simplist abdominal incision offering good exposure
vertical midline
how is a vertical midline reinforced
single layer continuous absorbable suture
incision for appendectomy
McBurnery
describe McBurney
8cm oblique in RLQ
incision right or left under ribs
subcostal
subcostal incision structures
right: gallbladder, pancreas, biliary tree
left: spleen
incision for pelvic surgery .5 in. above symphysis pubis
pfannensteil
incision for operations on proximal stomach and distal esophagus
thoracoabdominal
2 functions of organs in alimentary canal
mechanical/chemical breakdown of food
Peristalsis
what structures does esophagus lie between in neck
trachea
cervical spine
3 parts of stomach
fundus
body
pylorus
upper margin of stomach
cardia
lower margin of stomach
pyloris
what is attached to greater curvature of stomach
greater omentum
what is attached to lesser curvature of stomach
lesser omentum
what is omentum
double fold of peritoneum attached to stomach and viscera
fatty, prevent friction, wall off infection
what attaches intestines to posterior abdominal wall?
mesentery
start and end of small intestine
pyloric sphincter to large intestine
3 sections of small intestine
duodenum
jejunum
ileum
what portion of small intestine do CBD and pancreatic duct enter
duodenum at ampulla of vater
ligament stabilizing the duodenojejunal flexure and landmark for abdominal orientation
Treitz
the ileum empties into large intestine via what valve
ileocecal
start and end of large intestine
cecum to anus
3 portions of large intestine
cecum
colon
rectum
what structure projects from the blind pouch of the cecum
appendix
4 parts the colon is divided into
ascending
transverse
descending
sigmoid
the rectum begins and ends where
sacrum to coccyx
rectum lies behind what
bladder
sphincters of anus
internal
external
what is bowel technique
isolation to prevent cross-contamination of wound/abdomen w/ bowel bacteria
non-traumatic grasping forceps used on intestine
DeBakey
Wagonstein
Singley
forceps used on skin
Adson
process by which food is moved through stomach and intestine
peristalsis
function of small intestine
absorb nutrients
barrier for harmful, injected substances
function of large intestine
absorb water and electrolytes
2 suction tips in GI
yankeaur
frazier
poole
what is bariatric surgery
weight loss/reduction
what is Barrett’s esophagus
lining of esophagus damaged by stomach acid and changed to lining like stomach
during EGD what position is used to view fundus & cardia of stomach
left lateral
what is a colonoscopy
visualization of large intestine with a colonoscope
what is a sigmoidoscopy
visualization of sigmoid colon and rectum
what preop prep is done before colonoscopy and sigmoidoscopy
bowel clean/enema
and is another name for esophageal diverticulum
Zenker’s diverticulum
what is an esophageal diverticulum
weakening in wall of cervical esophagus
collects small food and sensation of fullness in nexk
what position is used for an esophageal diverticulum
supine w/ shoulder roll
over which muscle is the incision for zenker’s diverticulum made
sternocleidomastoid
what is hiatal hernia
portion of stomach enters throacic cavity
congenital or accidental
what is hiatal hernia repaired
lap nissen fundoplication
lap nissen fundoplication were developed why?
hiatal hernia
how many trocars are used for lap nissen?
5
lithotomy with rev. trendelenburg (CHECK)
what is esophagomyotomy?
Incision into esophageal muscle to treat a food obstruction
incision for esophagomyotomy
abdominal midline
why is esophageal dilation done
stricture
dilators for esophageal dilation
Hurst
Malony
what does interrupting the parasymphathetic innervation during vagotomy do
reduce gastric acid generation in patients with duodenal ulcers
incision for vagotomy
midline
what is the more frequent reason a pyloroplasty is done?
peptic ulcer, midline incision
what is a gastrostomy and why is it done?
Incision into stomach to insert a feeding tube
instrument used to retract tissue near the surface
Senn
Army/Navy
what does PEG stand for
percutaneous endoscopic gastrostomy
what is a Billroth I and between which 2 structures is the anastomosis
resect diseased portion of stomach
stomach + duodenum
what is a Billroth II and between which 2 structures is the anastomosis
resect distal portion of stomach
stomach + jejunum
between which 2 structures is the anastomosis in a total gastrectomy
jejunum + esophagus
instrument for cross-clamp stomach
Payr
autosuture
what is a Meckel’s diverticulum
Congenital outpouch of sm. intestine (ileum)
what is appendectomy
removal of appendix with McBurney incision
surute on appendiceal base
nonabsorbable
why would a drain be used on appendectomy
continuous drainage
how many trocars for lap appy
3
why is small bowel resection done
tumors, gangrene, volvulus, herniation
2 non traumatic forceps
platapus, wagonstein, singley
what is ileostomy and 2 reasons its done
temp or permanent opening into ileum
extensive lesions, reduce activity in colon by diversion
can large intestine be resected laparoscopically
yes
what is colostomy, what 2 parts of large intestine cna be used?
mobilize loop of colon and externalize
transverse/descending
why colostomy is done
obstruction, trauma
what is the closure of colostomy
reestablishment of internal intestinal continuity and repair of abdomen
2 reasons right hemicolectomy and ileocolostomy are done
remove malignant lesion or inflammatory lesion in right colon
incision for transverse colectomy
transverse, upper midline
what is abdominoperineal resection
mobilization and division of a diseased segmant of lower bowel
what is done to proximal and distal bowel in APR
proximal: colostomy
distal: closure
why is APR performed
cancer
positions for APR and incision
supine, modified lithotomy
midline incision
what is hemorrhoidectomy/positions
remove hemorrhoids
jacknife/buie
instrument to grasp bottom of hemorrhoid
pennington
suture to tie proximal end of hemorrhoid
2-0 synthetic absorbable
what are J, S, and Y pouches for rectal reconstruction
CHECK
what is the excision of pilonidal cyst and sinus. Do they recur?
intergluteal fold on posterior surface of lower rectum
they can recur
position for pilonidal cyst excision. how are tracts identified and marked
jacknife
probes and incision
how is incision from pilonidal cyst protected
left open and packed with a pressure dressing
what quadrant is liver located. what cells manufacture bile
RUQ
hepatocytes
hepatic ducts join to form which common duct
common hepatic duct
the cystic duct and common hepatic duct form which duct
common bile duct
what is gallbladder. it ends in which duct
RUQ on underside of liver
cystic duct
what is the function of the gallbladder. how does bile aid in digestion
store bile
emulsify fat in duodenum
what is blood supply of gall bladder
cystic artery
where is pancreas located. what structure is head of pancreas fixed to?
CHECK
an an exocrine gland, what does the pancreas secrete and through which duct
digestive enzyme
Wirshung
as an endocrine gland what 2 hormones does pancreas secrete and by which cells are they produced
insulin, glucagon
islets of Langerhan
where is spleen and what is its function
LUQ: defend body with phagocytosis
what does ERCP stand for and what is it
endoscopic retrograde cholangiopancreatography
visualization of biliary tree
during laparotomy the patient is at risk for hypothermia. how can you help prevent it with irrigation
warm solution for thermoregulation
what is applied to patient to help prevent DVT
sequential compression device TED stocking
train used after common duct exploration
t-tube
where do abdominal drains exit skin and why are they anchored
stab wounds
prevent retraction
what is cholecystectomy
remove gallbladder
stones/disease
position and 2 incisions for gallbladder
supine
right subcostal/upper midline`
hand held retractors used to retract liver
Harrington
Deaver
what is divided and what is left intact in cholecystectomy
cut artery/cystic duct
leave common bile duct
what is intraoperative cholangiogram
visualize CBD, hepatic duct branches
access patency of CBD
what is injected during cholangiogram to look for stones
contrast medium
remove bubbles b/c they look like stones
what is Hasson technique
open insufflation w/ blunt cannula
patients w’ previous surgery or adhesions
max pressure for insufflation unit
15mmhg
trocar sites for lap chole
4
what is cholecystostomy and who is it performed on
open incision into gallbladder to drain/remove stones
advanced medical problems
instrument through purse-string to drain gallbladder
trocar
CHECK
what is another name for pancreatoduodenectomy, why is it done
whipple-cancer
pancreatic transplant is done to treat what
type 1 diabetes
how does CUSA work
dissect tissue with ultrasonic waves with fluid and suction
what is splenectomy done and what is the incision
trauma, malignancy, leukemia, jaundice
midline/subcostal
what is danger with incarcerated hernia and what additional procedure must you be prepared to do
become strangulated/ischemia
resect necrotic bowel
3 landmarks of Hasselbach’s triangle
rectus abdominis, inguinal ligament, inferior epigastric vessels
has direct inguinal hernias
what hernia occurs laterally to deep epigastric vessels
indirect inguinal
direct and indirect hernias represent a weakness in what
transverse fascia
what hernia protrudes into inguinal canal but not into cord, rarely into scrotum
direct inguinal
what hernia results from heavy lifting
direct inguinal
what hernia leaves the abdominal cavity at internal ring and passes with cord structures into scrotum
indirect inguinal
what hernia is congenital or acquired
inguinal
what is a pantaloon hernia
indirect + direct
what incision is used for a hernia repair
inguinal
why is a moistened penrose drain used in hernia repair
retract spermatic cord
2 spontaneously occuring ventral hernias
epigastric
umbilical
name for a postop ventral hernia and what incisions is it found in
incisional hernia
vertical midline
examples of synthetic material in hernia repairs
mersilene, prolene, dacron
lobes of thyroid and what separates them
2, isthmus
blood supply to thyroid gland
superior thypoid/external carotid
how many parathyroid glands are there
4
what preop test provides info in diagonses of cancer in thyroid
Fine needle biopsy/ CT/ MRI
position for thyroidectomy, incision
supine, transverse
nerve in close proximity to thyroid
laryngeal
what knife handle holds a 10,11,12,15 blade
3
what is the name of the most common congenital cyst in neck
thyroglassal duct
why does a parathyroid gland need to stay in the body
prevent hypocalcemia
what type of glands are there in the breasts, what is areola
mammory/pigmented area around nipple
what lesions are fibroademonas
benign
incisional vs. excisional breast biopsy
incisional: just part of mass
excisional: take whole mass
what are sentinal nodes
1st nodes along lymphatic channel from primary tumor site
if patient has positive lymph nodes what procedure is done (breast)
radical mastectomy
2 substances used in IDing sentinal nodes
isosulfan blue dye, radiocolloid
what radioactive material is used what device is used to detect it
Geiger counter/neoprobe
when axillary node dissection is done how is the arm positioned
extended on armboard less than 90 degrees
what is subcutaneous mastectomy
under skin removal
overlying skin + nipple remain
what is simple/total mastectomy
remove entire involved breast w/o lymph node dissection
what is modified radical mastectomy?
CHECk
clamp used to hold breast lumps
allis
incision for modified radical mastectomy
elliptical
drain in modified radical mastectomy
closed wound suction catheter
what is Nissen Fundoplication
wrap fundus around esophagus
GERD/hiatal hernia
what is pylormyotomy
CHECK
what age is pyloromyotomy done and what is the first sign of the condition
2-6 weeks
projectile vomiting
what is omphalocele
hernia where intestines and other organs are outside of body through belly button
what is intussusception?
CHECK
what is a frequent site for intestinal obstruction
ileocecal junction
what is an imperforate anus. describe anorectoplasty
no hole
make an anus
what is the most common hernia in pediatrics
umbilical
what is lumpectomy
remove lump for biopsy
what anesthesia is given for liver needle biopsy
general
2 needles for liver needle biopsy
tru-cut
silverman
franklin
