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General Surgery Flashcards

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1
Q

A Right paramedian incision is used for?

A

Biliary pancreas procedures

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2
Q

A left upper paramedian incision is used for?

A

Gastronomy

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3
Q

Left lower paramedian incisions are used for?

A

Sigmoid procedures

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4
Q

A subcostal incision is also called

A

Kocher

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5
Q

A subcostal incision requires cutting what?

A

The eighth intercostal nerve

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6
Q

A right subcostal incision is used for what?

A

Biliary and pancreas procedures

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7
Q

Left subcostal incisions are used for what?

A

Spleen surgery

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8
Q

The McBurney incision is used during what surgery?

A

Appendectomy

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9
Q

Pfannenstiel incisions are made where?

A

Curved transverse incisions along the lower abdominal fold.

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10
Q

A mid abdominal transverse incision are made for what type of procedures?

A

Used to approach for retro peritoneal organs.

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11
Q

Transverse incisions are made for what procedures?

A

Liver rejections or transplants

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12
Q

At what point in abdominal surgery should the tech switch from raytex to laps?

A

Once the peritoneum is opened.

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13
Q

Define postoperative paralytic ileus. What is the prevention/ treatment?

A

Absence of peristalsis with abdominal distention.
Use of nasogastric tube for decompression.
NPO until bowel sounds return.

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14
Q

Define atelectasis. What is the prevention/ treatment?

A

Collapse of Lung due to inadequate respiration, secondary to shallow breathing. Encourage to take deep breaths, cough, and turn frequently.

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15
Q

define wound dehiscence/ eviceration. What is the treatment/ prevention?

A

Partial/ complete disruption of the incision line. Due to excessive stress on the suture line during the early phases of healing, support incision during straining/ coughing/ sneezing.

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16
Q

Define wound infection. What is the treatment/prevention?

A

Formation of pus at the surgical site. maintain aseptic technique and sterile field, use irrigation with or without antibiotics.

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17
Q

Define urinary retention. What is the prevention/ treatment?

A

Inability to micturate (void). Urinary output should be closely monitored and record first void.

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18
Q

What are the advantages and disadvantages of minimally invasive surgery?

A

Advantages: direct observation under magnification, less tissue trauma, shorter hospital stay, more rapid return to optimal level of wellness.
Disadvantage: cost, procedure length, may need to convert to open

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19
Q

What is used to create pneumoperitoneum? What is the optimal pressure?

A

Carbon dioxide 12 to 15 mm Hg

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20
Q

What are contraindications for minimally invasive surgery?

A

Extensive adhesions, obesity, malignant disease, large stones, pregnancy, abdominal sepsis/ peritonitis.

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21
Q

What are surgical hazards of minimally invasive surgery?

A

Perforation of organ with the grocer, persistent bleeding from the biopsy site, injury to a major vessel.

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22
Q

What is a postoperative complication of minimally invasive surgery?

A

Moderate abdominal and shoulder pain due to CO2 under the diaphragm.

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23
Q

What are the six predisposing factors for an acquired hernia?

A

Straining at work, chronic cough, straining to void, straining at stools, ascites (collection of fluid in the abdomen), obesity.

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24
Q

Define ascites.

A

Collection of fluid in the abdomen.

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25
Q

What is the most common site for hernia formation?

A

Hesselbach’s triangle.

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26
Q

What is Hesselbach’s triangle?

A

Formed by the rictus abdominal muscle, inguinal ligament, and the deep epigastric vein and artery.

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27
Q

The inguinal canal contains what?

A

Spermatic cord in men, round ligament in women

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28
Q

Name the membrane below the subcutaneous tissue.

A

Scarpa’s fascia

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29
Q

The inguinal ligament is also called

A

Poupart’s ligament

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30
Q

Surgical hazards of inguinal hernia repair include damage to what 3 structures?

A

Spermatic cord, testicular artery or vein, femoral artery or vein

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31
Q

name the two postoperative complications of inguinal hernia surgery.

A

Scrotal hematoma or acute urinary retention

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32
Q

Direct inguinal hernias occur due to a defect in what structure.

A

The transversalis fascia

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33
Q

An indirect inguinal hernia results from a defect in what structure.

A

The internal inguinal ring

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34
Q

What is the most common type of hernia?

A

An indirect inguinal hernia

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35
Q

Femoral hernias are a result in a defect in what?

A

Transversalis fascia

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36
Q

Femoral hernias protrude through what structure?

A

The femoral ring, just below the inguinal ligament.

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37
Q

A hernia that involves both a direct and indirect inguinal hernia is called

A

Pantaloon

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38
Q

A Hiatal hernia occurs where?

A

In the diaphragm at the area of passage of the esophagus into the abdominal cavity.

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39
Q

Where do breast receive their blood supply from?

A

Branches of the internal mammary artery, lateral branches of the intercostal arteries, and a branch of the axillary artery.

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40
Q

What is the tail of Spence?

A

An extension of breast tissue that extends into the axilla.

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41
Q

What procedure would involve the use of a Geiger counter?

A

Sentinel node biopsy

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42
Q

Breast tissue is approximated using what type of suture? On what needle?

A

Absorbable on a cutting needle

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43
Q

What type of needle is used to perform a needle biopsy on breast tissue?

A

Cutting needle or Vim-Silverman needle

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44
Q

What is removed during a lumpectomy?

A

The entire mass and healthy tissue margins

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45
Q

A simple mastectomy is removal of what?

A

The breast without lymph node dissection.

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46
Q

Why is a simple mastectomy performed?

A

Palliative measures for extensive benign disease or for gynecomastia.

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47
Q

Sentinel node biopsy involves injection of what substance?

A

Isosulfan blue or lymphazurin.

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48
Q

What is the most common type of breast cancer?

A

Invasive ducal carcinoma

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49
Q

What is a subcutaneous mastectomy?

A

It is a skin sparing mastectomy where the skin and nipple are not removed, but the breast is.

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50
Q

What is removed during a modified radical mastectomy?

A

The entire breast is removed and sentinel node biopsy or axillary dissection performed.

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51
Q

What is removed during a radical mastectomy?

A

The entire breast, all axillary nodes, and the chest wall muscles are removed.

52
Q

Surgical hazards associated with radical breast surgery include what 5 things.

A

Pneumothorax, injury to axillary blood vessels, injury to the long thoracic nerve, injury to the lateral thoracic neve, damage to the brachial plexus

53
Q

Breast abscess generally are caused by what 2 organisms?

A

Streptococci and staphylococci

54
Q

Bowel serosa is approximated with…

A

Nonabsorbable interrupted suture

55
Q

Bowel mucosa is approximated with..

A

Absorbable suture using a continuous running stitch

56
Q

Intestinal occluding clamps include what 4 clamps?

A

Glassman, payr, Allen, or doyen

57
Q

Nissan fundoplication is a corrective procedure to treat what?

A

GastroEsophageal Reflux Disease/ hiatal hernia.

58
Q

Describe how Nissen Fundoplication is accomplished.

A

The fungus of the stomach is folded around the esophagus below the hiatus to act as a sphincter.

59
Q

Esophagogastrectomy involved what?

A

Removal of diseased portion of the esophagus and stomach form relief of strictures in the lower esophagus or management of varies or varicose veins.

60
Q

Strictures in the lower esophagus may be initially treated in what two ways?

A

Insertion of tube with inflation balloon (Sengstaken-Blakemore) to control bleeding by pressure or sclerotherapy

61
Q

For a esophagogastrrectomy, what incision is made?

A

Throacoabdominal incision

62
Q

Zenker’s Diverticulum is what?

A

A weakening in the wall of the esophagus that balloons out in the cervical portion of the esophagus that collects food, causing fullness in the neck.

63
Q

Zenker’s Diverticulum is performed with the patient in what position? Where is the incision made?

A

Semi-Flower

Incision in the inner borders of sternocleidomastoid muscle from hyoid bone to clavicle.

64
Q

Define vagotomy. Why is this performed?

A

Resection of a portion of the vagus nerve to interrupt parasympathetic stimulation. Reducing gastric acid secretions. Required a high abdominal incision.

65
Q

Define pyloroplasty.

A

Drainage procedure for the stomach following a vagotomy or a widening procedure for acquired pyloric stenosis.

66
Q

Define Gastrostomy.

A

Palliative procedure to prevent malnutrition and starvation in a patient with an obstructed esophagus or mechanical swallowing problem.

67
Q

What type of incision is made for a Gastrostomy.

A

Midline or left paramedian.

68
Q

What is another name for a gastrojejunostomy?

A

Roux-en-Y Gastroenterostomy.

69
Q

Define Roux-en-Y Gastroenterostomy.

A

Permanent communication between the wall of the stomach and proximal jejunum without removal of a section. Preformed to treat gastric ulcers, gastric carcinoma, long-term weight loss control. Can be done to bypass pyloric stenosis

70
Q

Define Gastrectomy. What are the 3 different types.

A

Removal of a diseased portion of the stomach (ulcer or cancer)
Billroth I and II and total.

71
Q

What is the difference between a Billroth I and Billroth II?

A

Billroth I gastroduodenostomy: duodenum is anastomoses to the remaining portion of the stomach
Billroth II: Gastrojejunostomy: duodenal stump and loop of jejunum is anastomoses to the remaining portion of the stomach

72
Q

The appendix is located where?

A

The end of the cecum

73
Q

Define Meckel’s Diverticulum.

A

Unobliterated congenital duct in the distal ileum which may be ulcerated, bleed, or perforate.

74
Q

Name the seven reasons for a small bowel resection.

A

Cancer, strangulation, volvulus (twisting), intussusception (telescoping of the bowel), strangulation, removal of Meckel’s Diverticulum, paralytic ileus, peptic ulcer

75
Q

Define ileostomy.

A

Surgical creation of an opening in the ileum to the body surface to reduce activity in the colon. Done for colitis or as a diversion when the large intestine has been removed.

76
Q

Define colostomy. What is the purpose?

A

Surgical creation of an opening in the colon to the surface of the body. To treat an obstruction caused by a malignant lesion, advanced inflammation or trauma (colitis, diverticulitis, ruptured Diverticulum) to decompress and give the bowel rest

77
Q

How long after the first stage loop colostomy, does the second stage occur?

A

After 48 hours.

78
Q

What are two other names for a abdominoperineal resection?

A

Miles resection or proctocolectomy

79
Q

Hemorrhoidectomy define.

A

Removal of varicose veins in the rectum

80
Q

Define pilonidal cystectomy.

A

Nest of hair, cyst of congenital origin on the posterior surface of the lower sacrum in the inter gluteal fold.

81
Q

Define polypectomy.

A

Removal of polyp.

82
Q

Define anoplasty.

A

Surgical restoration or formation of an anus. Performed on infants with an imperforate anus or congenital absence of an anus.

83
Q

Define pediatric colorectal resection.

A

Resection of a diseased portion of colon and rectum with an end to end anastomoses of the colon to the lower rectum. Performed on children with Hirschssprung’s disease-congenital aganglinoic megacolon, a section of the colon or rectum that lacks ganglion cells in the muscle layer thereby resulting in an inability of the segment to relax and permit the passage of feces and leading to constipation, megacolon, and other problems.

84
Q

Describe the flow of bile from the liver to the duodenum.

A

Liver through right and left hepatic ducts. Join to form the common hepatic duct. The cystic duct from the pancreas meets the common hepatic duct to form the common bile duct. The common bile duct joins the pancreatic duct (duct of Wirsung) and enters the duodenum at the ampulla of Vater. The ampulla of Vater is controlled by the sphincter of Oddi.

85
Q

Define cholelithiasis.

A

Gallstones

86
Q

Define Choledocholithiasis.

A

Gallstones in the common bile duct

87
Q

Define biliary atresia.

A

Congenital absence of the bile duct, leading to obstructive jaundice.

88
Q

Define cholecysitis.

A

Inflammation of the gallbladder.

89
Q

What are the two hazards of biliary surgery?

A

Hemorrhage, injury to the extra hepatic duct system

90
Q

The dilator used in the common duct is called

A

Bakes

91
Q

What is an ERCP?

A

Endoscopic Retrograde Cholangiopancreatography

92
Q

Specialty instruments include what type of common duct scoops and what type of aspirating Trojan?

A

Mayo common duct scoops and Oschner gallbladder aspirating trocar.

93
Q

What is ligated during a cholecystectomy?

A

Cystic duct, cystic artery, and cystic vein.

94
Q

What may be used for visualization assistance during cystic duct exploration?

A

Choledochoscope.

95
Q

What type of contrast media is used for a cholangiogram?

A

diatrizoate sodium Hypaque or Renografin.

96
Q

Define cholecystostomy. What type of drains are used?

A

Drainage of the gallbladder. Mushroom/ Pezzar catheter.

97
Q

Define choledochostomy. What type of drain is used?

A

Drainage of the common bile duct through the abdominal wall with a T-tubE insertion.

98
Q

What needles are used to biopsy the liver?

A

Silverman, Tru-cut

99
Q

Define portosystemic shunts. What are the three types?

A

To treat hemorrhage get esophageal varies, generally secondary to cirrhosis of the liver, surgical treatment by decompressing the portal vein and shunting blood away from the liver.

  1. Portocaval shunt: anastomoses between the portal vein and the inferior vena cava.
  2. Mesoscaval shunt: superior mesenteric vein to the vena cava.
  3. Splenorenal shunt: splenic vein to the left renal vein.
100
Q

Define Pancreaticojejunostomy.

A

Roux-en-Y: anastomoses of a loop of the jejunum to the pancreatic duct, a drainage procedure done for chronic alcoholic pancreatitis and pseudo cysts of the pancreas.

101
Q

Define Pancreaticoduodenectomy.

A

Whipped procedure: surgical removal of the duodenum, head of the pancreas, distal stomach, and lower half of the common bile duct with the following anastomoses. Choledochojejunostomy, Pancreaticojejunostomy, and gastrojejunostomy. A radical procedure done for carcinoma of the head of the pancreas or ampulla of vater.

102
Q

Define pancreatectomy.

A

Removal of segment/ all of the pancreas for malignancy.

Hormonal, enzyme, or organ replacement necessary.

103
Q

Define hypersplenism.

A

Overactive destruction of blood cells.

104
Q

Enlargement of the spleen is seen in what disease?

A

Hodgkins

105
Q

Define splenorrhaphy. What are the 4 methods.

A

Repair of the splenic laceration.

  1. Topical hemp static agent or Argon coagulation.
  2. Splenic artery may be ligated
  3. Lacerated section may be wrapped in a synthetic mesh or omental pouch.
  4. Closed vacuum drainage may be placed in wound
106
Q

Define Splenectomy.

A

Surgical removal of the spleen. Hemorrhage is the major hazard.

107
Q

During a laparoscopic splenectomy, the spleen may be removed with what?

A

A morcellator.

108
Q

Morbid obesity is a BMI over what?

A

40

109
Q

Bile is necessary for what/

A

The breakdown of cholesterol and helps stimulate peristalsis in the small intestine during digestion.

110
Q

Insulin is produced by what type of cells?

A

Alpha cells

111
Q

Glucagon is synthesized by what type of cells?

A

Beta cells

112
Q

Insulin and glucagon are produced where in the pancreas?

A

Islet of langerhans

113
Q

Delta cells in the pancreas produce what?

A

Somatostatin, which controls the rate of nutrient absorption form the intestine.

114
Q

Gamma cells in the pancreas produce what?

A

Pancreatic polypeptide which reduces appetite.

115
Q

What is the most common reason for a splenectomy other than trauma?

A

Immune thrombocytopenia purpura. Alterations in the immune system result in loss of platelets, which are critical for clotting.

116
Q

During a splenectomy, it is essential to have what 4 things?

A
  1. Access to the hemorrhage site
  2. Visualization-suction
  3. Excellent lighting
  4. Clamps
117
Q

The liver is divided into how many sections?

A

2 right and left

118
Q

What is the structure that splits the liver in half?

A

The falciform ligament

119
Q

Each lobe of the liver is further divided into how many subsections?

A

8

120
Q

The liver is encapsulated by a thick fibrous sheath called what/

A

Glisson capsule.

121
Q

The subphrenic spaces are common sites for what?

A

Abscesses.

122
Q

The subhepatic space is a common site for what?

A

A site that traps intestinal contents after a rupture of the appendix. Can become infected.

123
Q

The submucosal folds have folds called what?

A

Rugae.

124
Q

The distal or lower portion of the stomach is called?

A

The Antrum.

125
Q

The colon forms a series of puckers called

A

Haustra.

126
Q

The longitudinal band of muscle on the colon is called

A

Teniae coli

Microbiology (12 decks)

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