Laparoscopy Flashcards
definition of laparoscopy
minimal invasive surgery using gas to insufflate perineum and instrument manipulated through ports introduced through small incisions with video camera guidance
indication for laparoscopy
theraputic, diagnostic
maximum amount of intraperitoneal pressure that the peritoneal cavity can accommodate in adults, kids
adults: 14 mmhg , can reach up to 16/18 mmhg in obese individual kids: 6-8 mmhg
what is the name of this insturment? and what is it used for? and where is this neede used
verus needle used in closed techneique (more advanced, can puncture organs or vessels if incorectly placed)
used for insufflation (introducing gas)
periumblical, subcostal, transumblical
what gas is used in laparoscopy
carbon dioxide CO2
Nitrous: more expensive, less toxic
what are the diffrent ways of insuflation
Closed method (needle-technique)
- more advanced
- can dammage organ/ vessels
Open method
- (safer, time consuming)
- (going layer by layer through skin, subcotaneous tissue, linea alba, peritoneum )
what is the name of this insturment? what is it used for?
trocars
indications for diagnostic laparoscopy
acute abdomen (equivocal physical sign)
critically ill patient
abdominal truma (stable patients)
chronic abdominal condition (abdominal TB, crohns)
contraindication:
unstable patient, bullet
!!MCQ!!
what is the TB crieteria by laparoscopy?
peritoneal Tubercles (white nodules)
ascites straw color (cytology)
multiple adhesion
mesenteric lymph nodes (biopsy)
clear ascites, skip lesions, creeping of mesentry over serosa of bowel
what is the crohns crieteria by laparoscopy?
clear ascites
mutliple skip lesions
creeping of mesentry over serosa of bowel
what are the contraindication of laparoscopy?
unstable patient
inabiliity to anesthetize
benefit of laparoscopy
smaller scars
shorter hospital stay
decrease postoperative pain
shorter recovery time
!!MCQ!!
40-year-old women who presented to the ER 2-3 days post lap chole with fever, tachycardia, tenderness positive Rovsing’s, whats the diagnsosis?
of coure i dont excpect you to know this as its not a clear case with clear questions but its important as it may come in exam
go ahead look at the answer best of luck :)
biliary peritonitis;
leakage from common bile duct due to iatrogenic common bile duct injury
what to do next?
1- ultrasound
2- guided drainage by US/CT of bile from peritoneal cavity
3- iv antibiotic
4- NPO 4-6 days
5- MRCP, ERCP to locate injury
managment :-
- partial tear - stent
- complete tear - bypass Hepatojejeunostomy or choledocojejunostomy
