Surgical Procedures Flashcards
What are the 2 classifications of people in the OR?
Sterile and nonsterile
Who is part of the sterile team?
Surgeon, surgical assistant, physician assistant, scrub nurse, CST(Certified surgical tech)
Who is part of the non sterile team?
Anesthesia provider, circulator, radiographer, others
What clothing/items may be worn in surgery?
protective eyewear, masks, shoe covers, caps, gloves, radiation and ID badges, lead aprons
What is the purpose of wearing specific things in surgery?
To maintain a sterile environment
When a person is sterile there are parts of them that are sterile and parts that are not. You need to be able to describe these parts.
Their back, shoes, everything waist down is nonsterile
What are some rukes you should follow in the OR if you are not sterile to keep from breaking sterile field?
Don’t reach over a sterile field, cover nonsterile items, move back to back with sterile persons, watch front of clothing don’t lean over and let it get close to anything sterile
What must be done if a sterile field is broken?
The field will have to be made sterile again. Basically start the process over
What are the steps of making an IR sterile and unsterile?
To make an IR sterile:
Step 1: A sterile person (CST) will open a sterile bag.
Step 2: You (a non-sterile person) will carefully place the IR in the bag. DO NOT touch any part of the bag with the exception of the inside!!!
Step 3: The CST will carefully wrap the bag around the IR.
Getting the exposed IR back:
Step 1: The radiographer puts on gloves!
Step 2: The radiographer carefully takes the IR in the bag.
Step 3: The radiographer carefully removes the IR so as not to get body fluids/blood on themselves or the equipment.
Step 4: Properly dispose of the contaminated bag.
Step 5: Use a hospital approved disinfectant to wipe down the outside of the IR before leaving the OR.
Be able to name some things that increase the risk of a sterile field becoming contaminated
long procedure, crowded room, poor lighting, staffing levels(too high or too low), don’t place anything sterile on the floor
Why should a radiographer be familiar with the equipment they will use in the OR?
Smoother flow and less mistakes
What are some types of equipment used in surgery?
C_arms, portable, In room urologic equipment (not mobile), Stereotactic equipment (not mobile)
What do you clean the surgery equipment used in surgery?
hospital approved cleaner
How often should surgical equipment be cleaned
after each surgical case
How far should the radiographer stand from the radiation source?
As far as possible. Minimum of 6ft
Where should the tube of the C arm be placed in respect of the patient?
Under the patient
Who in the surgical suite should wear lead and radiation doses
Everyone other than the patient
Where in respect to the primary beam is there less scatter radiation?
right angle
What are the 2 parts of the digestive system?
Accessory glands and alimentary canal
What are the accessory glands?
Liver and gall bladder, pancreas, salivary glands
The alimentary canal extends between what two structures
Mouth and anus
What are the 4 layers of the alimentary canal?
fibrous, muscular, submucosal, mucosal
The junction where the esophagus meets the stomach is termed as
cardiac sphincter
What is the cardiac antrum?
terminal end of the esophagus
The esophagus is ____ the spine.
Anterior
What are the four parts of the stomach
cardia, fundus, body, pylorus
What is ruggae?
folds
What is the lesser curvature?
right border of stomach
What’s the greater curvature?
left border of the stomach
What is chyme?
food after the stomach has processed it
What is the pyloric sphincter?
Between the stomach and small intestine
What is the cardiac sphincter?
Between esophagus and stomach
The small intestine extends from what two points?
Pyloric sphincter to ileocecal valve
Absorption of nutrients occurs in what part of the alimentary canal?
Small intestine
what’s the length of the small intestine is?
22 feet
What are villi??
finger-like projections
What are the three parts of small intestine?
Duodenum, jejunum, ileum
What are gyri?
free moving loops in the jejunum and ileum
The head of the pancreas is cradled in the ____ of the duodenum.
C loop or 2nd portion
The duodenal bulb is what part of the duodenum?
first of the four parts
What is the hepatopancreatic ampulla? Where is it located?
It is where the common bile duct and pancreatic duct meet on the 2nd portion of the duodenum
What are the 4 parts of the large intestine?
cecum, colon, rectum, anal canal
How long is the large intestine?
5 feet long
What is the haustra?
pouches within the large intestine
What is the ileocecal valve?
located between small intestine and large intestine
What is the vermiform appendix?
Attached to cecum
What are the subdivisions of the colon?
Ascending, right colic flexure, left colic flexure, transverse, descending
What is the largest organ of the body?
liver
What is the function of the liver?
produces bile and stores it in the gall bladder
What divides the liver into right and left halves?
falciform ligament
What is the smallest lobe of the liver?
caudate lobe
BE able to describe how the ducts converge in the biliary system?
The right and left hepatic ducts combine together to create the common hepatic duct which combines with the cystic duct to create the common bile duct.
What is the sphincter of Oddi?
muscle that controls bile at the hepatopancreatic ampula
What is the gall bladder?
thin walled pear shaped sac that holds bile until cholecystokinin stimulates release of bile for digestion
____ stimulates the gall bladder to contract and release bile.
Cholecystokinin
Does the pancreas aid in digestion?
Yes it creates digestive enzymes
What are the parts of the pancreas?
Head, neck, body, tail, uncinate process
What are the parts of the urinary system?
2 kidneys, 2 ureters, urethra, urinary bladder
What is the smallest functioning unit of the urinary system?
nephron
Where do the kidneys and ureters lie?
in the retroperitoneium
Urinary system functions?
Removes waste, maintains fluid balance, controls blood pressure and other body functions
What are the draining branches of the urinary system?
calyces
Where is the renal pelvis located?
Immediately before ureter
What is the renal capsule?
outer covering
What is the renal cortex?
outer tissue
What is the renal medulla?
inner tissue contains collecting tubules
Renal pyramids are located where?
In the renal medulla
What is the uretropelvic junction?
Located between the ureter and the renal pelvis. Common place for stones to lodge.
What’s the ureterovesical junction?
Where the ureter joins the bladder (part of trigone)
What’s the trigone?
Two ureteral openings and internal urethral orifice
The urethra passes through what organ on a male?
Prostate
Does the bladder have rugae?
Yes
When is surgical cholangiography performed?
during biliary tract surgery
What does surgical cholangiography show? Be specific.
The ducts in and out of the liver(intrahepatic and extrahepatic)
Can surgical cholangiography be done in the presence of obstruction?
NO
What things might the doctor be looking for in surgical cholangiography ?
Tiny calculi that may not otherwise be seen, neoplasms within the duct, stricture of dilation of the ducts, function of the ampulla of vater/sphincter of oddi
surgical cholangiography is usually done in conjunction with what other surgical procedure?
Cholecystectomy
surgical cholangiography is usually performed these days by?
By using a T-tube, needle, or small catheter
In surgical cholangiography the patient may need to be tilted in a certain position to aid in filling of the ducts.. What position is it?
Trendelenburg
What is ERCP used to diagnose?
Biliary and pancreatic pathology
Can ERCP be done when biliary ducts are dilated or obstructed?
NO
How do you do surgical ERCP?
How is it done?
A fiberoptic scope is passed down the patient’s throat and down into the duodenum.
Fluoroscopy is used to guide its way.
No food or drink 1 hour post procedure since the pharynx is paralyzed from the anesthetic.
Food may be held up to 10 hours to decrease irritation to stomach and small bowel
What is cystography?
A bladder examination
What is cystourethrography?
bladder examination includes inspection of urethra
What is retrograde urography?
Contrast is introduce against the normal flow of urine
What type of contrast is utilized for these studies?
Same as IVU may use reduced concentration
Denser=ducts well seen, but stones may be missed.
Diluted=stones better seen
What type of lab test should be done prior to these studies?
Kidney function/diabetic
BUN and creatine
Prep?
NPO after midnight
How do they inject the contrast for these studies?
Catherization-contrast is injected directly into the pelvicaliceal system
What are some indications for retrograde urography?
Vesicoureteral reflux
Recurrent lower urinary tract infections
Posterior urethral valves(only happens in males)
What are some contraindications for retrograde urography?
If the patient has a reason they cannot be catheterized
What position is the patient in for retrograde urography?
modified lithotomy position
What images are taken for retrograde urography?
AP scout, AP pyelogram, AP ureterogram
In retrograde urography what might need to be done to better fill the pelvicalceal system? What if you want to better see the ureters?
- Head of bed may need to be lowered 10-15 degrees to keep contrast within the kidneys and not let it go down into the ureters– AP pyleogram
- Head of table may be raised 35-40 degrees for the ureters to be well filled and the kidneys to be allowed to move. – AP ureterogram
An AP ureterogram demonstrates what 2 things?
tortuosity of ureters and mobility of kidneys
In cystography what projections are taken?
AP, AP axial, AP Oblique(60 degree rotation), Lateral
AP Bladder or AP Axial Urinary Bladder
Patient Position:
CR:
Structures Seen:
Patient Position: Supine on table with legs stretched out.
CR: 10-15 degrees caudal; enters 2” above the pubic symphysis. –or- Perpendicular same entrance.
Structures Shown: AP Axial projection –or- AP projection of the bladder filled with contrast. If reflux is present then the distal ureters are also visualized.
AP Oblique Projection
Patient Position: Rotated in an RPO or LPO position (40-60 degree rotation).
Central Ray: Perpendicular; enters 2” above the pubic symphysis and 2” medial the up ASIS.
Structures Shown: Oblique projections of the bladder filled with contrast. If reflux is present then the distal ureters will be seen too.
Lateral Projection
Patient Position: Lateral Recumbent
Central Ray: Perpendicular; 2” above the pubic symphysis on MCP.—can use greater trochanter
Structures Shown: Lateral contrast filled bladder. Distal ureters when reflux is present. Lateral and Posterior bladder walls and the base of the bladder
Males: AP Oblique Projection (RPO/LPO)
Patient Position: Patient rotated 35-40 degrees so that the urethra can be seen without superimposition.
The radiographer will take the image as the physician is injecting contrast so that the urethra can be fully seen.
Female: AP Voiding Projection
Patient Position: Supine
Angle tube 5 degrees caudal to see bladder neck elongated.
The physician will fill the bladder with contrast and images are taken as the patient voids.
