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Surgical Tech 200 > Genitourinary surgery on 9/23 > Flashcards

Genitourinary surgery on 9/23 Flashcards

1
Q

What areas of the body does the genitourinary surgery cover?

A

urinary organs
male reproductive organs
adrenal glands

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2
Q

Where are the adrenal glands located?

A

on top of each kidney

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3
Q

What do the adrenal glands do?

A

secrete steroids and hormones necessary for body function

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4
Q

What 4 hormones come from the adrenal glands

A

cortisol
aldosterone
adrenaline
androgen/ estrogen

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5
Q

Where are the kidneys found?

A

retroperitoneal

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6
Q

What do the kidneys do?

A

filtrate blood
waste removal
body fluid levels
electrolyte levels (sodium and potassium)

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7
Q

What are the 3 surrounding layers of the kidney?

A

renal fascia-outer anchor
perirenal fat- protection
Gerota’s capsule- between adrenal gland and kidney

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8
Q

What are 8 structures of the kidney?

A

cortex
medulla/ pyramids
calyx/calyces
renal pelvis
hilum
renal artery
renal vein
ureters

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9
Q

What does the cortex of the kidney do? Describe its location.

A

body of kidney
outer area surrounding other structures

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10
Q

What does the medulla of the kidney do? Describe its location?

A

renal pyramid- inside the cortex

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11
Q

What does the calx/ calyces of the kidney do? Describe its location.

A

collection of urine
cup like structures at point of medullas

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12
Q

What does the renal pelvis do? Describe its location.

A

collects urine from the calx
all renal calyces come together

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13
Q

What does the hilum do? Describe its location.

A

concave indentation
where renal vein and artery, and ureter exit the kidney

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14
Q

What are 3 parts of the nephron?

A

glomerulus
Bowmans capsule
loop of henle

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15
Q

What is a nephron?

A

microscopic filtration system

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16
Q

What is the glomerulus?

A

capillary bed
waste products and H2O filtered from the blood

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17
Q

What is Bowmans capsule?

A

tissue enclosing the glomerulus
beginning of urine production

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18
Q

What is the loop of Henle?

A

recovery of H2O and nutrients based on needs
drains urine out

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19
Q

What are the ureters? How many are there?

A

emerge from renal pelvis
go directly to urinary bladder
carries urine
2 for each kidney

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20
Q

What are the 5 steps for the blood flow and urinary production?

A

Renal artery: inflow of blood
Nephrons: filtration
Calyces: collection of urine
renal pelvis: calyces merge
Ureter- urine to bladder

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21
Q

What is the urinary bladder?

A

reservoir for urine

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22
Q

Where do the ureters attach to the bladder?

A

the trigone muscles

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23
Q

Where is the detrusor muscle located?

A

smooth muscle coating inside of the bladder

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24
Q

What does the urethra do?

A

convey (carry) urine
ejaculation in male

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25
Q

How long is the urethra?

A

male- 20cm (7-8 in)
female- 3-4 cm (1.5 in)

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26
Q

What are the 2 columns of tissue in the penis called? How many of each are there?

A

Corpora cavernosa (2)
dorsal/ erectile tissue
Corpus spongiosum (1)
ventral/ urethra & erectile tissue

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27
Q

What membrane lines the scrotum?

A

tunica vaginalis

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28
Q

What is the Dartos layer of the scrotum? What is its purpose?

A

muscular layer
expansion and contraction

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29
Q

What do the testes produce?

A

sperm
testosterone

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30
Q

What is the epididymis?

A

long coiled up structure (~ 22ft)
stores sperm and maturation

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31
Q

What is the spermatic cord?

A

flow to and from testes
(cremaster muscle)

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32
Q

What is the prostate gland?

A

surrounds urethra
about 50 lobules
secretes alkaline fluid for sperm mobility
(neutralizes urine)

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33
Q

What is a PSA lab test?

A

prostate specific antigen
detects elevated levels
Normal PSA is <4ng/ml

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34
Q

What would a urinalysis test detect?

A

urine composition
sugar, protein, blood, microbes
UTI’s

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35
Q

What would a BUN test detect?

A

blood urea nitrogen
urea in blood
high urea indicative of renal issue
inflammation may be cancer

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36
Q

What would a blood creatine test detect?

A

waste product of muscle
rises with kidney failure

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37
Q

What are 6 diagnostic assessments for GU surgeries?

A

cystoscopy
cystogram
urethrogram
KUB
Intravenous urogram
retrograde pyelogram

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38
Q

What is a cystoscopy?

A

endoscopic exam of lower urinary tract
-urethra, bladder, and ureteral orifices

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39
Q

What is a cystogram?

A

xray of bladder
contrast medium through the urethral catheter

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40
Q

What is a urethrogram?

A

xray or urethra
medium into the urethra

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41
Q

What is a KUB assessment?

A

kidney, ureter, bladder
abdominal xray
no contrast used

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42
Q

What is an IVU?

A

intravenous urogram
xray of ureter, renal pelvis, and bladder
radiopaque die by IV
filtered by the kidney

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43
Q

What is a retrograde pyelogram?

A

xray of kidney ureters, and bladder
radiopaque die via ureteral catheterization

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44
Q

What are 6 incisional approaches for GU procedures?

A

inguinal
scrotal
abdominal
Gibson
Thoracoabdominal
Lumbar

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45
Q

If approaching through an inguinal incision what procedure is being done? What position is the patient in?

A

inguinal canal for an orchiectomy
supine

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46
Q

If approaching through a scrotal incision what procedure is being done? What position is the patient in?

A

scrotal contents
supine

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47
Q

If approaching through an abdominal incision what procedure is being done? What position is the patient in?

A

low line incision
prostatectomy or cystectomy
supine, split leg, or low lithotomy

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48
Q

If approaching through a Gibson incision what procedure is being done? What position is the patient in?

A

lower ureters
kidney implantation
supine

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49
Q

If approaching through a thoracoabdominal incision what procedure is being done? What position is the patient in?

A

open kidney resections
or subcostal
lateral position

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50
Q

If approaching through a lumbar incision what procedure is being done? What position is the patient in?

A

lateral or prone position

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51
Q

What are the 3 basic surgical approaches for the GU system?

A

transurethral
laparoscopic
open (less common)

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52
Q
A
53
Q

What kind of surgical approach is a cystoscopy/ ureteroscopy?

A

Transurethral

54
Q

What structures can be seen in a cystoscopy/ ureteroscopy? What can be removed?

A

Bladder, ureters, and urethra
Remove urinary tract stones

55
Q

What structures can be seen in a cystoscopy? What can be removed?

A

Bladder, ureters, and urethra
Remove urinary tract stones

56
Q

What position is a patient in for cystoscopy/ ureteroscopy?

A

Lithotomy on a cysto table

57
Q

How is a patient prepped for a cysto procedure? Is this a clean or sterile procedure?

A

Betadine
Scrub person does prep
Begin at meats work outward
Clean case NOT sterile

58
Q

If a cystoscopy uses anesthesia, what are the steps?

A

Anesthesia jelly instilled in urethra
Penile clamp used to hold jelly in place

59
Q

In a cystoscopy how is the bladder distended?

A

Sorbitol/ mannitol &1.5% glycine

Never saline can conduct electricity and cause burns

60
Q

What kind of contrast media is used in cystoscopies?

A

Omnipaque
Visipaque
Emigration
Isovue
Can be harmful to kidneys- dilute

61
Q

What are the parts of a cystoscope?

A

Sheath- hollow tube
Obturator-blunt metal in sheath
Bridge- allows instrument insertion
Telescope- 30 or 70 degree

62
Q

What is a resecto scope?

A

Scope with cautery element
Resects bladder, urethral and prostrate tissue

63
Q

When using a resectoscope, how are the loose tissues removed?

A

Collect in bladder
Removed with Ellik evacuator (looks like a bong)
or toomey syringe (large 60cc)

64
Q

What is a TURP procedure?

A

Transurethral resection of the prostate
Remove some prostate gland with resectoscope

65
Q

What does a TURP procedure treat?

A

Trouble urinating
Commonly from benign prostatic hypertrophy
Sometimes to tx cancer (not cure)

66
Q

After a TURP procedure what is done to the bladder?

A

Bladder continuously irrigated with a 3 way foley
30cc retention balloon to aid in hemostasis

67
Q

What is a complication of a TURP procedure?

A

Post TURP syndrome- systemic absorption of irrigating fluid
Be alert for Jerking of legs
Can lead to seizures, coma, cardio respiratory problems

68
Q

What is a TURBT procedure?

A

Same as TURP but tissue is respected from the bladder
Malignant or benign masses
Use H2O to irrigate

69
Q

Why would a laser be used in a cystoscopy?

A

For stone obliteration and tissue resection

70
Q

What 2 cysto procedures and what laser is used for each?

A

Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)

71
Q

What 2 cysto procedures and what laser is used for each?

A

Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)

72
Q

What 2 cysto procedures and what laser is used for each?

A

Lithotripsy- holmium yag laser
Prostate resection- green light (neodymium YAG)

73
Q

What structures are seen in a ureteroscopy?

A

Ureters
Passed through urethra and bladder
Rigid or flexible

74
Q

What is a ureterolithotomy procedure?

A

Removal of ureteral stones
Via ureteroscopy

75
Q

What instrument is used to collect stones in a ureterolithotomy procedure?

A

Basket stone forceps

76
Q

How are ureter stones sent to pathology?

A

Dry

77
Q

What is a ureteral stent?

A

Placed after stone removal
Keeps ureters patent during healing

78
Q

What are urethral catheters used for?

A

Shirt or long term drainage
Bladder irrigation
Patent of urethra
Hemostasis after surgery

79
Q

What are 2 types of urethral catheters?

A

Robinson (red rubber) used for quick bladder drainage
Coude has a bent tip to pass through urethral passages

80
Q

What is the urethral catheter guide?

A

Rigid insert for difficult catheter insertion

81
Q

What is a suprapubic/ percutaneous catheter?

A

Placed percutaneously above the arch into bladder
Or directly into renal pelvis

82
Q

When would a suprapubic/ percutaneous catheter be used? What incision is used?

A

Long term placement
Urethral or ureteral damage
Terminal illness/ impairment
Seldingers technique

83
Q

What are 2 types of suprapubic catheters?

A

Malecot
Pezzer (yellow rubber

84
Q

What is hypospadias?

A

Anomaly where urethral opening not at normal position

85
Q

Where does hypospadias occur on a male and female?

A

Male- ventral side of penis accompanied by chordee (curve of penis)
Female- urethra opens into vagina

86
Q

What is epispadias?

A

Males- opening on dorsal side of penis
Females- opening above clitoris

87
Q

What procedure fixes hypospadias and epispadias?

A

Urethroplasty- reconstruct and reposition of urethra

88
Q

What is phimosis?

A

Occurs on uncircilumcised males
Prepuce does not retract from glans

89
Q

What is paraphimosis?

A

Can’t unretract a retracted prepuce
Possible necrosis
Cover prepuce after foley insertion

90
Q

What is a circumcision?

A

Excision of foreskin
At birth for religious or prophylaxis

91
Q

What is a penile implant?

A

Tx for sexual impotence
(Diabetes, vascular disorders, nerve damage, trauma)
Rigid or inflatable prosthesis in corpus cavernosa

92
Q

What is a hydrocelectomy?

A

Tx of hydrogels- fluid in membrane of testicle (Tunica vaginalis)

Incision into scrotum to drain fluid and remove part of tunica vaginalis

93
Q

What is a spermatocelectomy?

A

Removal of mass on epididymis
Usually caused by tubular system

94
Q

What is a varicocele?

A

Enlargement of veins of spermatic cord

95
Q

What is vericocelectomy procedure?

A

Ligation and partial excision of veins of scrotum

96
Q

What is a vasectomy procedure?

A

Excision of section of vas deferens
Male sterilization

97
Q

What is a vasovasostomy?

A

Reversal of vasectomy
Anastomosis of vas deferens

98
Q

What is cryptorchidism? what 2 incisions are done?

A

testicle fails to descend during development
link to testicular cancer
inguinal incision to push into place
scrotal incision to suture into place

99
Q

What is a testicular torsion?

A

testicles rotate/ twist
inhibits blood supply to testes
surgical emergency- necroses possible

100
Q

What is orchiopexy?

A

suturing of testicle to floor of the scrotum

101
Q

What is an orchiectomy procedure? Why would it need to be done?

A

removal of testes
cancer, trauma, necrosis

102
Q

What types of orchiectomy procedures are there?

A

simple and radical

103
Q

What is a simple orchiectomy? what incision is used?

A

removal of testes and epididymis
scrotal incision

104
Q

What is a radical orchiectomy? What incision is used?

A

removal of testes, epididymis, and spermatic cord
inguinal incision

105
Q

What is a radical prostatectomy?

A

complete removal of prostate gland

106
Q

After a radical prostatectomy what needs to be resected? anastomosed?

A

resect retroperitoneal lymph node
anastomosis of bladder neck to remaining urethra

107
Q

What is a potential disadvantage of a radical prostatectomy?

A

nerve damage leading to impotence

108
Q

What is brachytherapy? What instruments are used?

A

radiation therapy for small localized prostate cancer
percutaneous radioactive seeds implanted with a guide

109
Q

What is an interstim implant? Where is it implanted?

A

“pacemaker” for sacral nerves
helps with urinary retention, overactive bladder, and incontinence
near sacral nerves/ iliac crest

110
Q

What is a cystectomy?

A

removal of the bladder

111
Q

What are the different types of cystectomies?

A

partial and total

112
Q

What is a partial cystectomy?

A

removal of diseased portion of the bladder

113
Q

What is a total cystectomy? What must be done after this procsdure?

A

removal of entire bladder
must create a urinary conduit

114
Q

What is a ureteroileostomy? What are the main steps?

A

creation of new bladder using a piece of the ileum
ureters anastomosed to ileum
urostomy created with ileum

115
Q

What is a pyelolithotomy? What incision will be used?

A

remove of staghorn stones through renal pelvis of the kidney
lumbar incision

116
Q

What is Extracorporeal shockwave lithotripsy?

A

ESWL
shockwaves break up stones so can pass

117
Q

What is an adrenalectomy?

A

partial or total excision of adrenal glands

118
Q

Why is an adrenalectomy performed?

A

hyperfunction of gland
tumors
tumors elsewhere affected by adrenal hormones

119
Q

What is a nephrectomy?

A

surgery to remove all or part of a kidney

120
Q

What are the different types of nephrectomies?

A

Heminephrectomy
simple nephrectomy
radical nephrectomy

121
Q

What is a heminephrectomy?

A

partial excision of kidney due to small tumor
clamp renal vessels to limit bleeding
NO more than 30 minutes

122
Q

What is a simple nephrectomy? What needs to be ligated?

A

removal of whole kidney
renal vein, renal artery, and ureter ligated

123
Q

What is a radical nephrectomy? Why do this procedure?

A

removal of kidney, adrenal gland, perirenal fat, Gerota’s capsule, and involved periaortic lymph nodes
advanced cancer

124
Q

What is Wilm’s tumor? What is required to be done?

A

childhood malignant tumor in 3-8 yo
nephrectomy and chemo/ radiation

125
Q

What is a renal transplantation?

A

end stage renal failure or polycystic disease
matching blood types
living or deceased donor

126
Q

What are the surgeries involved in gender confirmation for male to female?

A

penectomy
orchiectomy
labiaplasty
vaginoplasty

127
Q

What are the surgeries involved in gender confirmation for female to male?

A

phalloplasty
testicular implants
vaginectomy
hysterectomy/ salpingectomy

128
Q
A

Surgical Tech 200 (11 decks)

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