Midterm Examination Prep Flashcards
NOTES
Natural orifice transluminal endoscopic surgery
Surgeon must open a closed viscera intentionally to access the abdomen. Complications related to the failure of that opening to heal after closure can result in peritonitis.
The head of the pancreas is fixed to the:
Duodenum.
The pancreas is a fixed structure lying transversely behind the stomach in the upper abdomen. The head of the pancreas is fixed to the curve of the duodenum.
Potential risk associated with pneumoperitoneum
Gas embolus into an exposed blood vessel during the procedure
Elevated CO2 levels and respiratory acidosis may occur because CO2 diffuses into the patient’s bloodstream during laparoscopy
Subcutaneous emphysema has a characteristic crackling-feel to the touch, a sensation that has been described as similar to touching warm Rice Krispies.
Inguinal ligament, rectus abdominis muscle, deep epigastric vessels
Boundaries of the Hesselbach triangle
TEP Repair
Totally extraperitoneal patch (TEP) laparoscopic hernia repair technique
A balloon dissector is placed on the anterior surface of the posterior rectus sheath and inflated, thereby creating an optical cavity.
Identify A in the Diagraph
Bartholin’s Glands
Bartholin’s glands and ducts are located on each side of the lower end of the vagina at the 5 and 7 o’clock positions, secrete mucus.
Identify A in the Diagrapm
This structure is the flexure at the junction of the duodenum and jejunum. Maybe referred to as the suspensory ligament.
Ligament of Treitz
Identify the area within the red line
Triangle of Doom
During the placement of the mesh it is vital that the surgeon does not place any staples in the shaded triangle area
This structure provides the arterial supply to the bladder
Internal iliac
Identify A (blue line) in the diagram.
This structure is the anatomical division between the inguinal and femoral regions. Also, may be referred to an inguinal ligament.
Poupart’s ligament
Identify A in the diagram
The cystic artery arises from this structure.
Right hepatic artery
Identify A in the diagram
This ligament encloses the round ligament and extends from the lateral surface of the uterus to the pelvic wall.
Broad
Name the 3 anatomic sites of abdominal wall weakness with a potential for hernias
Inguinal canal
Femoral rings
Umbilicus
Identify the Blue Structure
Spleen
A total spleen is performed for multiple reasons, including trauma to the spleen
Stores and concentrate bile
Gallbladder
Reason a laparoscopic adjustable gastric banding (LAGB) would be performed
Obesity
Bariatric surgery, also termed weight loss or weight reduction surgery, is surgical treatment of obesity
What does triangulation mean:
Laparoscopic port incisions
Traditional laparoscopic port placement, via triangulation, is the fundamental concept of laparoscopic surgery.
Identify the type of incision
McBurney
Identify A in the Diagram
Pilonidal cyst
Removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach
Whipple procedure
Advantages of Robotic Surgery
The robot extends the surgeon’s skills by providing a 360-degree range of motion that is not possible with traditional laparoscopic instruments
Other advantages include:
Reduced post-surgery pain
Less blood loss
Fewer and smaller scars
Increased precision for more accurate joint replacements
Faster recovery
Shorter hospital stay
Less risk of infection
Identify A in the Diagram
Femoral Hernia
Femoral hernias occur much more frequently in women, and only 2% of women will develop inguinal hernias in their lifetime
What type of hernia occurs within the Hesselbach triangle
Direct inguinal hernia
Hernias that occur within the Hesselbach triangle are called direct inguinal hernias. Indirect inguinal hernias occur laterally to the deep epigastric vessels.
Why would surgeon have to perform an open common bile duct (CBD) exploration
Prior biliary surgery.
What has happened it the diagram
Incarcerated hernia
Patients with incarcerated hernias may have signs of intestinal obstruction, such as vomiting, abdominal pain, and distention.
Identify the fascia in the diagram (labeled A)
Key landmark of the roof of inguinal canal
Transversalis fascia
Which laparoscopic hernia repair provides access to the preperitoneal space without entering the peritoneum
TEP - Totally extraperitoneal
What action does the ova travel through the fallopian tubes toward the uterus
Peristalsis
What can be inquired if the arms are extended beyond the 90 degree angle
Brachial plexus injury.
What surgical procedure is usually done to treat CIS (Carcinoma in situ) of the vulva when it is multicentric
Simple vulvectomy
Intravasation of the fluid during a hysteroscopy can lead to what disorder, marked by the sodium level in the blood is below normal
Hyponatremia
The absorption of glycine solution into the extracellular space will make the blood hypertonic with a higher volume, which will draw the fluid outside the cells. Both events, in turn, will cause hyponatremia due to the dilutional effect.
What drugs usually cause hormonal stimulation of the uterus
Oxytocics
Oxytocics are medications that increase motor activity within the uterus by hormonal stimulation or by direct stimulation on the smooth muscles, usually resulting in uterine contractions. They may be used intraoperatively and postoperatively. The following are some nursing considerations after their administration: monitor blood pressure, assess for continued bleeding, and monitor fundal response to the drug.
Identify A - this structure is located between the bladder neck and the urethra
Prostate
Endoscopy of the genitourinary tract is considered what wound classification
Class II (clean-contaminated)
What is the hormone that controls your body’s metabolism, the process in which your body transforms the food you eat into energy
Thyroid hormones
Condition where the thyroid doesn’t create and release enough thyroid hormone into your bloodstream. This makes your metabolism slow down. Also called underactive thyroid, can make you feel tired, muscle cramps, gain weight and be unable to tolerate cold temperatures
Hypothyroidism
Occurs when one or more milk ducts beneath your nipple widens. The duct walls may thicken, and the duct may fill with fluid. The milk duct may become blocked or clogged with a thick, sticky substance. The condition often causes no symptoms, but some women may have nipple discharge, breast tenderness or inflammation of the clogged duct
Ductal ectasia
What is a FNAB
Fine-needle aspiration biopsy
Usually the fluid is sent for cytology study
What organ is usually removed using the incision within the diagram
Spleen
Identify A in the Diagram.
Inferior Rectal Artery
When the perineal dissection is being performed, the inferior rectal artery should be identified, ligated and divided
Identify A and B in the Diagram
A = Cecum
B = Ileocecal value
During an open appendectomy, it is necessary to identify these 2 structures
Identify A in the Diagram
Gastric artery
When assisting on a Nissen Fundoplication you don’t want to place too much medial traction, it will rip and start bleeding
Identify A and B in the Diagram. These structures provide arterial blood supply to the thyroid
A = External Carotid
B = Superior Thyroid
Identify A in the Diagram. This structure forms an envelope around the spermatic cord
Cremaster Muscle
The cremaster muscle arises from the internal oblique and inguinal ligament. It surrounds the spermatic cord and testis. The muscle is supplied by the genitofemoral nerve
Identify A in the Diagram. This is connective tissue that surrounds the kidney
Gerota’s Fascia
Identify drain. Can be placed in the CBD to allow drainage
T-Tube
Sudden onset anterior chest pain, shortness of breath, and sweating profusely are signs of what condition.
Pulmonary embolism
A pulmonary embolism is a postoperative complication of laparoscopic Roux-en-Y. Sudden onset anterior chest pain, shortness of breath, and sweating profusely are all signs of pulmonary embolism.
What part of the colon is likely to be affected by ulcerative colitis
Rectum
Transverse colon
Lasers that are most often used in GYN surgery
CO2
Nd:YAG
Why would the surgeon attach a loop of jejunum with the side of the esophagus after a total gastrectomy
Prevent regurgitation esophagitis
This structure is formed by the cystic duct, common hepatic duct, and the lower edge of the liver.
Triangle of Calot
Identify A in the diagram. This structure is likely to be injured when performing a CBD exploration.
Hepatic Artery
These are a series of archades along the mesenteric border through the length of the colon.
Marginal Artery of Drummond
These structures are parallel, equally distributed, and form a triple helix structure from the appendix to the sigmoid colon. Often used as a landmark when performing appendectomy.
Taeniae coli
Identify A in the diagram. This nerve must be dissected from the lesser curvature of the stomach whenever performing a highly selective vagotomy
Nerves of Latarjet
The right colic artery is a branch of what structure. This artery supplies the ascending colon. See A on the diagram.
Superior mesenteric artery
There are two methods for creation of a pneumoperitoneum: open and closed. The closed method involves blind puncture using a Verres needle. What can be performed to help the surgeon know if he/she is within the abdominal cavity
Use a syringe with saline
A ruptured appendix with no visual bowel contents represents what wound classification
Class IV - Dirty Infected
Perforated viscera indicate a class IV wound.
Identify A in the diagram. The cystic duct arises from this structure.
Right Hepatic Artery
Trace urine from kidney to the bladder
Bowman’s capsule, collecting ducts, renal calyx, renal pelvis, and ureter
The main nerve of the perineum
Pudendal nerve
What artery serves as principal blood supply to the splenic flexure of the colon
Inferior Mesenteric Artery
The anatomic region boarded by the cystic duct, the common hepatic duct, and the cystic artery is referred to as:
Calot’s Triangle
Identify A in the diagram. These structures provide blood supply to the pancreas
Superior Mesenteric Artery/Vein
Identify A in the diagram. Branch of the external carotid artery, and supplies blood to the thyroid
Superior Thyroid
The major parenchymal cells in the liver, are responsible for a variety of cellular functions including carbohydrate, lipid and protein metabolism, detoxification and immune cell activation to maintain liver homeotasis. Recent studies show hepatocytes play a pivotal role in liver inflammation
Hepatocytes
Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.
From the neck to midthigh; bedline to bedline
When both direct and indirect hernias are present, the defect is called:
Pantaloon Hernia
Also known as a saddlebag hernia
Patient has a hernia with a short, wide neck, and a thick-walled sac, what type of hernia:
Congenital
In a congenital hernia, the hernia sac has a small neck , is … In an acquired indirect hernia the neck is wide, and the sac is both short and thick walled.
The characteristic “reducible” hernia:
Visceral contents can be returned to the abdomen
What’s the problem with prolonged Trendelenburg
Decreased pulmonary compliance and functional residual capacity
A procedure to closely examine your cervix, vagina and vulva for signs of disease, often performed on patients who have an abnormal Pap smear
Colposcopy
Identify A in the diagram, renal artery and vein enter and exit the kidney on the medial side
Hilum
Surgical method of treating benign obstructive enlargement of the prostate gland
TURP
What kind of urology catheters include the open-ended, whistle tip, cone tip, and olive tip
Ureteral
Identify A in the diagram, a branch of the vagus nerve, innervates the intrinsic muscles of the larynx. During surgery, care is taken to identify and protect this nerve.
Recurrent Laryngeal Nerve
The most common form of malignant thyroid nodule is a poorly encapsulated. Patient will have total thyroidectomy
Papillary carcinoma
Breast surgery procedure is also called the nipple-sparing technique (NSM)
Subcutaneous mastectomy
What part of the colon is the anvil of the EEA is inserted into
Sigmoid
What angle of scope is most often used for a laparoscopic cholecystectomy
30 degree lens
Involves resection of the head of the pancreas, duodenum, and segments of the stomach and jejunum
Pancreaticoduodenectomy
Segments of the stomach and jejunum with reconstruction of the duct of Wirsung, duct of Santorini, and Common bile duct
The most common structure involved in a sliding left indirect hernia
Sigmoid Colon
Identify A in the diagram, this muscle may be retracted during a thyroidectomy
Sternocleidomastoid
During a cholecystectomy, it is important to isolate this ligament, consisting of the common bile duct, hepatic artery, and portal vein
Hepatoduodenal
Be sure to look at picture to see where the ligament is located
During a rectocele repair this muscle can be used to build up the perineum
Identify A
Levator ani
Complication of steep reverse Trendelenburg position
Deep Vein Thrombosis
Identify A in the diagram. This structure can be injured in Lithotomy position, with the buttocks too far over the edge
Obturator Nerve
Identify A in the diagram. During an abdominal hysterectomy, the surgeon initially isolates the uterus by separating it from this structure
Round Ligaments
Identify A in the diagram. This is usually repaired in conjunction with a Nissen or Toupet Fundoplication
Hiatal Hernia
Identify A in the diagram. The tissue expander is placed below this muscle.
Pectoralis Major
Identify A in the diagram. Injury to this nerve can result in paralysis of the serratus anterior muscle, causing patient to have a winged scapula
Long Thoracic
Using the diagram, identify the purple triangle area. During a laparoscopic cholecystectomy, the infundibulum of the gallbladder is retracted to expose this structure
Triangle of Calot
