General Surgery Packet Flashcards
esophagus
- 10 inches in adult*
- extends pharynx to cardia of stomach
- transport ingested material by peristalsis from pharynx to stomach
- musculomembranous
function of large intestine (4)
- reabsorb water/electrolytes
- form solid waste
- synthesize vitamin K and B-complex vitamins
- elimination by defecation
large intestine: define haustra
sacculations that are outpouchings of the bowel wall
large intestine: blood supply
superior and inferior MESENTERIC arteries
large intestine:
- ileocecal valve
- veriform appendix
- junction of the ileum and the cecum (small bowel meets large)
- extends from lower portion of cecum
appendectomy is done for?
uncomplicated acute appendicitis
appendicitis often mimics (3)
- ectopic pregnancy
- ovarian cyst
- ureteral stone
methods of transecting the appendix
- endoscopic linear stapler
- ligating loop instrument (endoloop)
- suture instrument
colon resection: mocker’s diverticulum are located?
in the Ileum
colon resection: what can neoplasms form as a result of?
Polyps: pedunculated tumors
colon resection: endoscopic anesthesia options (3)
- local anesthesia
- IV conscious sedation
- general anesthesia
what is given to patient prior to colonoscopy to cleanse bowel?
-citrate of magnesia
position of patient for colonoscopy
PT placed on left side to allow for visualization
what is PT observed for following colonoscopy? (3)
- post procedural bleeding
- pain
- signs of perforations
sigmoidoscopy is performed for?
visualization of the sigmoid up to splenic flexure
intestinal clamps
- allen clamp
- dennis clamp
- doyen clamp
when is bowel technique used? (2)
- when GI tract is clamped and resected
- used to isolate any instruments that come in contact with the mucosa or bowel contents
suture method: serosal layer of posterior wall
- interrupted mattress stitch
- non absorbable
how is colostomy secured to skin?
- closed bowel loop
- bridge is used/plastic rode
when is second stage colostomy formed?
performed in PTs room or treatment room 24hr after surgery
laparoscopic nissen fundoplication
- upper curves of stomach (fundus) wrapped around esophagus and sewn in place to strengthen valve between esophagus/stomach
- stops acid from backing up so easily
diagnostic interventions: fundoplication (5)
- history/physical
- barium swallow
- endoscopy (esophagus, stomach, duodenum identified)
- manometry
- CT scan
laparoscopic nissen fundoplication: which dilators are used/why?
- hurst / maloney*
- esophageal dilators prevents stricture/maintains patency during wrap procedure
difference between Billroth 1 / Billroth 2
Bilroth 1: re-anastomosis stomach to duodenum
Bilroth 2: re-anastomosis stomach to jejunum
used to treat neoplasms/ulcerative disease
what is bile manufactured by?
what collects and transports bile to ducts?
- hepatocytes
- bile canuliculi
what stores and concentrates rates of bile?
gallbladder
what is common bile duct?
where does it transport bile?
- joining of common hepatic/cystic duct
- brings bile to duodenum
what does ERCP stand for?
endoscopic retrograde cholangiopancreatography
anesthesia for cholecystectomy
- prophylaxis used to prevent post op infection
- nasogastric tube placed for medicine delivery or attached to suction to keep stomach empty
what incision is made for open approach cholecystectomy?
- right subcostal aka Kocher (preferred method)
- right paramedian
- midline
what is used to harvest core structure for liver biopsy?
Vim-Silverman core biopsy needle
suture considerations for liver resection?
- absorbable suture
- blunt needles (tapered)
incision for splenectomy?
- left subcostal*
- upper midline
pancreaticoduodenectomy (whipple procedure)
used to treat pancreatic cancer
head of pancreas, duodenum, portion of stomach are removed, adjacent tissues are removed
incision for whipple procedure
- upper transverse
- paramedian
- bilateral subcostal (chevron)
suspensory ligaments of the breast?
coopers ligaments
tail of spence
extension of breast tissue that extends into the axilla
what is a fibroadenoma?
benign lesion of the breast
early menarche is?
- increased risk factor for breast cancer*
- early menstruation
diagnostic intervention of breast cancer? (4)
- breast examination
- mammography
- core biopsy (vim silverman needle)
- stereotactic biopsy (computer guided system used to digitally locate/pinpoint non palpable lesions)
sentinel node biopsy:
- first lymph node along lymphatic channel from primary tumor site
- surgeon injects ISOSULFAN to locate position of sentinel nerve
skin prep considerations for breast biopsy
-vigorous scrubbing is avoided to prevent spread of cancerous cells
modified radical mastectomy
removal of:
- entire breast
- pectoralis major fascia
- axillary nodes (axillary, pectoral, superior apical)
breast mastectomy incision
elliptical transverse
allow 4cm margin from lesion
considerations when handling specimen during mastectomy?
- always ask surgeon before passing off
- be ready with marking stitch
mastectomy tagging stitches (3)
- long lateral
- short superior
- 3-0 silk on SH needle
incarcerated hernias
- trapped by defect
- not reducible
strangulated hernias
- incarcerated hernia that has vascular compromise
- emergency situation
inguinal herniorrhaphy
direct:
- results from heavy lifting or straining
- protrudes through hesselbachs triangle
