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General Surgery Flashcards

(55 cards)

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1
Q

GI anatomy

A

Major structures:
Mouth
Pharynx
Esophagus
Responsible for ingesting food
Stomach
Secreting, mixing food, digestion
Small intestine (duodénum, jejunum, ilium)
Absorption of nutrients
Large intestine (cecum, ascending colon, transverse colon, descending colon, sigmoid colon)
Adsorption of water (electrolytes)
Rectum and anus
Elimination

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2
Q

Endoscopy

Define/anatomy/physiology/pathophysiology/indication

A

Visual exam of the bronchus/bronchi
Epiglottis, true vocal cords, trachea, carina, right & left main stem of the bronchi
Performed to diagnose hemoptysis, infection, carcinoma. It is also performed to treat foreign bodies.

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3
Q

peristalsis

A

A progressive (involuntary), wave-like movement in a tubular structure

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4
Q

Microlaryngoscopy

Define/anatomy/physiology/pathophysiology/indication

A

Visual examof the larynx with the use of the microscope
Larynx
Vocal cords
Vocal cord nodules or polyps

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5
Q

Triple Endoscopy

Define/anatomy/physiology/pathophysiology/indication

A

(AKA panendoscopy)
Visual exam of larynx, bronchi, and esophagus
Larynx; epiglottis, vocal cords, Trachea; carina; bronchi, Esophagus
Diagnostic for spread of malignancy

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6
Q

Breast Biopsy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of a portion of breast tissue for pathology examination
Breast, Areola/nipple, Adipose tissue, Glandular tissue (lobes), Lactiferous ducts
Lactation/nourish infant
Breast mass or abnormal mammogram
Patient may be awake
Use warm prep solutions
Be very mindful of your conversations
Have mammograms available
There may be a wire placed by the radiologist during the confirmation before surgery

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7
Q

Sentinel node biopsy (CoR)

Define/anatomy/physiology/pathophysiology/indication

A

Identification and removal of the first lymph nodes along the lymphatic channel that drains the tumor site
Breast, Areola/nipple, Adipose tissue, Glandular tissue (lobes), Lactiferous ducts, Lymph nodes
Breast cancer
Performed to determine if the cancer spread to the lymph nodes

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8
Q

Modified Radical Mastectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A 
Excision of the breast with removal of all axillary contents:
     Breast
     Areola/nipple
     Adipose tissue
     Glandular tissue (lobes)
     Lactiferous ducts
Pectoralis major muscle
Tail of Spence (axillary tail) 
Axillary lymph nodes
lactation
May need lots of laps and #10 blades
Have Mammograms available
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9
Q

Total Thyroidectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of both lobes of the thyroid gland and all thyroid tissue
Thyroid gland (and parts)
2 lobes and isthmus
Parathyroid glands, Recurrent laryngeal nerve (RLN; see procedure step 4), Trachea, Thyroid and cricoid cartilages
Endocrine gland
Metabolism; growth and development in fetuses and infants
Produce hormones T4; T5
Malignant tumors of the thyroid gland
Imaging available
Meticulous dissection
Need mosquitos, fine right angles, lots of ties, hemoclips, and/or harmonic/ligasure

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10
Q

Laparoscopic Cholecystectomy

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of gallbladder with the use of minimally invasive technique
Gallbladder; cystic duct; cystic artery, Liver; hepatic duct & artery, Common bile duct; duodenum
Storage/concentration of bile to emulsify ingested fat
Cholecystitis; cholelithiasis
Have images available in OR
May do intraoperative cholangiogram
Make sure that the OR bed must be compatible
May do common bile duct exploration if stones present
It is rare but the procedure convert to open cholecystectomy
May use closed or open technique to establish laparoscopic access
Closed:
Use Veress needle for initial insufflation
“Open” (Hasson technique):

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11
Q

Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of gallbladder with a record or writing of the bile vessels
Gallbladder; cystic duct; cystic artery, Liver; hepatic duct & artery, Common bile duct; duodenum
Cholecystitis; cholelithiasis

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12
Q

Liver Resection (Hepatic resection) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of part of the liver
Liver and its right and left lobes; falciform ligament; quadrate lobe; caudate lobe is in dorsal segment, Porta hepatis, Hepatic ducts, hepatic arteries and veins, lymph nodes
Hepatocellular tumors (cancer); bleeding or maceration from trauma
Expect significant blood loss
This is a meticulous and time-intensive procedure
use of blunt-tip needles with chromic suture

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13
Q

Pancreaticoduodenectomy (Whipple procedure) Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Removal of the head of the pancreas, entire duodenum, part of
Pancreas; head and tail, pancreatic duct, Common bile duct, Duodenum, Jejunum, Stomach
Cancer of the head of pancreas
Has a high morbidity (complications)
High mortality (death from complications)
Long, involved procedure
Expect significant blood loss if things go wrong

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14
Q

Laparoscopic Splenectomy Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Excision of spleen through a minimally invasive technique
Spleen, Splenic artery and vein (AKA: splenic pedicle), Short gastric vessels, Stomach, left kidney, pancreas, colon
Phagocytosis of bacteria and old RBC’s; formation of WBC’s
Splenomegaly
Benign hematologic disorders such as:
Idiopathic thrombocytopenia purpura (immune disorder in which the blood doesn’t clot normall (ITP))
Tumors, cysts
Have images available

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15
Q

Inguinal Herniorrhaphy open Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Suture (repair of) a tear in the transversalis fascia
Transversalis fascia, Inguinal canal; inguinal ligament; Cooper ligament, Internal and external inguinal rings, Hesselbach’s triangle, ilioinguinal nerve, Spermatic cord (Vas deferens, Testicular vessels, Cremaster muscle)
Several different types of repairs:
mesh-plug, a type of tension-free repair
Have bowel items ready if this is an emergency strangulated inguinal hernia

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16
Q

Incisional/ventral hernia repair Define/anatomy/physiology/pathophysiology/indication/special considerations

A

Suture (repair of) an incisional/ventral hernia
Incisional: pertaining to; an incision•Ventral: pertaining to; anterior abdomen
Abdominal wall fascia near the defect
Abdominal body wall support
Ventral can be complex and large, requiring very large mesh patch

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17
Q

tylectomy

A

Excision of palpable breast lesion

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18
Q

Summarize procedure step sequence for Breast Biopsy

A

Inject the incision site with local (10 or 20 cc syringe and 25 ga needle)
Create an incision (#10 blade on #3 handle) over the abnormal tissue
Hemostasis is achieved using ESU
Dissect with Metz or ESU and Adson with teeth
Retract skin and the subcutaneous layers with Senns x 2 or Army-Navy x 2
Continue dissection with Metz or ESU and DeBakey
Grasp mass with Allis
Remove mass with deep knife (#10 blade on #3 handle), Metzenbaum, or ESU
Irrigate wth warm saline
Hemostasis is achieved with ESU
Close with suture, needle holder, Adson with teeth
Dress with wet one, dry one, and Steri-Strips, one 4x4 folded

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19
Q

Summarize procedure step sequence for Modified Radical Mastectomy

A

I/H/D/R to develop skin flaps
FYI: Skin hooks, rakes, Richardsons
Dissect breast from chest wall (pec major muscle)
FYI: Knife, ESU, Metz & tissue forceps
Continue into axilla and dissect axillary contents
FYI: Metz & TF, Richardson, hemoclips
Remove specimen en bloc
New term: “en bloc” means all in one piece
I/H, place drain, C/D

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20
Q

Summarize procedure step sequence for Total Thyroidectomy

A

I/H/D/R
Identify thyroid gland and dissect it, ligating appropriate blood vessels
Identify RLN and preserve it; preserve parathyroid glands if possible
Remove thyroid gland
I/H/drain PRN/C/D

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21
Q

Summarize procedure step sequence for Liver Resection (Hepatic resection)

A

I/H/D/R
FYI: ipsilateral just means on the same side, so right subcostal
Identify vessels; determine resection line; resect identified portion of liver
I/H/drain/C/D

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22
Q

parenchyma mean

A

Essential or functional parts of an organ

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23
Q

Summarize procedure step sequence for Pancreaticoduodenectomy (Whipple procedure)

Study These Flashcards
A

I/H/D/R
Dissect and remove the head of the pancreas, entire duodenum, part of jejunum, distal 1/3 of stomach, lower half of common bile duct
Re-establish continuity of biliary, pancreatic, and GI tracts by anastomoses
I/H/drain/C/D

24
Q

Summarize procedure step sequence for Laparoscopic Splenectomy

Study These Flashcards
A

Establish laparoscopic access; EUA
Retract stomach; mobilize splenic flexure
Clamp and divide supporting ligaments
Clamp, divide, and ligate short gastric vessels and splenic artery and vein
Spleen placed in endo-bag and removed
I/H/C/D

25
Summarize procedure step sequence for Inguinal Herniorrhaphy open
I/H/D/R Mobilize spermatic cord and place Penrose drain FYI: Kitners, Metz & TF (smooth or DeBakey) Dissect and push hernia sac back into peritoneal cavity (McVay, so now we go to step 9 in text) Size inguinal ring, select mesh, suture in place I/H/C/D
26
Summarize procedure step sequence for Incisional/ventral hernia repair
I/H/D/R Identify defect Insert mesh, suture in place for ventral I/H/C/D
27
Types of Hernias
``` Inguinal Direct (usually acquired) Indirect (usually congenital) Femoral Umbilical Epigastric AKA ventral or incisional Hiatal (diaphragm) ```
28
Definition of abdominal hernia
Protrusion of a peritoneum-lined sac through a defect in the layers of the abdominal wall.
29
Reducible Non-reducible AKA incarcerated Strangulated Pantaloon hernia
Contents will go back in Contents will not go back in, “stuck” inside hernia sac Loop of bowel stuck in sac, blood supply compromised–On call case; plan for bowel resection When both direct and indirect hernias are present (not Common)
30
Anatomy for Inguinal Hernia:
``` Transversalis fascia Inguinal canal Cremaster muscle Spermatic cord In females; the round ligament is in place of the spermatic cord Inguinal ligament Cooper ligament Ilioinguinal nerve Internal inguinal ring External inguinal ring ```
31
Hesselbach’s Triangle
Rectus abdominus muscle medially (RAMM) Inguinal ligament inferiorly (ILI) Deep epigastric vessels laterally (DEVL)
32
Direct inguinal hernias occur | Indirect inguinal hernias occur
Within Hesselbach’s Triangle | Outside of Hesselbach’s Triangle
33
Umbilical hernia repair Define/anatomy/physiology/pathophysiology/indication/special considerations
Suture (repair of) an umbilical (pertaining to; umbilicus) hernia
34
TEP Hernia Repair Define/anatomy/physiology/pathophysiology/indication/special considerations
Totally extra-peritoneal patch Repair of a tear in the transversalis fascia through a minimally invasive approach Transversalis fascia, Inguinal canal; inguinal ligament; Cooper ligament, Internal and external rings, Hesselbach triangle(RAMM, ILI, DEVL) ilioinguinal nerve, Spermatic cord (Vas deferens, Testicular vessels, Cremaster muscle) Inguinal hernia; direct or indirect Several different types of endoscopic repairs; risk of injury to abdominal organs is reduced if approached from outside peritoneal cavity Set-up similar to a basic MIS procedure
35
Total Gastrectomy Define/anatomy/physiology/pathophysiology/indication/special considerations
Complete removal of stomach and establishment of anastomosis between esophagus and jejunum (aka. Esophagojejunostomy). Stomach, Greater omentum and lesser omentum, Esophagus, Duodenum, Jejunum, Spleen and liver digestion and absorption Gastric cancer Have images available Have blood ordered; track blood loss at field May need longer instruments May need thoracic access; may need bowel technique
36
Gastrostomy (PEG) Define/anatomy/physiology/pathophysiology/indication/special considerations
Percutaneous endoscopic gastrostomy New opening; stomach esophagus and stomach, patient need for enteral (to intake of food through a tube that goes directly to the stomach) feedings Usually done in Endoscopy lab now Gastroenterologist rather than surgeon Various techniques; combinations of push and pull
37
Laparoscopic Roux-en Y Gastric bypass Define/anatomy/physiology/pathophysiology/indication/special considerations
Creation of a small gastric pouch connected to a segment of jejunum with connection of the duodenal limb to the lower jejunum using MIS techniques. Stomach, Duodenum, Ligament of Treitz, Jejunum, Omentum, and Mesentery Digestion ; absorption of nutrients Morbid obesity Bariatric patients require lots of special considerations Special hospital bed; transport to OR in that bedSpecial OR bed; positioning challenges Extra long trocars; wide BP cuffs, large SCD’s And particularly sensitivity and compassion
38
LAPAROSCOPIC NISSEN FUNDOPLICATION Define/anatomy/physiology/pathophysiology/indication/special considerations
Wrapping and securing the gastric fundus around the distal esophagus through a minimally-invasive approach Esophagus, Diaphragm, Vagus nerve, Stomach, and cardia, and fundus, and Liver Ingestion and digestion, GERD (Gastroesophageal reflux disorder) with failed medical management Have images available Camera person should be at patient’s right side otherwise you are reaching over the patient to point at upper left May be performed on children
39
Summarize procedure step sequence for Umbilical hernia repair
I/H/D/R Identify defect Suture defect (mesh is not always needed) I/H/C/D
40
Summarize procedure step sequence for TEP Hernia Repair
I/H/dissect with balloon Insufflate, place other ports Continue dissection to identify and reduce hernia Place mesh and secure (with staples/tacks) I/H/remove ports/C/D
41
Summarize procedure step sequence for Total Gastrectomy
I/H/D/R Mobilize the stomach by dissection and ligation of the ligaments and gastric vessels Resect stomach with staplers at duodenum and esophagus Mobilize small intestine and bring loop of jejunum up to esophagus Perform anastomoses (Esophagojejunostomy and Duodenojejunostomy) and close stapler accesses So bile can get to the jejunum I/H/C/D
42
Summarize procedure step sequence for Gastrostomy (PEG)
Insert gastroscope; insufflate stomach with air Back light stomach to abdominal wall (turn room lights off) Incision over light, insert PEG needle from outside abdomen Insert snare through EGD scope and guide wire through PEG needle Snare guide wire, pull up through mouth, and attach to PEG tube to guide wire, pull guide wire out PEG needle, seating PEG internal bolster securely Place external bolster, cut excess tubing, place connector and dress
43
Summarize procedure step sequence for Lap Roux-en Y Gastric bypass
Establish laparoscopic access Create gastric pouch with staplers Identify ligament of Treitz by retracting away theOmentum and transverse colon Transect jejunum with stapler Create gastrojejunostomy (pass jejunum up to stomach and staple or sew) Perform duodenojejunostomy (biliary limb)Check for leaks; close mesenteric defect; I/H/C/D
44
Summarize procedure step sequence for LAPAROSCOPIC NISSEN FUNDOPLICATION
Establish laparoscopic access Place Penrose, dissect esophageal hiatus, repair hernia PRN Grasp stomach and mobilize fundus Wrap fundus around lower esophagus and secure I/H/deflate/C/D
45
COLON RESECTION (Colectomy) Define/anatomy/physiology/pathophysiology/indication/special considerations
Excision or resection of the colon Colon (Cecum, Ascending, Transverse, Descending, Sigmoid colon, Rectum), Mesentery, Liver, Spleen, and Ureters Absorption of water; defecation Colon cancer Have images available Bowel technique Isolate operative site; don’t use instruments that have been used on bowel to close abdominal wal
46
COLOSTOMY (LOOP) Define/anatomy/physiology/pathophysiology/indication/special considerations
Create a new opening for the colon through the abdominal wall Colon (Cecum, Ascending, Transverse, Descending, Sigmoid colon, Rectum), Mesentery, Liver, Spleen, and Ureters colitis, diverticulitis or colon cancer
47
LAPAROSCOPIC APPENDECTOMY Define/anatomy/physiology/pathophysiology/indication/special considerations
Excision of appendix using minimally invasive techniques Appendix, Mesoappendix (containing appendiceal vessels), Cecum Function is currently unclear Acute appendicitis Usually done on-call Set up just like general laparoscopy with added endo-GIA
48
Summarize procedure step sequence for COLON RESECTION (Colectomy)
I/H/D/R Mobilize colon, isolate from mesentery (blood supply) Clamps placed on colon, transect colon (stapler x 2 fires) Perform anastomosis (1 GIA; 1 TA) Remove contaminated items to prepare for clean closing Close mesentery; I/H/C/D
49
Summarize procedure step sequence for COLOSTOMY (LOOP)
I/H/D/R Open mesentery, place penrose Isolate loop of colon and bring it to abdominal wall through a separate incision Place bridge and secure colon I/H/C/D Then open the stoma and secure edges (with silk sutures)
50
Summarize procedure step sequence for LAPAROSCOPIC APPENDECTOMY
``` Establish laparoscopic access Grasp appendix (endoBabcock) Make window in mesoappendix Transect appendix at cecum Transect mesoappendix Remove specimen (endobag PRN) I/H/desufflate/C/D ```
51
Volvulus | Intussusception
A twisting of the intestine | A telescoping of the intestine
52
APPENDECTOMY; OPEN Define/anatomy/physiology/pathophysiology/indication/special considerations
``` Excision of appendix Appendix, Mesoappendix (containing appendiceal vessels), Cecum Function is currently unclear Acute appendicitis Take longer to do ```
53
Summarize procedure step sequence for APPENDECTOMY; OPEN
I/H/D/R Grasp appendix (Babcock) Make window in mesoappendix and ligate Clamp base and place purse-string suture on cecum Ligate and excise appendix (contaminated); remove specimen Invert cecal stump; isolate instruments used I/H/C/D
54
Hemorrhoidectomy Define/anatomy/physiology/pathophysiology/indication/special considerations
Excision and ligation of enlarged anal cushions Rectum, Anus, Anal veins, Internal and external sphincters, Anal valves Defecation Enlarged anal cushions that prolapse and cause pain Frequently done as office procedure; those patients with 3rd or 4th degree prolapse are candidates for surgery Multiple techniques are available; surgeon choice Banding; coagulation; sclerotherapy; stapled hemorrhoidectomy Maintain patient dignity
55
Summarize procedure step sequence for Hemorrhoidectomy
Dilate anal canal; place anoscope or retractor/s Grasp hemorrhoid Ligate and excise hemorrhoid Reinforce with suture by over-sewing area Repeat PRN Hemostasis/Dress

Surginal Procedures (14 decks)

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