
-first lymph nodes located along lymphatic channels
If a patient is found to have positive lymph nodes, what procedure is done?
-mastectomy or lymphectomy (breast conserving surgery), axilliary node dissection
Name 2 substances used in identifying sentinel nodes?
- blue dye: (patent blue)
- radionuclide method (injection)
When the radioactive material is used, what piece of equipment is used to locate the radioactive nodes? What is the name of the device we use here at MMC?
-lymphoscintigraphy/NANAPROBE
When an axillary node dissection is done, how should the patient’s operative arm be positioned?
-supine w/ arm extended board less than 90 degrees
What is a subcutaneous mastectomy?
-tissue is removed through incision under breast, leaving skin around nipple intact
What is a simple mastectomy?
-removal of breast tissue, nipple, areola, skin, but not all lymph nodes
What is modified radical mastectomy?
- removal of entire breast, pectorals major, fascia, axillary nodes
- Axillary, pectoral, superior apical nodes
From the instrument list, the clamp that is used to hold breast lumps during removal?
-allis, Babcock, lahey
What is the incision for a modified radical mastectomy?
-elliptical transverse incision
What type of drain would be used and where is it inserted?
- jackson pratt or hemovac drains through separate stab incisions
- anterior (chest), lateral (axilla)
What is a Pyloromyotomy and what is it done for?
- incision into longitudinal/circular muscles of pylorus
- tx hypertrophic pyloric stenosis
For what age group is pylormyotomy done a?
-new borns/infants consistently sick, vomit is symptom
What is an Omphalocele?
-newborns intestines and abdominal organs outside abd cavity from hole in belly button canal
What is an Intussusception?
-slipping of intestines between or below another portion
What is a frequent site for this intestinal obstruction?
-ileum enters cecum is common site of intussusception
What is an imperforate anus? Describe anorectoplasty.
- anorectal malformation: rectum does not function
- pull through procedure to establish anus
What is the most common hernia seen in pediatric patient?
-umbilical hernia
What is a vagotomy and why is it done?
-removal of part of vagus nerve for TX of recurrent duodenal ulcers and gastric outlet obstruction
What are some of the biopsy needles used for a liver biopsy?
-Vim: Silverman, Tru-Cut, percutaneous
