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Surgical Procedures 2 > General Surgery > Flashcards

General Surgery Flashcards

1
Q

What is the simplest abdominal incision offering good exposure to any part of the abdominal cavity?

A

-vertical midline incision

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2
Q

The vertical midline incision can be reinforced in its closure by means of what?

A

-closure reinforced with retention sutures sutures to prevent postoperative wound dehiscence/evisceration

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3
Q

What incision is used for an open appendectomy?

A

-McBurney incision

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4
Q

Is a McBurney incision oblique, vertical or transverse? Which quadrant is it located in?

A
  • Oblique incision

- RLQ

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5
Q

Name the incision that can be made on either the right or left side under the ribs.

A

-right or left subcostal

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6
Q

If the incision in Ques. 5 is done on the right, what structures can be operated on?
If done on the left?

A
  • Right: gallbladder, biliary system, pancreas

- Left: spleen

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7
Q

What incision is used frequently for pelvic surgery 3-5cm above the symphysis pubis?

A

-Pffanastiel incision

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8
Q

What incision is used for operations on the proximal stomach & distal esophagus?

A

-Left throaco abdominal

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9
Q

Name 2 of the many functions that the organs of the alimentary canal responsible for?

A
  • digestion

- elimination

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10
Q

As the esophagus passes thru the neck, between which 2 structures does it lie?

A
  • trachea

- vertebral column

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11
Q

Fundus

A

-superior most portion for temporary storage/mixing area

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12
Q

Cardiac portion

A

-superior opening of stomach, surrounds cardiac sphincter (entrance to stomach)

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13
Q

Body

A

-largest, dilated central-most, main region

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14
Q

Antrim

A

-funnel shaped connecting main body to narrow pyloric canal

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15
Q

Pylorus

A

-terminus of of pyloric region and stomach itself

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16
Q

What is attached to the greater curvature of the stomach?

A

-greater omentum

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17
Q

The blood supply to the stomach comes from?

A

celiac trunk of the aorta

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18
Q

What is the omentum?

A
  • fold of peritoneum connecting stomach with other abdominal organs
  • fat that covers intestines
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19
Q

What attaches the intestines to the posterior abdominal wall?

A
  • 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
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20
Q

Where does the small intestine begin and end?

A
  • pyloric sphincter

- ileocecal valve

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21
Q

Name the 3 sections of the small intestine.

A
  • duodenum
  • jejunum
  • ileum
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22
Q

What portion of the small intestine do the common bile duct and pancreatic duct enter & what is the name of that area?

A
  • duodenum

- Ampula of Vader

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23
Q

What is the name of a ligament which stabilizes the duodenojejunal flexure & serves as a landmark for abdominal orientation?

A

-ligament of treitz

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24
Q

The ileum empties into the large intestine where?

A

-cecum

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25
Q

Where is the hepatic flexure?

A
  • RUQ

- first turn of large intestine

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26
Q

Name the 3 portions of the large intestine?

A
  • cecum
  • colon
  • rectum
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27
Q

What structure projects from the posterior medial wall?

A

-appendix

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28
Q

Name the 6 parts the colon is divided into.

A
  • ascending
  • hepatic flexure
  • transverse
  • splenic flexure
  • descending
  • sigmoid
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29
Q

The rectum lies behind which structures in the male and female?

A
  • male: prostate, bladder, seminal ducts and glands

- female: uterus

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30
Q

The rectum begins where?

A

-end of the sigmoid

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31
Q

Name the sphincters of the anus

A
  • internal

- external

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32
Q

What is “bowel technique”?

A

-preventing cross contamination between the dirty bowel and other clean tissue

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33
Q

From the instrument list, name the non-traumatic grasping clamp that is used on the intestine. (Clinical Practice)

A

-babcock forcep

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34
Q

From the instrument list, name the forceps generally used on the skin.

A

-adsons forceps

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35
Q

What is the process by which food is moved through the stomach and intestines?

A

-peristalsis

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36
Q

What is the function of the plicae circulares of Kerckring in the small intestine?

A

-to provide greater mucosal surface area for nutrient absorption

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37
Q

What is the Haustra?

A

-sacculations that are out pouching of the bowel wall

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38
Q

Name common sutures used in GI procedures?

A
  • 3-0, 4-0 absorbable suture
  • polyglycolic acid
  • polyglactin 910 (vicryl)
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39
Q

What is Bariatric Surgery?

A
  • weight loss surgery

- weight reduction surgery

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40
Q

What is a Barrett’s Esophagus?

A

-metaplastic changes to esophageal cells from continuous exposure to gastric acid

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41
Q

During EGD, what is the position that may be utilized to view the fundus & cardia of the stomach?

A

-sims or lateral

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42
Q

What is a Colonoscopy and the instrument used?

A
  • direct visualization of rectum

- colonoscope

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43
Q

What is another name for an esophageal diverticulum?

A
  • zenkers diverticulum

- diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle

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44
Q

What position is used for an esophageal diverticulum?

A

-supine position using shoulder roll to extend neck

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45
Q

Which muscle is the incision made through for a Zenker’s diverticulum?

A

-sternocleidomastoid

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46
Q

What is a hiatal hernia?

A
  • stomach moves into chest cavity

- portion of stomach

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47
Q

How can a Hiatal Hernia be repaired?

A

-nissen fundoplication

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48
Q

The laparoscopic Nissen Fundoplication & other procedures similar to it were developed for the management of what condition?

A

-GERD

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49
Q

What instruments might be used for a Laparoscopic Nissen?

A
  • esophageal dilators: Hurst, Maloney
  • prevent stricture maintain esophageal potency during wrapping
  • graspers, cautery, suture cut, passers
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50
Q

What is Esophagomyotomy (or Heller cardiomyotomy) and why is it done?

A
  • 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
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51
Q

Name some dilators used for an esophageal dilation.

A
  • hurst

- maloney

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52
Q

What is a PEG tube?

A

-tube that provides enteral feeding for someone who can’t orally eat but has a normal GI tract

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53
Q

What is the more frequent reason a Pyloroplasty is done? Which incision is used?

A
  • peptic ulcer disease

- midline, paramediaan, high transverse

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54
Q

What is a gastrojejunostomy and why is it done?

A

-anastamosis between stomach and jejunum (small intestine) to bypass obstruction

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55
Q

instrument used to retract tissue near the surface.

A
  • senn

- rake

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56
Q

What is a Billroth I and between which 2 structures is the anastomosis?

A
  • distal gastrectomy

- stomach to duodenum

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57
Q

What is a Billroth II and between which 2 structures is the anastomosis?

A
  • distal gastrectomy

- stomach to jejunum

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58
Q

From the instrument list, this is an instrument used to cross-clamp the stomach.

A

-payer clamp

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59
Q

What is a Meckel’s diverticulum?

A
  • congenital slight bulge in the DISTAL ILEUM of small intestine
  • small pouch or sac
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60
Q

What type of suture is used on the appendiceal base, absorbable or nonabsorbable?
-non absorbable suture

A

-absorbable

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61
Q

Why might a drain be used on an appendectomy?

A

-if the appendix has ruptured

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62
Q

Name some reasons a small bowel resection is done?

A

-diseased, necrotic, obstructed bowel

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63
Q

From the instrument list, 2 other non-traumatic forceps.

A
  • debakey

- gerald

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64
Q

What is an end ileostomy and 2 reasons why it’s done?

A
  • stoma created with ileum for bowel resection

- for diversion of fecal matter

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65
Q

Can the large intestine be resected laparoscopically?

A

-yes

66
Q

What is a colostomy & which 2 parts of the large intestine can be utilized?

A
  • surgical opening of the bowel and suturing it to the skin to create an orifice
  • TRANSVERSE OR DESCENDING colon
67
Q

Name some reasons a colostomy is done. Are they temporary, permanent or either?

A

.

68
Q

What is the closure of a colostomy?

A

.

69
Q

What is an abdominoperineal resection?

A

-complete excision of sigmoid colon, rectum, anus

70
Q

What positions can be used for an abdominoperineal resection?

A
  • prone
  • lithotomy
  • kraske (jackknife)
71
Q

What two incisions are used for abdomenoperineal resection?

A
  • midline incision for abdomen

- perianal incision for rectum

72
Q

What is a hemorrhoidectomy?

A

-removal of hemorrhoid: congestion and dilation of the submucosal and subcutaneous venous plexus

73
Q

An instrument that can be used to grasp the base of the hemorrhoid?

A
  • allis

- pennington (Duval) clamp

74
Q

What are “J” , “S”, and “Y” pouches as used for rectal reconstruction?

A

-ileanal pull through

75
Q

What is the excision of a pilonidal cyst and sinus?

A

-hair that tracts through the skin causing a cyst to form

76
Q

Can the above reoccur?

A

-cyst and tract must be removed entirely to prevent reoccurrence

77
Q

Which position is used for the excision of a pilonidal cyst?

A

-prone

78
Q

Which position is used for the excision of a pilonidal cyst?

A

-prone

79
Q

How are the tracts identified and marked for pilonidal cyst?

A

-methylene blue dye is injected

80
Q

In which quadrant is the liver located? Which cells in the liver manufacture bile?

A
  • RUQ right upper quadrant

- hepatocytes

81
Q

Hepatic ducts within the liver join to form what?

A

common hepatic duct

82
Q

Hepatic ducts within the liver join to form what?

A

common hepatic duct

83
Q

What is Glisson’s capsule?

A
  • capsule surrounding layer

- ensheathes artery, portal vein, bile ducts in liver

84
Q

The cystic duct and the common hepatic duct merges to form which duct?

A

-common bile duct

85
Q

Where does the gall bladder lie?

A
  • RUQ

- beneath right lobe of liver

86
Q

What is the function of the gall bladder?

A

-stores and concentrates bile

87
Q

The sphincter of Oddi is where?

A
  • ampulla of vater

- controls release bile/digestive enzymes to duodenum

88
Q

What is the blood supply of the gall bladder?

A

-cystic artery

89
Q

What structure is the head of the pancreas fixed to?

A

duodenum of small intestines

90
Q

Where is the pancreas located?

A
  • abdominal cavity behind stomach

- LUQ

91
Q

What 2 hormones does the pancreas secrete and by which cells are those hormones produced?

A
  • insulin
  • glycogin
  • islets of langerhans
92
Q

As an digestive gland, what does the pancreas secrete and through which duct?

A
  • digestive enzymes in pancreatic juice

- duct of wursung

93
Q

Where is the spleen located?

A
  • LUQ

- under ribcage & above stomach

94
Q

What is the function of the spleen?

A
  • filter for blood
  • red blood cells recycled
  • platelets/white blood cells stored
  • fights bacteria causing meningitis/pneumonia
95
Q

What does ERCP stand for and what is the procedure?

A
  • Endoscopic Retrograde CholangioPancreatography
  • direct visualization of biliary system
  • cystic duct, common bile duct, hepatic ducts
96
Q

What is Gelfoam?

A

-hemostatic agent made of absorbable gelatin

97
Q

What is Surgicel?

A

-hemnostatic agent, oxidized cellulose polymer, control post surgical bleeding

98
Q

During a laparotomy, the patient is at risk for hypothermia. What is one way in which

A

-make sure irrigation solution is warm

99
Q

What can the circulator apply to the patient to prevent deep venous thrombosis?

A

-venodyne leg compression stockings

100
Q

What type of drain might be used after a common duct exploration?

A

t-tube drain

101
Q

Where do abdominal drains usually exit the patient’s skin and why are they anchored (or sutured)?

A

.

102
Q

What is a cholecystectomy and why is it performed?

A
  • TX for diseased gallbladder

- removal of gallbladder

103
Q

What 2 incisions that can be used for a cholecystectomy?

A
  • RIGHT SUBCOSTAL (kocher)*
  • right paramedian
  • midline (?)
104
Q

What hand held retractors might be used to retract the liver?

A
  • deaver retractor

- harrington retractor

105
Q

Of the cystic artery, cystic duct and common bile duct, which is ligated & divided and which is left intact?

A
  • cystic artery: divided and ligated

- cystic duct: divided

106
Q

intraoperative cholangiogram?

A

-small catheter placed into cystic duct to drain bile from gallbladder into common bile duct

107
Q

Why is it important to remove air bubbles from the syringe before injecting?

A

-prevent air embolus

108
Q

What is the Hasson technique and why is it done?

A
  • open method of tracer insertion for lap. Procedures

- verres needle & first trocar significant cause of complication

109
Q

What is the maximum pressure setting for the insufflation unit?

A

-15MMHG

110
Q

What is the saline drop test?

A
  • used to confirm verres needle position

- needle flushed with saline to ensure integrity

111
Q

What does the term NOTES stand for?

A

-Natural Orifice Transluminal Endoscopic Surgery (scarless abd operations)

112
Q

What instrument is inserted thru the purse-string suture to drain the gall bladder
contents?

A

-endoscopic needle aspirator

113
Q

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?

A

-Whipple procedure TX for cancer of head of pancreass

114
Q

A pancreatic transplant is done to treat which condition?

A

diabetes

115
Q

During a hepatic resection, the surgeon may use a CUSA. How does the CUSA work?

A

-to fragment/aspirate liver parenchyma tissue, exposing vascular/ductal structures to be ligated and clipped

116
Q

What are some reasons a splenectomy is done? Which incision is used?

A
  • cancer, hereditary spherocytosis, ITP, trauma, ruptures splenic artery, Hodgkins
  • LEFT SUBCOSTAL incision
117
Q

Which 3 landmarks form Hesselbach’s triangle? Which hernia occurs here?

A
  • inguinal
  • inferior epigastric vessels
  • lateral border of rectus abdominus
  • direct inguinal hernia**
118
Q

Which hernia occurs laterally to the deep epigastric vessels?

A

-indirect inguinal hernia

119
Q

Direct & indirect hernias represent a weakness in what?

A

-fascia

120
Q

Which hernia protrudes into the inguinal canal but not into the cord, rarely into the scrotum?

A

-direct hernia (inguinal)

121
Q

Which hernia results from heavy lifting?

A

-direct hernia (inguinal)

122
Q

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?

A

pantaloon hernia

123
Q

Which hernia may be either congenital or acquired?

A

pantaloon hernia

124
Q

What is a pantaloon hernia?

A

-both direct and indirect hernia are present

125
Q

What type of incision is used for a hernia repair?

A

-oblique or transverse incision

126
Q

Why is a moistened penrose drain used in a hernia repair?

A

-retract the spermatic cord

127
Q

Name 2 spontaneously occurring ventral hernias.

A

-epigastric and umbilical hernias occur spontaneously

128
Q

What is another name for a postoperative ventral hernia and what type of incisions does it appear in?

A

-incisional hernia, occurs near/along prior abdominal surgical incision

129
Q

Give some examples of synthetic material used as reinforcement in hernia repairs?

A
  • polypropylene
  • polyester
  • dexon/vicryl (absorbable)
130
Q

How many lobes does the thyroid gland have and name the structure that unites the lobes.

A

-two lobes connected by thyroid isthmus

131
Q

What is the blood supply to the thyroid gland?

A

-right/left, superior/inferior thyroid arteries

132
Q

How many parathyroid glands are there?

A

-4 to 5

133
Q

Which preoperative test provides the most useful information in the diagnosis of cancer of the thyroid?

A

-needle biopsy

134
Q

What position is used for a thyroidectomy?

A
  • supine w/ sandbag or roll towel to hyperextend the neck

- reverse trendelenberg

135
Q

Which nerves lie in close proximity during a thyroidectomy and must be identified and preserved?

A
  • upper laryngeal nerve

- recurrent laryngeal nerve (branch of vagus)

136
Q

What type of incision is used for a thyroidectomy?

A

-symmetrical transverse incision

137
Q

What is the name of the most common congenital cyst found in the neck?

A

-thyroglossal duct cysts (TGDCs)q

138
Q

A portion of one parathyroid gland must remain in order to prevent what condition?

A

-hypocalcimia

139
Q

What type of glands are the breasts?

A

-mammary glands = modified sweat glands

140
Q

What is the areola?

A

-surrounds nipple, conceals sebaceous glands

141
Q

What type of lesions are fibroadenomas?

A

-benign lesions of the breast

142
Q

What is the difference between and incisional & excisional breast biopsy?

A

incisional: smaller area of tissue is taken
Excision: entire abnormality or area of interest is removed

143
Q

What are the sentinel nodes?

A

-first lymph nodes located along lymphatic channels

144
Q

If a patient is found to have positive lymph nodes, what procedure is done?

A

-mastectomy or lymphectomy (breast conserving surgery), axilliary node dissection

145
Q

Name 2 substances used in identifying sentinel nodes?

A
  • blue dye: (patent blue)

- radionuclide method (injection)

146
Q

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?

A

-lymphoscintigraphy/NANAPROBE

147
Q

When an axillary node dissection is done, how should the patient’s operative arm be positioned?

A

-supine w/ arm extended board less than 90 degrees

148
Q

What is a subcutaneous mastectomy?

A

-tissue is removed through incision under breast, leaving skin around nipple intact

149
Q

What is a simple mastectomy?

A

-removal of breast tissue, nipple, areola, skin, but not all lymph nodes

150
Q

What is modified radical mastectomy?

A
  • removal of entire breast, pectorals major, fascia, axillary nodes
  • Axillary, pectoral, superior apical nodes
151
Q

From the instrument list, the clamp that is used to hold breast lumps during removal?

A

-allis, Babcock, lahey

152
Q

What is the incision for a modified radical mastectomy?

A

-elliptical transverse incision

153
Q

What type of drain would be used and where is it inserted?

A
  • jackson pratt or hemovac drains through separate stab incisions
  • anterior (chest), lateral (axilla)
154
Q

What is a Pyloromyotomy and what is it done for?

A
  • incision into longitudinal/circular muscles of pylorus

- tx hypertrophic pyloric stenosis

155
Q

For what age group is pylormyotomy done a?

A

-new borns/infants consistently sick, vomit is symptom

156
Q

What is an Omphalocele?

A

-newborns intestines and abdominal organs outside abd cavity from hole in belly button canal

157
Q

What is an Intussusception?

A

-slipping of intestines between or below another portion

158
Q

What is a frequent site for this intestinal obstruction?

A

-ileum enters cecum is common site of intussusception

159
Q

What is an imperforate anus? Describe anorectoplasty.

A
  • anorectal malformation: rectum does not function

- pull through procedure to establish anus

160
Q

What is the most common hernia seen in pediatric patient?

A

-umbilical hernia

161
Q

What is a vagotomy and why is it done?

A

-removal of part of vagus nerve for TX of recurrent duodenal ulcers and gastric outlet obstruction

162
Q

What are some of the biopsy needles used for a liver biopsy?

A

-Vim: Silverman, Tru-Cut, percutaneous

Surgical Procedures 2 (5 decks)

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