Chapter 14 pt 2 Flashcards
general surgery
1
Q
pathology of the pancreas
A
cysts
transplant (w/ kidney)
tumors of surrounding structures
cancer- worst cancer
- 80% die
2
Q
surgical considerations with pancreas
A
must be done as a combination procedure
removal depends on location of tumor
3
Q
what blood supply does the head and tail of the pancreas share
A
head shares with duodenum
tail shares with spleen
4
Q
what is a whipple
A
removes head of pancreas, duodenum, and sometimes gallbladder
5
Q
steps of a distal pancreatectomy
A
- left subcostal/ upper midline
- retractors for exposure
- lesser omentum opened
- colon mobilized- exposes pancreas
- ultrasound to outline pancreatic duct
6
Q
part 2 of distal pancreatectomy
A
- vascular clamp placed
- parenchyma divided sharply
- posterior vessels divided
- pancreas dissected from spleen
- tail and body removed
- retaining pancreatic stump is closed
7
Q
what type of anastomosis do you use for pancreaticojejunostomy
A
roux en y
8
Q
when do you sue a roux en y with a pancreatectomy
A
chronic pancreatitis
9
Q
what is the real name of the whipple
A
pancreaticoduodenectomy
10
Q
in a whipple you en bloc remove the:
A
- head of pancreas
- distal ⅓ of stomach
- duodenum
- proximal 10 cm of jejunum
- CBD or cystic duct
- gallbladder
- peripancreatic + hepatoduodenal lymph nodes
11
Q
three anastomosis of whipple
A
stomach
pancreas
liver
12
Q
difference between classic whipple and pyloric sparing whipple
A
classic- distal ⅓
pyloric- starts at duodenum
13
Q
pathology of the spleen
A
trauma
intraop injury
thrombocytopenia
splenomegaly
splenic abscess
parasitic cysts
tumors
14
Q
what is a hernia orifice
A
defect in the abdominal wall
15
Q
what is a hernia sac
A
outpouching of the peritoneum
16
Q
5 hernia types
A
umbilical
R+L inguinal
R+L femoral
17
Q
inguinal hernia
A
above the abdomincaocrural crease
>95% male
18
Q
direct inguinal hernia
A
acquired- weak fascia
within hasselbachs triangle
19
Q
indirect inguinal hernia
A
congenital
follows spermatic cord
20
Q
femoral hernia
A
below the abdominaocrural crease
>97% female
originates form the femoral canal
21
Q
A
22
Q
muscle layers of the scrotum
A
external oblique aponeurosa
internal oblique muscle
trasnversalis muscle fascia
peritoneum
23
Q
three ways to repair inguinal hernia
A
open: mesh
lap: mesh
open: suture
24
Q
mesh (patch) inguinal hernia repairs- lichtenstein
A
mesh placed over the transversalis fascia and wrapped around spermatic cord
25
mesh (patch) inguinal hernia repairs-rutkow
plug placed below the transversalis fascia in addition to a mesh wrapped around spermatic cord
26
two types of lap inguinal hernia mesh repairs
TEP
TAPP
27
*suture inguinal hernia repairs- bassini*
*unite the triple layer to the inguinal ligament*
triple layer closure
28
suture inguinal hernia repairs- shouldice (modified bassini)
4 layer closure
29
two types of open mesh inguinal hernia repairs
lichtenstein
rutkow
30
types of inguinal hernia suture reapairs
bassini
shouldice
mcvay
31
*suture inguinal hernia repairs: Mcvay*
*unite triple layer to the coopers ligament*
32
*how to expose the hernia structures*
incise
- skin
- subQ
- scarpas fascia
33
*when expesing the hernia strucutrs, what instrument do you use to incise the skin*
*blade*
34
*when expesing the hernia strucutrs, what instrument do you use to incise the subQ*
*bovie*
35
*when expesing the hernia strucutrs, what instrument do you use to incise the scarpas fascia*
*goulet/ army navy x2*
36
*what instruments do you use to incise to expose the inguinal canal*
*kelly (allis) x2, metz, gelpi, goulet/ army navy*
37
*what instrumetns do you use in preserving nerves*
*debakey x2*
38
what are the two nerves you need to identify and protect in inguinal hernia
ilioinguinal + iliohypogastric nerves
39
what muscle do you encounter for a male inguinal hernia
cremaster muscle
- fibers separated
- dont need to close
40
what do you do for IH after spermatic cord is identified
dissect free of attachemtns
41
*what instruments do you use to dissect spermatic cord free of attachemtns*
*metz/ bovie*
42
what do you do in IH after the spermatic cord is freed
retract it
43
*what instruments do you use to retract he spermatic cord*
*moistened penrose w/ pean*
44
what do you do in IH once the spermatic cord is retracted
identify if its direct (medial) or indirect (lateral)
45
if the IH is indirect, what do you do first
dissected away from spermatic cord and cremaster muscle
46
after the spermatic cord is dissected away for indirect IH, whats next
sac contents are pushed back into the abd cavity
47
*what instrument do you use to push the sac contents back into the abd cavity for IH*
*sponge stick*
48
what comes after sac is pushed back into abd cavity for indirect IH
purse string suture may be used to reduce sac and excess sac trimmed off
49
what is the next step of IH reapir after purse string is tied
suture repair of transversalis fascia defect, interrupted
- into coopers ligament
50
how do you do the large defect of IH
mesh repair
51
what layers do you close with IH
external oblique aponeurosa
scarpa fascia
subQ
skin
52
pathology of the breasts
neoplasms
cancer
gynecomastia
53
what incision is used for a modified radical mastectomy
elliptical transverse incision into axilla
53
*how many setups does a modified radical mastectomy require*
*may require 2*
53
thyroid pathology
hyperthyroidism
thyrotoxicosis
hypothyroidism
53
4 counts of thyroidectomy
initial
prior to fascia
prior to skin close
final count
53
steps of thyroidectomy
transverse incision
retract
muscles seperated
tissue dissected
find arteries for preservation
dissect thyroid from trachea
hemostasis+ close
54
what type of hemostat for thyroidectomy
fine tipped, lots of them
55
stage i breast cancer
less than 2 cm
56
stage ii breast cancer
gerater than 2 cm, less than 5 cm
57
stage iii a breast cancer
up to 5 cm, may not be fixed
58
stage iii b breast cancer
tumor of any dimension
59
what preservative can you not put breast BX in
formalin, makes it permanent
60
*what is the CST biggest precaution when prepping for a breast BX*
*do not dislodge the needle*
61
*what will the surgeon ask the tech to facilitate during the breast BX*
*place traction on the skin to facilitate skin incision*
62
what type of incision is made for breast BX
curvilinear- follows skin line directly
63
*what is the tech responsible for grasping during breast bx*
*grabbing the mass to provide visualization to surgeon*
64
*how should the tech pass off the specimen of breast Bx*
*not 4x4, place in specimen cup with debakey*
65
rule of 5s breast BX
5ml of dye, 5 sites, 5 cm of diameter, massage into tissue for 5 mins
66
pathology of gastric sleeve
obestiy
diabetes
67
special consideration for bariatric patients
may require bigger instruments/ supplies
permanently change eating habits
68
what does a gastric sleeve do
make the stomach small so patient feels more full
69
gastric sleeve vs gastric band
sleeve- cut off left side of sotmach
band- band the cardia
70
what class are gastric sleeve and band
sleeve- class ii
band- class i
71
steps of gastric sleeve
insufflation + trocar
mobiliation of stomach, dissection from surrounding
calibration tubing stapled le
72
steps of gastic band
insufflation + trocar
dissect angle of his
band placed around
73
pathology for laparoscopic nissen fundoplication
hiatal hernia, GERD
74
positioning for laparoscopic nissen fundoplication
supine w/ abducted legs
maybe stirrups
75
instruments used for laparoscopic nissen fundoplication
harmonic scalpel
lapscopes
fan retractor
bovie hook
clip applier
76
how many trocars used for laparoscopic nissen fundoplication
5
77
steps to laparoscopic nissen fundoplication
- liver retracted
-lesser ometum opened
- incision into peritoneum
- retract the stomach
- fundus wrapped around esophagus + stapled
78
what is laparoscopic nissen fundoplication
using the stomach as its own lap band
79
counts for laparoscopic nissen fundoplication
initial
closure of peritoneum
closure of skin
final
80
what class is laparoscopic nissen fundoplication
class ii
- as long as nothing ruptured
81
pathology for liver resection
hepatocellular tumors
82
what is the problem with liver cancer
it usually is never contained to one area and will require a transplant
83
skin prep for liver resection
clavicle to mid thighs
84
incisions for liver resecton
midline
subcostal
thoracoabdominal
85
steps for liver resection
common incision
- mobilize liver and inspect
- blood flow control
--- hepatic artery + portal vein
- division of parenchyma
- continue resection
- hemostasis and drain insertion
- closure
86
what class is a liver resection
class ii
87
pathology for appy
appendicitis
88
special considerations for appy
be prepared to open procedure from lap
89
positioning for appy
supine + trendelenburg, right side elevated
90
ports for appy
suprapubic
umbilical
left iliac
91
steps for lap appy
- insert scopes
- babcock to grap cecum
- grasp appendix- CST holds
- opening in mesoappendix
- surg pref of appy transected
- pulled thorugh iliac port
---- use pouch if its inflammed
- stump sealed, ports closed
92
what class is appy
class ii
93
appy considerations for women
laparoscopy may be done to rule out ovarian cysts or ectopic preggo
94
steps for open appy
- mcburney incision + retractors
- graps appendix with babcock
- mesoappendix transected from appy
- clamp placed near base of appy
-suture passed through cecum
- appendix amputated
- tightened with pursestring
95
wound classification of appy
class ii
class iii if ruptured
96
which appy instruments are not contaminated
ones used to remove the appendix
