(Principles of Surgery) Flashcards
Define:
Aseptic Technique
Describes the practices used to minimize risk of infection following surgical procedure
What do aseptic techniques include? (5)
Management of the surgical facility, patient, surgical site, surgeon and equipment
_____________ used to clean __________ in the _________ room, but they do not eliminate ______
Disinfectants
Facilities
Operating
Spores
True or False:
Every surgical instrument is a potential source of contamination
True
As every surgical instrument is a potential source of contamination, hence the importance of _____________ where all ______________, including ______, are killed
Sterilization
Microorganisms
Spores
List means of sterilization (2)
Pressurized steam
Chemical
Define:
Autoclave
Used to sterilize instruments using pressurized steam, and the instruments are packed in surgical wrap which the steam can penetrate
What are used to distinguish equipment that has been sterilized?
Heat sensitive markers
What are surgical packs often composed of? (6)
A needle holder
Forceps
Hemostats
Tissue scissors
Draping material
Absorptive gauze sponges
Good quality instruments are made of _________ _____, allowing for __________ and minimizing _________
Stainless steel
Durability
Corrosion
State the purpose of:
Scalpel
Allowing for incision to the tissues
State the purpose of:
Needle holder
Holds the needle for suturing
True or False:
There are several different styles of scissors available
True
State the purpose of:
Curved scissors
Used for more maneuverability
State the purpose of:
Straight blade scissors
Used to cut through tougher tissues
Describe and state the purpose of:
Tissue forceps
Have the appearance of tweezers, tip has a serrated end for delicate handling of tissue
State the purpose of:
Hemostatic Forceps
Clamp blood vessels so vessel can be ligated to prevent bleeding
State the purpose of:
Retractors
Hold tissues to expose surgical area
State the purpose of:
Towel Forceps
Surgical drapes to cover animal except for surgical incision region
State the purpose of:
Spay hook
To bring uterus through small incision
True or False:
Stainless steel can withstand high temp of autoclave
True
True or False:
All surgical instruments can be sterilized with autoclave
False; Stainless steel can withstand high temp of autoclave, but other surgical instruments may be damaged
How are other surgical instruments sterilized? What is used?
Sterilization via chemical means is used
Ethylene oxide is employed
Ethylene oxide is _____ and requires special ________ for ______________
Toxic
Chambers
Administration
True or False:
Surgeons are not a source of contamination
False, surgeons ARE ALSO a source of contamination
Surgeons must be dressed with a ____ _____ and ________ ____, _______ ________ ____ and ______
Head cover
Surgical mask
Sterile surgical gown
Gloves
Describe:
The scrubbing procedure
Surgeons washing their hands and forearms with a surgical scrub
Why do surgeons have to be dressed with all the listed apparel and perform the scrubbing procedure?
Greatly decreases the number of bacteria present
_______ ____ with the use of ___________ is important
Contact time
Antiseptics
True or False:
Antiseptics kill the bacteria immediately
False; Antiseptics DO NOT kill the bacteria immediately, so prolonged contact is necessary
How long does the scrub last? Why?
Usually lasts ~5 minutes
So that the antiseptic can greatly reduce the number of bacteria present
State the position(s) during scrubbing and the reason for that position
Hands are held the highest (cleanest part is held the highest)
As elbow have higher bacterial count, water does not run from elbows to contaminate the hands
What is used to dry the hands and arms in scrubbing?
A sterile towel, dry the hands then the arms
True or False:
Surgical conditions greatly vary and impact the surgery
True
Describe and state an example of:
Clean surgeries
Involve healthy skin and tissue being removed
E.x. Spay and Castration
Surgeries involving the _____, __________ and ____________ ______ are riskie
Mouth
Intestines
Contaminated wounds
What is the relationship between the risk of infection and the degree of contamination?
The risk of infection is DIRECTLY PROPORTIONAL to the degree of contamination
Surgery creates a _____ and the _______ _______ - which occurs in ______ - is an important step in understanding surgery
Wound
Healing Process
Stages
Wound Healing:
What is the phase that begins right after the trauma or incision called?
Hemostasis phase
Wound Healing:
In __________ phase, ________ is beneficial in ________ the wound of _____________
Hemostasis
Bleeding
Flushing
Contamination
Wound Healing:
In __________ phase, the _____ _______ _________, slowing the ____ of _____
Hemostasis
Blood vessels constrict
Flow
Blood
Wound Healing:
In Hemostasis phase, what is signalled? What happens from this?
Coagulation factors are signalled
The blood begins to clot, protecting the animal from excess blood loss
Wound Healing:
In __________ phase, ______ ____ ____ the ______ and _____ it, as the ____ _____, a ____ is formed
Hemostasis
Fibrin clot fills
Wound
Seals
Clot dries
Scab
Wound Healing:
In Hemostasis phase, what is the purpose of the scab? (2)
Protects the damaged area
Allows for healing to happen underneath
Wound Healing:
Describe the Inflammation phase
Takes place when the blood vessels eventually dilate and release histamine and prostaglandins
Wound Healing:
What does the dilation and release of histamine and prostaglandins in the Inflammation phase do?
Brings more white blood cells to help destroy the damaged tissue and bacteria
Wound Healing:
In ____________ phase, ___________ and _________ protect the _____ from ________ and ______ ______
Inflammation
Neutrophils
Monocytes
Wound
Bacteria
Tissue debris
Wound Healing:
What do the monocytes in the Inflammation phase become? When? For what?
Macrophages
A few days later
Clear the wound of debris and bacteria
Wound Healing:
In ____________ phase, the _________ _____ ____ produced to the area results in… (4)
Inflammation
Increased blood flow
Plasma leakage, adding to the swelling, causing pain and possible redness
Wound Healing:
Describe the Repair/Proliferation phase
Describes fibroblasts entering the damaged area and forming fiber rich connective tissue
Wound Healing:
In ______/_____________ phase, there is an _________ _________ of ______ and ______
Repair/Proliferation
Increased deposition
Fibers
Matrix
Wound Healing:
In ______/_____________ phase, ___________ grow into newly forming ___________ ______, providing ______ and _________ to the new ______
Repair/Proliferation
Capillaries
Connective tissue
Oxygen
Nutrients
Tissue
Wound Healing:
In Repair/Proliferation phase, what is the healing tissue known as? Why?
Granulation tissue
Due to its granular appearance
Wound Healing:
In ______/_____________ phase, what cells move across the wound? What does this do? (3)
Repair/Proliferation
Epithelial cells
Minimize fluid loss, providing protection
Wound Healing:
In Repair/Proliferation phase, _________ ____ ___________ allows the ____ _____ to _______
Continued cell replication
Skin layer
Thicken
Wound Healing:
In Repair/Proliferation phase, more ________ is deposited after the ______ looks completely ______, allowing for the _____ to ________ in ____ over time
Collagen
Wound
Healed
Wound
Decrease
Size
Wound Healing:
What brings the skin closer together in Repair/Proliferation phase? For what?
Contraction
So that less time is required for epithelial cells to reach across the entirety of the wound
In a ________ ________, _________ are brought together with _______, the ____ edges are held close together to minimize the _______ _______
Surgical incision
Incisions
Sutures
Skin
Healing process
Define:
First intention healing
Describes a wound with the edges closely apposed
Define:
Golden period
Describes the first 6-8 hours where bacterial numbers are modest so the wound can be closed
What cannot be done past the “golden period”? Why?
Beyond this period, the wound cannot be sutured
Bacterial contamination may be too high to suture the wound
Define:
Second intention healing
Describes wound healing where granulation tissue is needed to fill the gap between the skin edges for epithelial cells to grow
What is Proud Flesh?
A condition affecting horses where an overgrowth of granulation tissue prevents epithelial tissue from growing across the wound
In Proud Flesh:
It is ideal to ______ ___________ on ______ immediately for _____ _________ _______
Suture lacerations
Horses
First intention healing
When suturing _________ ______, ____ ______ and ____________ within wound, _______ should be removed
Traumatic wounds
Dead tissue
Contaminants
Margins
Define:
Debridement
Describes the process where damaged and contaminated tissue are removed
Define:
Hematoma
Describes an accumulation of blood in the dead space
______ has fluid similar to _____ with a small number of ___ _____ _____
Seroma
Serum
Red blood cells
True or False:
Fluid in a seroma may be white (with no red blood cells) or light red
False; Fluid in a seroma may STRAW COLOURED (with no red blood cells) or light red
In Hematoma/Seroma:
This collection of _____ increases the _______ on the ________, preventing the ____ from ________ to the ______ underneath
Fluid
Tension
Incision
Skin
Adhering
Tissue
In Hematoma/Seroma:
This fluid needs to be removed for ________ _______, if great amounts of _____ accumulate, a ______ must be used to remove the _____
Complete healing
Fluid
Needle
Fluid
In Hematoma/Seroma:
If not removed, the excess _____ can cause a ________ buildup and fluid may ____ from the area
Fluid
Pressure
Leak
Define:
Dehiscence
The breaking of wound edges
Where may dehiscence occur? Why?
Can occur along the length of the suture line
This failure to heal may be due to excess tension of infection
How might dehiscence be caused in animals?
May be caused by the animal scratching or licking at their wounds
True or False:
Suture material varies greatly
True
Suture material varies greatly and depends on… (2)
The strength and type of tissue being sutured
How many major classes of suture material are there? What are they?
2
Absorbable and Nonabsorbable
For absorbable suture material:
It is used within the ____. The body eventually destroys the ________ for it to be completely __________
Body
Material
Eliminated
What is the primary requirement for absorbable suture material?
The material should maintain strength for a long enough time for complete healing to take place
_____________ suture material is not destroyed by the ____ and are later _______
Nonabsorbable
Body
Removed
True or False:
Suture needle type and pattern is the same regardless of surgery
False; Suture needle type and pattern DEPEND ON THE SURGERY
Define and Describe:
Simple interrupted pattern
A suture pattern
Describes the suture passes straight through the 2 sides of the incision, is tied and the ends are cut
Define and Describe:
Simple continuous pattern
A suture pattern
Describes an initial simple interrupted suture which is then tied, the resulting end is not cut
True or False:
Tying knots is a good skill for surgeons
False; Tying knots is an ESSENTIAL skill for surgeons
Multiple ______ ____ are tied to secure the ______
Square knots
Suture
The knot ________ of materials varies, so some materials require a _______ number of _____
Security
Greater
Knots
What is the purpose of the suture? What is not the purpose?
To appose the edges, not overtighten the tissues
What are endoscopes?
A technological advancement that provide a light source and means to see inside a body cavity in surgery
On endoscopes:
It is less ________ than ____________ surgery and is ________ for tracking through structures such as the _________
Invasive
Conventional
Flexible
Intestine
True or False:
Instruments can be placed at the end of the endoscope
True
What instruments can be placed at the end of the endoscope? (3)
Forceps, needle holders, scissors, and others
Define:
Recumbent patients
Describe animals under anesthesia
What can’t animals under anesthesia maintain?
Can’t maintain their body temperature
Describe what is done to animals under anesthesia to maintain their body temperature
A heavy towel or blanket between the animal and table provide minimized heat transfer and supplemental heat
What is important to note for surgeries? (2)
There is not just one standardized method to performing surgeries
Many variations are possible given the approach or situation
What is a common abdominal surgery in pets?
Ovariohysterectomy, otherwise known as the Spay
In ovariohysterectomy:
The animal is ____________ and secured to the _______ _____. _______ is _______ and _______ prior to surgery
Anesthetized
Surgery table
Abdomen
Clipped
Scrubbed
In ovariohysterectomy:
A _______ _______ ________ is performed, where the ________ allows for __________ ______ from both sides of the _________ ____ to meet
Ventral midline incision
Midlines
Connective tissue
Abdominal well
In ovariohysterectomy:
An ________ through the ____ and ____________ ______ to expose the _____ ____
Invision
Skin
Subcutaneous tissue
Linea alba
In ovariohysterectomy:
What is used to locate the uterus?
A spay hook
In ovariohysterectomy:
Once the ______ is locate, the ____ of the uterus is brought to the _______ and the _____ is identified
Uterus
Horn
Surface
Ovary
In ovariohysterectomy:
A ______ is placed around the _______ _______
Suture
Ovarian vessels
True or False:
In ovariohysterectomy, the entire uterus and ovaries are removed
True
What can be closed when the entire uterus and ovaries are removed in ovariohysterectomy?
The abdominal incision can be closed
Define:
Intestinal Anastomosis
Describes the procedure where 2 regions of the intestine are joined
How is intestinal anastomosis done?
Manually or with stainless steel staples
Describe an intestinal anastomosis
The damaged section of the intestines is removed and entail that this procedure is used to join the 2 areas of the intestine
True or False:
Gastric Dilatation-Volvulus Syndrome is a surgical emergency in cats
False; Gastric Dilatation-Volvulus Syndrome is a surgical emergency in DOGS
Who does gastric dilatation-volvulus syndrome occur in? (3)
Usually occurs in large, deep-chested dogs where:
Dogs have consumed a large meal/volumes of water
Have been physically active following this
In Gastric Dilatation-Volvulus Syndrome:
Factors caused the accumulation of ___ and ________ of the _______
Gas
Rotation
Stomach
In Gastric Dilatation-Volvulus Syndrome:
The dogs make attempts to ____ and compromises ___________ to the _______
Omit
Circulation
Stomach
In Gastric Dilatation-Volvulus Syndrome:
What can be done to drain the stomach?
A ventral midline incision can be made in the cranial region of the abdomen to drain the stomach
________ regions of the _____ should _______ during the _______
Necrotic
Organ
Removed
Surgery
In surgeries involving the lung tissue, what must the anesthetist do??
Must breathe regularly for the animal
The breaths in surgeries involving lung tissue must be coordinated with who?
The surgeon
In lung tissue surgeries:
The added challenge of working with the _______ _____ and expanding _____ mean that special care to avoid __________ the ______ with the ______/_____ instrument must be taken
Beating heart
Lungs
Puncturing
Tissue
Needle/sharp
An ________ ____ must also be created to avoid ________ of ___
Airtight seal
Leakage
Air
