General Surgery Flashcards
(162 cards)
1
Q
What is the simplest abdominal incision offering good exposure to any part of the abdominal cavity?
A
-vertical midline incision
2
Q
The vertical midline incision can be reinforced in its closure by means of what?
A
-closure reinforced with retention sutures sutures to prevent postoperative wound dehiscence/evisceration
3
Q
What incision is used for an open appendectomy?
A
-McBurney incision
4
Q
Is a McBurney incision oblique, vertical or transverse? Which quadrant is it located in?
A
- Oblique incision
- RLQ
5
Q
Name the incision that can be made on either the right or left side under the ribs.
A
-right or left subcostal
6
Q
If the incision in Ques. 5 is done on the right, what structures can be operated on?
If done on the left?
A
- Right: gallbladder, biliary system, pancreas
- Left: spleen
7
Q
What incision is used frequently for pelvic surgery 3-5cm above the symphysis pubis?
A
-Pffanastiel incision
8
Q
What incision is used for operations on the proximal stomach & distal esophagus?
A
-Left throaco abdominal
9
Q
Name 2 of the many functions that the organs of the alimentary canal responsible for?
A
- digestion
- elimination
10
Q
As the esophagus passes thru the neck, between which 2 structures does it lie?
A
- trachea
- vertebral column
11
Q
Fundus
A
-superior most portion for temporary storage/mixing area
12
Q
Cardiac portion
A
-superior opening of stomach, surrounds cardiac sphincter (entrance to stomach)
13
Q
Body
A
-largest, dilated central-most, main region
14
Q
Antrim
A
-funnel shaped connecting main body to narrow pyloric canal
15
Q
Pylorus
A
-terminus of of pyloric region and stomach itself
16
Q
What is attached to the greater curvature of the stomach?
A
-greater omentum
17
Q
The blood supply to the stomach comes from?
A
celiac trunk of the aorta
18
Q
What is the omentum?
A
- fold of peritoneum connecting stomach with other abdominal organs
- fat that covers intestines
19
Q
What attaches the intestines to the posterior abdominal wall?
A
- mesentery
- The mesentery is a continuous set of tissues which is formed by the double fold of peritoneum that attaches the intestines to the wall of the abdomen
20
Q
Where does the small intestine begin and end?
A
- pyloric sphincter
- ileocecal valve
21
Q
Name the 3 sections of the small intestine.
A
- duodenum
- jejunum
- ileum
22
Q
What portion of the small intestine do the common bile duct and pancreatic duct enter & what is the name of that area?
A
- duodenum
- Ampula of Vader
23
Q
What is the name of a ligament which stabilizes the duodenojejunal flexure & serves as a landmark for abdominal orientation?
A
-ligament of treitz
24
Q
The ileum empties into the large intestine where?
A
-cecum
25
Where is the hepatic flexure?
- RUQ
| - first turn of large intestine
26
Name the 3 portions of the large intestine?
- cecum
- colon
- rectum
27
What structure projects from the posterior medial wall?
-appendix
28
Name the 6 parts the colon is divided into.
- ascending
- hepatic flexure
- transverse
- splenic flexure
- descending
- sigmoid
29
The rectum lies behind which structures in the male and female?
- male: prostate, bladder, seminal ducts and glands
| - female: uterus
30
The rectum begins where?
-end of the sigmoid
31
Name the sphincters of the anus
- internal
| - external
32
What is “bowel technique”?
-preventing cross contamination between the dirty bowel and other clean tissue
33
From the instrument list, name the non-traumatic grasping clamp that is used on the intestine. (Clinical Practice)
-babcock forcep
34
From the instrument list, name the forceps generally used on the skin.
-adsons forceps
35
What is the process by which food is moved through the stomach and intestines?
-peristalsis
36
What is the function of the plicae circulares of Kerckring in the small intestine?
-to provide greater mucosal surface area for nutrient absorption
37
What is the Haustra?
-sacculations that are out pouching of the bowel wall
38
Name common sutures used in GI procedures?
- 3-0, 4-0 absorbable suture
- polyglycolic acid
- polyglactin 910 (vicryl)
39
What is Bariatric Surgery?
- weight loss surgery
| - weight reduction surgery
40
What is a Barrett’s Esophagus?
-metaplastic changes to esophageal cells from continuous exposure to gastric acid
41
During EGD, what is the position that may be utilized to view the fundus & cardia of the stomach?
-sims or lateral
42
What is a Colonoscopy and the instrument used?
- direct visualization of rectum
| - colonoscope
43
What is another name for an esophageal diverticulum?
- zenkers diverticulum
| - diverticulum of the mucosa of the pharynx, just above the cricopharyngeal muscle
44
What position is used for an esophageal diverticulum?
-supine position using shoulder roll to extend neck
45
Which muscle is the incision made through for a Zenker’s diverticulum?
-sternocleidomastoid
46
What is a hiatal hernia?
- stomach moves into chest cavity
| - portion of stomach
47
How can a Hiatal Hernia be repaired?
-nissen fundoplication
48
The laparoscopic Nissen Fundoplication & other procedures similar to it were developed for the management of what condition?
-GERD
49
What instruments might be used for a Laparoscopic Nissen?
- esophageal dilators: Hurst, Maloney
- prevent stricture maintain esophageal potency during wrapping
- graspers, cautery, suture cut, passers
50
What is Esophagomyotomy (or Heller cardiomyotomy) and why is it done?
- lap. esophagomyotomy is superior to all other forms of TX for achalasia (muscles of lower esophagus don't relax)
- esophageal muscle incised w/ insulated laparoscopic instrument.
- portion of up. stomach wrapped around lower portion of esophagus prevent reflux.
- patients discharged first post-operative day after swallow study
51
Name some dilators used for an esophageal dilation.
- hurst
| - maloney
52
What is a PEG tube?
-tube that provides enteral feeding for someone who can't orally eat but has a normal GI tract
53
What is the more frequent reason a Pyloroplasty is done? Which incision is used?
- peptic ulcer disease
| - midline, paramediaan, high transverse
54
What is a gastrojejunostomy and why is it done?
-anastamosis between stomach and jejunum (small intestine) to bypass obstruction
55
instrument used to retract tissue near the surface.
- senn
| - rake
56
What is a Billroth I and between which 2 structures is the anastomosis?
- distal gastrectomy
| - stomach to duodenum
57
What is a Billroth II and between which 2 structures is the anastomosis?
- distal gastrectomy
| - stomach to jejunum
58
From the instrument list, this is an instrument used to cross-clamp the stomach.
-payer clamp
59
What is a Meckel’s diverticulum?
- congenital slight bulge in the DISTAL ILEUM of small intestine
- small pouch or sac
60
What type of suture is used on the appendiceal base, absorbable or nonabsorbable?
-non absorbable suture
-absorbable
61
Why might a drain be used on an appendectomy?
-if the appendix has ruptured
62
Name some reasons a small bowel resection is done?
-diseased, necrotic, obstructed bowel
63
From the instrument list, 2 other non-traumatic forceps.
- debakey
| - gerald
64
What is an end ileostomy and 2 reasons why it’s done?
- stoma created with ileum for bowel resection
| - for diversion of fecal matter
65
Can the large intestine be resected laparoscopically?
-yes
66
What is a colostomy & which 2 parts of the large intestine can be utilized?
- surgical opening of the bowel and suturing it to the skin to create an orifice
- TRANSVERSE OR DESCENDING colon
67
Name some reasons a colostomy is done. Are they temporary, permanent or either?
.
68
What is the closure of a colostomy?
.
69
What is an abdominoperineal resection?
-complete excision of sigmoid colon, rectum, anus
70
What positions can be used for an abdominoperineal resection?
- prone
- lithotomy
- kraske (jackknife)
71
What two incisions are used for abdomenoperineal resection?
- midline incision for abdomen
| - perianal incision for rectum
72
What is a hemorrhoidectomy?
-removal of hemorrhoid: congestion and dilation of the submucosal and subcutaneous venous plexus
73
An instrument that can be used to grasp the base of the hemorrhoid?
- allis
| - pennington (Duval) clamp
74
What are “J” , “S”, and “Y” pouches as used for rectal reconstruction?
-ileanal pull through
75
What is the excision of a pilonidal cyst and sinus?
-hair that tracts through the skin causing a cyst to form
76
Can the above reoccur?
-cyst and tract must be removed entirely to prevent reoccurrence
77
Which position is used for the excision of a pilonidal cyst?
-prone
78
Which position is used for the excision of a pilonidal cyst?
-prone
79
How are the tracts identified and marked for pilonidal cyst?
-methylene blue dye is injected
80
In which quadrant is the liver located? Which cells in the liver manufacture bile?
- RUQ right upper quadrant
| - hepatocytes
81
Hepatic ducts within the liver join to form what?
**common hepatic duct**
82
Hepatic ducts within the liver join to form what?
**common hepatic duct**
83
What is Glisson’s capsule?
- capsule surrounding layer
| - ensheathes artery, portal vein, bile ducts in liver
84
The cystic duct and the common hepatic duct merges to form which duct?
-common bile duct
85
Where does the gall bladder lie?
- RUQ
| - beneath right lobe of liver
86
What is the function of the gall bladder?
-stores and concentrates bile
87
The sphincter of Oddi is where?
- ampulla of vater
| - controls release bile/digestive enzymes to duodenum
88
What is the blood supply of the gall bladder?
-cystic artery
89
What structure is the head of the pancreas fixed to?
duodenum of small intestines
90
Where is the pancreas located?
- abdominal cavity behind stomach
| - LUQ
91
What 2 hormones does the pancreas secrete and by which cells are those hormones produced?
- insulin
- glycogin
- islets of langerhans
92
As an digestive gland, what does the pancreas secrete and through which duct?
- digestive enzymes in pancreatic juice
| - duct of wursung
93
Where is the spleen located?
- LUQ
| - under ribcage & above stomach
94
What is the function of the spleen?
- filter for blood
- red blood cells recycled
- platelets/white blood cells stored
- fights bacteria causing meningitis/pneumonia
95
What does ERCP stand for and what is the procedure?
- Endoscopic Retrograde CholangioPancreatography
- direct visualization of biliary system
- cystic duct, common bile duct, hepatic ducts
96
What is Gelfoam?
-hemostatic agent made of absorbable gelatin
97
What is Surgicel?
-hemnostatic agent, oxidized cellulose polymer, control post surgical bleeding
98
During a laparotomy, the patient is at risk for hypothermia. What is one way in which
-make sure irrigation solution is warm
99
What can the circulator apply to the patient to prevent deep venous thrombosis?
-venodyne leg compression stockings
100
What type of drain might be used after a common duct exploration?
t-tube drain
101
Where do abdominal drains usually exit the patient’s skin and why are they anchored (or sutured)?
.
102
What is a cholecystectomy and why is it performed?
- TX for diseased gallbladder
| - removal of gallbladder
103
What 2 incisions that can be used for a cholecystectomy?
* RIGHT SUBCOSTAL (kocher)*
- right paramedian
- midline (?)
104
What hand held retractors might be used to retract the liver?
- deaver retractor
| - harrington retractor
105
Of the cystic artery, cystic duct and common bile duct, which is ligated & divided and which is left intact?
- cystic artery: divided and ligated
| - cystic duct: divided
106
intraoperative cholangiogram?
-small catheter placed into cystic duct to drain bile from gallbladder into common bile duct
107
Why is it important to remove air bubbles from the syringe before injecting?
-prevent air embolus
108
What is the Hasson technique and why is it done?
- open method of tracer insertion for lap. Procedures
| - verres needle & first trocar significant cause of complication
109
What is the maximum pressure setting for the insufflation unit?
-15MMHG
110
What is the saline drop test?
- used to confirm verres needle position
| - needle flushed with saline to ensure integrity
111
What does the term NOTES stand for?
-Natural Orifice Transluminal Endoscopic Surgery (scarless abd operations)
112
What instrument is inserted thru the purse-string suture to drain the gall bladder
contents?
-endoscopic needle aspirator
113
What is another name for pancreatoduodenectomy where the head of the pancreas, the entire duodenum and a portion of the jejunum, stomach & common bile duct are removed/ why is it done?
-Whipple procedure TX for cancer of head of pancreass
114
A pancreatic transplant is done to treat which condition?
diabetes
115
During a hepatic resection, the surgeon may use a CUSA. How does the CUSA work?
-to fragment/aspirate liver parenchyma tissue, exposing vascular/ductal structures to be ligated and clipped
116
What are some reasons a splenectomy is done? Which incision is used?
- cancer, hereditary spherocytosis, ITP, trauma, ruptures splenic artery, Hodgkins
- LEFT SUBCOSTAL incision
117
Which 3 landmarks form Hesselbach’s triangle? Which hernia occurs here?
- inguinal
- inferior epigastric vessels
- lateral border of rectus abdominus
* direct inguinal hernia**
118
Which hernia occurs laterally to the deep epigastric vessels?
-indirect inguinal hernia
119
Direct & indirect hernias represent a weakness in what?
-fascia
120
Which hernia protrudes into the inguinal canal but not into the cord, rarely into the scrotum?
-direct hernia (inguinal)
121
Which hernia results from heavy lifting?
-direct hernia (inguinal)
122
Which hernia leaves the abdominal cavity at the internal ring, passes with the cord down the inguinal canal and may be found in the scrotum?
pantaloon hernia
123
Which hernia may be either congenital or acquired?
pantaloon hernia
124
What is a pantaloon hernia?
-both direct and indirect hernia are present
125
What type of incision is used for a hernia repair?
-oblique or transverse incision
126
Why is a moistened penrose drain used in a hernia repair?
-retract the spermatic cord
127
Name 2 spontaneously occurring ventral hernias.
-epigastric and umbilical hernias occur spontaneously
128
What is another name for a postoperative ventral hernia and what type of incisions does it appear in?
-incisional hernia, occurs near/along prior abdominal surgical incision
129
Give some examples of synthetic material used as reinforcement in hernia repairs?
- polypropylene
- polyester
- dexon/vicryl (absorbable)
130
How many lobes does the thyroid gland have and name the structure that unites the lobes.
-two lobes connected by thyroid isthmus
131
What is the blood supply to the thyroid gland?
-right/left, superior/inferior thyroid arteries
132
How many parathyroid glands are there?
-4 to 5
133
Which preoperative test provides the most useful information in the diagnosis of cancer of the thyroid?
-needle biopsy
134
What position is used for a thyroidectomy?
- supine w/ sandbag or roll towel to hyperextend the neck
| - reverse trendelenberg
135
Which nerves lie in close proximity during a thyroidectomy and must be identified and preserved?
- upper laryngeal nerve
| - recurrent laryngeal nerve (branch of vagus)
136
What type of incision is used for a thyroidectomy?
-symmetrical transverse incision
137
What is the name of the most common congenital cyst found in the neck?
-thyroglossal duct cysts (TGDCs)q
138
A portion of one parathyroid gland must remain in order to prevent what condition?
-hypocalcimia
139
What type of glands are the breasts?
-mammary glands = modified sweat glands
140
What is the areola?
-surrounds nipple, conceals sebaceous glands
141
What type of lesions are fibroadenomas?
-benign lesions of the breast
142
What is the difference between and incisional & excisional breast biopsy?
incisional: smaller area of tissue is taken
Excision: entire abnormality or area of interest is removed
143
What are the sentinel nodes?
-first lymph nodes located along lymphatic channels
144
If a patient is found to have positive lymph nodes, what procedure is done?
-mastectomy or lymphectomy (breast conserving surgery), axilliary node dissection
145
Name 2 substances used in identifying sentinel nodes?
- blue dye: (patent blue)
| - radionuclide method (injection)
146
When the radioactive material is used, what piece of equipment is used to locate the radioactive nodes? What is the name of the device we use here at MMC?
-lymphoscintigraphy/NANAPROBE
147
When an axillary node dissection is done, how should the patient’s operative arm be positioned?
-supine w/ arm extended board less than 90 degrees
148
What is a subcutaneous mastectomy?
-tissue is removed through incision under breast, leaving skin around nipple intact
149
What is a simple mastectomy?
-removal of breast tissue, nipple, areola, skin, but not all lymph nodes
150
What is modified radical mastectomy?
- removal of entire breast, pectorals major, fascia, axillary nodes
- Axillary, pectoral, superior apical nodes
151
From the instrument list, the clamp that is used to hold breast lumps during removal?
-allis, Babcock, lahey
152
What is the incision for a modified radical mastectomy?
-elliptical transverse incision
153
What type of drain would be used and where is it inserted?
- jackson pratt or hemovac drains through separate stab incisions
- anterior (chest), lateral (axilla)
154
What is a Pyloromyotomy and what is it done for?
- incision into longitudinal/circular muscles of pylorus
| - tx hypertrophic pyloric stenosis
155
For what age group is pylormyotomy done a?
-new borns/infants consistently sick, vomit is symptom
156
What is an Omphalocele?
-newborns intestines and abdominal organs outside abd cavity from hole in belly button canal
157
What is an Intussusception?
-slipping of intestines between or below another portion
158
What is a frequent site for this intestinal obstruction?
-ileum enters cecum is common site of intussusception
159
What is an imperforate anus? Describe anorectoplasty.
- anorectal malformation: rectum does not function
| - pull through procedure to establish anus
160
What is the most common hernia seen in pediatric patient?
-umbilical hernia
161
What is a vagotomy and why is it done?
-removal of part of vagus nerve for TX of recurrent duodenal ulcers and gastric outlet obstruction
162
What are some of the biopsy needles used for a liver biopsy?
-Vim: Silverman, Tru-Cut, percutaneous
