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Surginal Procedures > General Surgery > Flashcards

General Surgery Flashcards

1
Q

GI anatomy

A

Major structures:
Mouth
Pharynx
Esophagus
Responsible for ingesting food
Stomach
Secreting, mixing food, digestion
Small intestine (duodénum, jejunum, ilium)
Absorption of nutrients
Large intestine (cecum, ascending colon, transverse colon, descending colon, sigmoid colon)
Adsorption of water (electrolytes)
Rectum and anus
Elimination

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2
Q

Endoscopy

Define/anatomy/physiology/pathophysiology/indication

A

Visual exam of the bronchus/bronchi
Epiglottis, true vocal cords, trachea, carina, right & left main stem of the bronchi
Performed to diagnose hemoptysis, infection, carcinoma. It is also performed to treat foreign bodies.

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3
Q

peristalsis

A

A progressive (involuntary), wave-like movement in a tubular structure

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4
Q

Microlaryngoscopy

Define/anatomy/physiology/pathophysiology/indication

A

Visual examof the larynx with the use of the microscope
Larynx
Vocal cords
Vocal cord nodules or polyps

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5
Q

Triple Endoscopy

Define/anatomy/physiology/pathophysiology/indication

A

(AKA panendoscopy)
Visual exam of larynx, bronchi, and esophagus
Larynx; epiglottis, vocal cords, Trachea; carina; bronchi, Esophagus
Diagnostic for spread of malignancy

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6
Q

Breast Biopsy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of a portion of breast tissue for pathology examination
Breast, Areola/nipple, Adipose tissue, Glandular tissue (lobes), Lactiferous ducts
Lactation/nourish infant
Breast mass or abnormal mammogram
Patient may be awake
Use warm prep solutions
Be very mindful of your conversations
Have mammograms available
There may be a wire placed by the radiologist during the confirmation before surgery

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7
Q

Sentinel node biopsy (CoR)

Define/anatomy/physiology/pathophysiology/indication

A

Identification and removal of the first lymph nodes along the lymphatic channel that drains the tumor site
Breast, Areola/nipple, Adipose tissue, Glandular tissue (lobes), Lactiferous ducts, Lymph nodes
Breast cancer
Performed to determine if the cancer spread to the lymph nodes

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8
Q

Modified Radical Mastectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A 
Excision of the breast with removal of all axillary contents:
     Breast
     Areola/nipple
     Adipose tissue
     Glandular tissue (lobes)
     Lactiferous ducts
Pectoralis major muscle
Tail of Spence (axillary tail) 
Axillary lymph nodes
lactation
May need lots of laps and #10 blades
Have Mammograms available
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9
Q

Total Thyroidectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of both lobes of the thyroid gland and all thyroid tissue
Thyroid gland (and parts)
2 lobes and isthmus
Parathyroid glands, Recurrent laryngeal nerve (RLN; see procedure step 4), Trachea, Thyroid and cricoid cartilages
Endocrine gland
Metabolism; growth and development in fetuses and infants
Produce hormones T4; T5
Malignant tumors of the thyroid gland
Imaging available
Meticulous dissection
Need mosquitos, fine right angles, lots of ties, hemoclips, and/or harmonic/ligasure

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10
Q

Laparoscopic Cholecystectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of gallbladder with the use of minimally invasive technique
Gallbladder; cystic duct; cystic artery, Liver; hepatic duct & artery, Common bile duct; duodenum
Storage/concentration of bile to emulsify ingested fat
Cholecystitis; cholelithiasis
Have images available in OR
May do intraoperative cholangiogram
Make sure that the OR bed must be compatible
May do common bile duct exploration if stones present
It is rare but the procedure convert to open cholecystectomy
May use closed or open technique to establish laparoscopic access
Closed:
Use Veress needle for initial insufflation
“Open” (Hasson technique):

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11
Q

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of gallbladder with a record or writing of the bile vessels
Gallbladder; cystic duct; cystic artery, Liver; hepatic duct & artery, Common bile duct; duodenum
Cholecystitis; cholelithiasis

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12
Q

Liver Resection (Hepatic resection) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of part of the liver
Liver and its right and left lobes; falciform ligament; quadrate lobe; caudate lobe is in dorsal segment, Porta hepatis, Hepatic ducts, hepatic arteries and veins, lymph nodes
Hepatocellular tumors (cancer); bleeding or maceration from trauma
Expect significant blood loss
This is a meticulous and time-intensive procedure
use of blunt-tip needles with chromic suture

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13
Q

Pancreaticoduodenectomy (Whipple procedure) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Removal of the head of the pancreas, entire duodenum, part of
Pancreas; head and tail, pancreatic duct, Common bile duct, Duodenum, Jejunum, Stomach
Cancer of the head of pancreas
Has a high morbidity (complications)
High mortality (death from complications)
Long, involved procedure
Expect significant blood loss if things go wrong

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14
Q

Laparoscopic Splenectomy Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of spleen through a minimally invasive technique
Spleen, Splenic artery and vein (AKA: splenic pedicle), Short gastric vessels, Stomach, left kidney, pancreas, colon
Phagocytosis of bacteria and old RBC’s; formation of WBC’s
Splenomegaly
Benign hematologic disorders such as:
Idiopathic thrombocytopenia purpura (immune disorder in which the blood doesn’t clot normall (ITP))
Tumors, cysts
Have images available

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15
Q

Inguinal Herniorrhaphy open Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Suture (repair of) a tear in the transversalis fascia
Transversalis fascia, Inguinal canal; inguinal ligament; Cooper ligament, Internal and external inguinal rings, Hesselbach’s triangle, ilioinguinal nerve, Spermatic cord (Vas deferens, Testicular vessels, Cremaster muscle)
Several different types of repairs:
mesh-plug, a type of tension-free repair
Have bowel items ready if this is an emergency strangulated inguinal hernia

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16
Q

Incisional/ventral hernia repair Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Suture (repair of) an incisional/ventral hernia
Incisional: pertaining to; an incision•Ventral: pertaining to; anterior abdomen
Abdominal wall fascia near the defect
Abdominal body wall support
Ventral can be complex and large, requiring very large mesh patch

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17
Q

tylectomy

A

Excision of palpable breast lesion

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18
Q

Summarize procedure step sequence for Breast Biopsy

A

Inject the incision site with local (10 or 20 cc syringe and 25 ga needle)
Create an incision (#10 blade on #3 handle) over the abnormal tissue
Hemostasis is achieved using ESU
Dissect with Metz or ESU and Adson with teeth
Retract skin and the subcutaneous layers with Senns x 2 or Army-Navy x 2
Continue dissection with Metz or ESU and DeBakey
Grasp mass with Allis
Remove mass with deep knife (#10 blade on #3 handle), Metzenbaum, or ESU
Irrigate wth warm saline
Hemostasis is achieved with ESU
Close with suture, needle holder, Adson with teeth
Dress with wet one, dry one, and Steri-Strips, one 4x4 folded

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19
Q

Summarize procedure step sequence for Modified Radical Mastectomy

A

I/H/D/R to develop skin flaps
FYI: Skin hooks, rakes, Richardsons
Dissect breast from chest wall (pec major muscle)
FYI: Knife, ESU, Metz & tissue forceps
Continue into axilla and dissect axillary contents
FYI: Metz & TF, Richardson, hemoclips
Remove specimen en bloc
New term: “en bloc” means all in one piece
I/H, place drain, C/D

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20
Q

Summarize procedure step sequence for Total Thyroidectomy

A

I/H/D/R
Identify thyroid gland and dissect it, ligating appropriate blood vessels
Identify RLN and preserve it; preserve parathyroid glands if possible
Remove thyroid gland
I/H/drain PRN/C/D

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21
Q

Summarize procedure step sequence for Liver Resection (Hepatic resection)

A

I/H/D/R
FYI: ipsilateral just means on the same side, so right subcostal
Identify vessels; determine resection line; resect identified portion of liver
I/H/drain/C/D

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22
Q

parenchyma mean

A

Essential or functional parts of an organ

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23
Q

Summarize procedure step sequence for Pancreaticoduodenectomy (Whipple procedure)

A

I/H/D/R
Dissect and remove the head of the pancreas, entire duodenum, part of jejunum, distal 1/3 of stomach, lower half of common bile duct
Re-establish continuity of biliary, pancreatic, and GI tracts by anastomoses
I/H/drain/C/D

24
Q

Summarize procedure step sequence for Laparoscopic Splenectomy

A

Establish laparoscopic access; EUA
Retract stomach; mobilize splenic flexure
Clamp and divide supporting ligaments
Clamp, divide, and ligate short gastric vessels and splenic artery and vein
Spleen placed in endo-bag and removed
I/H/C/D

25
Q

Summarize procedure step sequence for Inguinal Herniorrhaphy open

A

I/H/D/R
Mobilize spermatic cord and place Penrose drain
FYI: Kitners, Metz & TF (smooth or DeBakey)
Dissect and push hernia sac back into peritoneal cavity (McVay, so now we go to step 9 in text)
Size inguinal ring, select mesh, suture in place
I/H/C/D

26
Q

Summarize procedure step sequence for Incisional/ventral hernia repair

A

I/H/D/R
Identify defect
Insert mesh, suture in place for ventral
I/H/C/D

27
Q

Types of Hernias

A 
Inguinal
     Direct (usually acquired)
     Indirect (usually congenital)
Femoral
Umbilical
Epigastric AKA ventral or incisional
Hiatal (diaphragm)
28
Q

Definition of abdominal hernia

A

Protrusion of a peritoneum-lined sac through a defect in the layers of the abdominal wall.

29
Q

Reducible
Non-reducible AKA incarcerated
Strangulated
Pantaloon hernia

A

Contents will go back in
Contents will not go back in, “stuck” inside hernia sac
Loop of bowel stuck in sac, blood supply compromised–On call case; plan for bowel resection
When both direct and indirect hernias are present (not Common)

30
Q

Anatomy for Inguinal Hernia:

A 
Transversalis fascia
Inguinal canal
Cremaster muscle
Spermatic cord
     In females; the round ligament is in place of the spermatic cord
Inguinal ligament 
Cooper ligament
Ilioinguinal nerve
Internal  inguinal ring
External inguinal ring
31
Q

Hesselbach’s Triangle

A

Rectus abdominus muscle medially (RAMM)
Inguinal ligament inferiorly (ILI)
Deep epigastric vessels laterally (DEVL)

32
Q

Direct inguinal hernias occur

Indirect inguinal hernias occur

A

Within Hesselbach’s Triangle

Outside of Hesselbach’s Triangle

33
Q

Umbilical hernia repair Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Suture (repair of) an umbilical (pertaining to; umbilicus) hernia

34
Q

TEP Hernia Repair Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Totally extra-peritoneal patch
Repair of a tear in the transversalis fascia through a minimally invasive approach
Transversalis fascia, Inguinal canal; inguinal ligament; Cooper ligament, Internal and external rings, Hesselbach triangle(RAMM, ILI, DEVL) ilioinguinal nerve, Spermatic cord (Vas deferens, Testicular vessels, Cremaster muscle)
Inguinal hernia; direct or indirect
Several different types of endoscopic repairs; risk of injury to abdominal organs is reduced if approached from outside peritoneal cavity
Set-up similar to a basic MIS procedure

35
Q

Total Gastrectomy Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Complete removal of stomach and establishment of anastomosis between esophagus and jejunum (aka. Esophagojejunostomy).
Stomach, Greater omentum and lesser omentum, Esophagus, Duodenum, Jejunum, Spleen and liver
digestion and absorption
Gastric cancer
Have images available
Have blood ordered; track blood loss at field
May need longer instruments
May need thoracic access; may need bowel technique

36
Q

Gastrostomy (PEG) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Percutaneous endoscopic gastrostomy
New opening; stomach
esophagus and stomach,
patient need for enteral (to intake of food through a tube that goes directly to the stomach) feedings
Usually done in Endoscopy lab now
Gastroenterologist rather than surgeon
Various techniques; combinations of push and pull

37
Q

Laparoscopic Roux-en Y Gastric bypass Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Creation of a small gastric pouch connected to a segment of jejunum with connection of the duodenal limb to the lower jejunum using MIS techniques.
Stomach, Duodenum, Ligament of Treitz, Jejunum, Omentum, and Mesentery
Digestion ; absorption of nutrients
Morbid obesity
Bariatric patients require lots of special considerations
Special hospital bed; transport to OR in that bedSpecial OR bed; positioning challenges
Extra long trocars; wide BP cuffs, large SCD’s
And particularly sensitivity and compassion

38
Q

LAPAROSCOPIC NISSEN FUNDOPLICATION Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Wrapping and securing the gastric fundus around the distal esophagus through a minimally-invasive approach
Esophagus, Diaphragm, Vagus nerve, Stomach, and cardia, and fundus, and Liver
Ingestion and digestion, GERD (Gastroesophageal reflux disorder) with failed medical management
Have images available
Camera person should be at patient’s right side otherwise you are reaching over the patient to point at upper left
May be performed on children

39
Q

Summarize procedure step sequence for Umbilical hernia repair

A

I/H/D/R
Identify defect
Suture defect (mesh is not always needed)
I/H/C/D

40
Q

Summarize procedure step sequence for TEP Hernia Repair

A

I/H/dissect with balloon
Insufflate, place other ports
Continue dissection to identify and reduce hernia
Place mesh and secure (with staples/tacks)
I/H/remove ports/C/D

41
Q

Summarize procedure step sequence for Total Gastrectomy

A

I/H/D/R
Mobilize the stomach by dissection and ligation of the ligaments and gastric vessels
Resect stomach with staplers at duodenum and esophagus
Mobilize small intestine and bring loop of jejunum up to esophagus
Perform anastomoses (Esophagojejunostomy and Duodenojejunostomy) and close stapler accesses
So bile can get to the jejunum
I/H/C/D

42
Q

Summarize procedure step sequence for Gastrostomy (PEG)

A

Insert gastroscope; insufflate stomach with air
Back light stomach to abdominal wall (turn room lights off)
Incision over light, insert PEG needle from outside abdomen
Insert snare through EGD scope and guide wire through PEG needle
Snare guide wire, pull up through mouth, and attach to PEG tube to guide wire, pull guide wire out PEG needle, seating PEG internal bolster securely
Place external bolster, cut excess tubing, place connector and dress

43
Q

Summarize procedure step sequence for Lap Roux-en Y Gastric bypass

A

Establish laparoscopic access
Create gastric pouch with staplers
Identify ligament of Treitz by retracting away theOmentum and transverse colon
Transect jejunum with stapler
Create gastrojejunostomy (pass jejunum up to stomach and staple or sew)
Perform duodenojejunostomy (biliary limb)Check for leaks; close mesenteric defect;
I/H/C/D

44
Q

Summarize procedure step sequence for LAPAROSCOPIC NISSEN FUNDOPLICATION

A

Establish laparoscopic access
Place Penrose, dissect esophageal hiatus, repair hernia PRN
Grasp stomach and mobilize fundus
Wrap fundus around lower esophagus and secure
I/H/deflate/C/D

45
Q

COLON RESECTION (Colectomy) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision or resection of the colon
Colon (Cecum, Ascending, Transverse, Descending, Sigmoid colon, Rectum), Mesentery, Liver, Spleen, and Ureters
Absorption of water; defecation
Colon cancer
Have images available
Bowel technique
Isolate operative site; don’t use instruments that have been used on bowel to close abdominal wal

46
Q

COLOSTOMY (LOOP) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Create a new opening for the colon through the abdominal wall
Colon (Cecum, Ascending, Transverse, Descending, Sigmoid colon, Rectum), Mesentery, Liver, Spleen, and Ureters
colitis, diverticulitis or colon cancer

47
Q

LAPAROSCOPIC APPENDECTOMY Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of appendix using minimally invasive techniques
Appendix, Mesoappendix (containing appendiceal vessels), Cecum
Function is currently unclear
Acute appendicitis
Usually done on-call
Set up just like general laparoscopy with added endo-GIA

48
Q

Summarize procedure step sequence for COLON RESECTION (Colectomy)

A

I/H/D/R
Mobilize colon, isolate from mesentery (blood supply)
Clamps placed on colon, transect colon (stapler x 2 fires)
Perform anastomosis (1 GIA; 1 TA)
Remove contaminated items to prepare for clean closing
Close mesentery; I/H/C/D

49
Q

Summarize procedure step sequence for COLOSTOMY (LOOP)

A

I/H/D/R
Open mesentery, place penrose
Isolate loop of colon and bring it to abdominal wall through a separate incision
Place bridge and secure colon
I/H/C/D
Then open the stoma and secure edges (with silk sutures)

50
Q

Summarize procedure step sequence for LAPAROSCOPIC APPENDECTOMY

A 
Establish laparoscopic access
Grasp appendix (endoBabcock)
Make window in mesoappendix
Transect appendix at cecum
Transect mesoappendix
Remove specimen (endobag PRN)
I/H/desufflate/C/D
51
Q

Volvulus

Intussusception

A

A twisting of the intestine

A telescoping of the intestine

52
Q

APPENDECTOMY; OPEN Define/anatomy/physiology/pathophysiology/indication/special considerations

A 
Excision of appendix
Appendix, Mesoappendix (containing appendiceal vessels), Cecum
Function is currently unclear
Acute appendicitis
Take longer to do
53
Q

Summarize procedure step sequence for APPENDECTOMY; OPEN

A

I/H/D/R
Grasp appendix (Babcock)
Make window in mesoappendix and ligate
Clamp base and place purse-string suture on cecum
Ligate and excise appendix (contaminated); remove specimen
Invert cecal stump; isolate instruments used
I/H/C/D

54
Q

Hemorrhoidectomy Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision and ligation of enlarged anal cushions
Rectum, Anus, Anal veins, Internal and external sphincters, Anal valves
Defecation
Enlarged anal cushions that prolapse and cause pain
Frequently done as office procedure; those patients with 3rd or 4th degree prolapse are candidates for surgery
Multiple techniques are available; surgeon choice
Banding; coagulation; sclerotherapy; stapled hemorrhoidectomy
Maintain patient dignity

55
Q

Summarize procedure step sequence for Hemorrhoidectomy

A

Dilate anal canal; place anoscope or retractor/s
Grasp hemorrhoid
Ligate and excise hemorrhoid
Reinforce with suture by over-sewing area
Repeat PRN
Hemostasis/Dress

Surginal Procedures (14 decks)

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