Midterm Examination Prep Flashcards by Terry Herring

NOTES

Natural orifice transluminal endoscopic surgery

Surgeon must open a closed viscera intentionally to access the abdomen. Complications related to the failure of that opening to heal after closure can result in peritonitis.

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The head of the pancreas is fixed to the:

Duodenum.

The pancreas is a fixed structure lying transversely behind the stomach in the upper abdomen. The head of the pancreas is fixed to the curve of the duodenum.

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Potential risk associated with pneumoperitoneum

Gas embolus into an exposed blood vessel during the procedure

Elevated CO2 levels and respiratory acidosis may occur because CO2 diffuses into the patient’s bloodstream during laparoscopy

Subcutaneous emphysema has a characteristic crackling-feel to the touch, a sensation that has been described as similar to touching warm Rice Krispies.

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Inguinal ligament, rectus abdominis muscle, deep epigastric vessels

Boundaries of the Hesselbach triangle

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TEP Repair

Totally extraperitoneal patch (TEP) laparoscopic hernia repair technique

A balloon dissector is placed on the anterior surface of the posterior rectus sheath and inflated, thereby creating an optical cavity.

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Identify A in the Diagraph

Bartholin’s Glands

Bartholin’s glands and ducts are located on each side of the lower end of the vagina at the 5 and 7 o’clock positions, secrete mucus.

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Identify A in the Diagrapm

This structure is the flexure at the junction of the duodenum and jejunum. Maybe referred to as the suspensory ligament.

Ligament of Treitz

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Identify the area within the red line

Triangle of Doom

During the placement of the mesh it is vital that the surgeon does not place any staples in the shaded triangle area

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This structure provides the arterial supply to the bladder

Internal iliac

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Identify A (blue line) in the diagram.

This structure is the anatomical division between the inguinal and femoral regions. Also, may be referred to an inguinal ligament.

Poupart’s ligament

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Identify A in the diagram

The cystic artery arises from this structure.

Right hepatic artery

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Identify A in the diagram

This ligament encloses the round ligament and extends from the lateral surface of the uterus to the pelvic wall.

Broad

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Name the 3 anatomic sites of abdominal wall weakness with a potential for hernias

Inguinal canal
Femoral rings
Umbilicus

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Identify the Blue Structure

Spleen

A total spleen is performed for multiple reasons, including trauma to the spleen

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Stores and concentrate bile

Gallbladder

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Reason a laparoscopic adjustable gastric banding (LAGB) would be performed

Obesity

Bariatric surgery, also termed weight loss or weight reduction surgery, is surgical treatment of obesity

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What does triangulation mean:

Laparoscopic port incisions

Traditional laparoscopic port placement, via triangulation, is the fundamental concept of laparoscopic surgery.

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Identify the type of incision

McBurney

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Identify A in the Diagram

Pilonidal cyst

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Removal of the head of the pancreas, the entire duodenum, a portion of the jejunum, the distal third of the stomach

Whipple procedure

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Advantages of Robotic Surgery

The robot extends the surgeon’s skills by providing a 360-degree range of motion that is not possible with traditional laparoscopic instruments

Other advantages include:

Reduced post-surgery pain
Less blood loss
Fewer and smaller scars
Increased precision for more accurate joint replacements
Faster recovery
Shorter hospital stay
Less risk of infection

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Identify A in the Diagram

Femoral Hernia

Femoral hernias occur much more frequently in women, and only 2% of women will develop inguinal hernias in their lifetime

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What type of hernia occurs within the Hesselbach triangle

Direct inguinal hernia

Hernias that occur within the Hesselbach triangle are called direct inguinal hernias. Indirect inguinal hernias occur laterally to the deep epigastric vessels.

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Why would surgeon have to perform an open common bile duct (CBD) exploration

Prior biliary surgery.

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What has happened it the diagram

Incarcerated hernia Patients with incarcerated hernias may have signs of intestinal obstruction, such as vomiting, abdominal pain, and distention.

Identify the fascia in the diagram (labeled A) Key landmark of the roof of inguinal canal

Transversalis fascia

Which laparoscopic hernia repair provides access to the preperitoneal space without entering the peritoneum

TEP - Totally extraperitoneal

What action does the ova travel through the fallopian tubes toward the uterus

Peristalsis

What can be inquired if the arms are extended beyond the 90 degree angle

Brachial plexus injury.

What surgical procedure is usually done to treat CIS (Carcinoma in situ) of the vulva when it is multicentric

Simple vulvectomy

Intravasation of the fluid during a hysteroscopy can lead to what disorder, marked by the sodium level in the blood is below normal

Hyponatremia The absorption of glycine solution into the extracellular space will make the blood hypertonic with a higher volume, which will draw the fluid outside the cells. Both events, in turn, will cause hyponatremia due to the dilutional effect.

What drugs usually cause hormonal stimulation of the uterus

Oxytocics Oxytocics are medications that increase motor activity within the uterus by hormonal stimulation or by direct stimulation on the smooth muscles, usually resulting in uterine contractions. They may be used intraoperatively and postoperatively. The following are some nursing considerations after their administration: monitor blood pressure, assess for continued bleeding, and monitor fundal response to the drug.

Identify A - this structure is located between the bladder neck and the urethra

Prostate

Endoscopy of the genitourinary tract is considered what wound classification

Class II (clean-contaminated)

What is the hormone that controls your body’s metabolism, the process in which your body transforms the food you eat into energy

Thyroid hormones

Condition where the thyroid doesn’t create and release enough thyroid hormone into your bloodstream. This makes your metabolism slow down. Also called underactive thyroid, can make you feel tired, muscle cramps, gain weight and be unable to tolerate cold temperatures

Hypothyroidism

Occurs when one or more milk ducts beneath your nipple widens. The duct walls may thicken, and the duct may fill with fluid. The milk duct may become blocked or clogged with a thick, sticky substance. The condition often causes no symptoms, but some women may have nipple discharge, breast tenderness or inflammation of the clogged duct

Ductal ectasia

What is a FNAB

Fine-needle aspiration biopsy Usually the fluid is sent for cytology study

What organ is usually removed using the incision within the diagram

Spleen

Identify A in the Diagram.

Inferior Rectal Artery When the perineal dissection is being performed, the inferior rectal artery should be identified, ligated and divided

Identify A and B in the Diagram

A = Cecum B = Ileocecal value During an open appendectomy, it is necessary to identify these 2 structures

Identify A in the Diagram

Gastric artery When assisting on a Nissen Fundoplication you don't want to place too much medial traction, it will rip and start bleeding

Identify A and B in the Diagram. These structures provide arterial blood supply to the thyroid

A = External Carotid B = Superior Thyroid

Identify A in the Diagram. This structure forms an envelope around the spermatic cord

Cremaster Muscle The cremaster muscle arises from the internal oblique and inguinal ligament. It surrounds the spermatic cord and testis. The muscle is supplied by the genitofemoral nerve

Identify A in the Diagram. This is connective tissue that surrounds the kidney

Gerota's Fascia

Identify drain. Can be placed in the CBD to allow drainage

T-Tube

Sudden onset anterior chest pain, shortness of breath, and sweating profusely are signs of what condition.

Pulmonary embolism A pulmonary embolism is a postoperative complication of laparoscopic Roux-en-Y. Sudden onset anterior chest pain, shortness of breath, and sweating profusely are all signs of pulmonary embolism.

What part of the colon is likely to be affected by ulcerative colitis

Rectum Transverse colon

Lasers that are most often used in GYN surgery

CO2 Nd:YAG

Why would the surgeon attach a loop of jejunum with the side of the esophagus after a total gastrectomy

Prevent regurgitation esophagitis

This structure is formed by the cystic duct, common hepatic duct, and the lower edge of the liver.

Triangle of Calot

Identify A in the diagram. This structure is likely to be injured when performing a CBD exploration.

Hepatic Artery

These are a series of archades along the mesenteric border through the length of the colon.

Marginal Artery of Drummond

These structures are parallel, equally distributed, and form a triple helix structure from the appendix to the sigmoid colon. Often used as a landmark when performing appendectomy.

Taeniae coli

Identify A in the diagram. This nerve must be dissected from the lesser curvature of the stomach whenever performing a highly selective vagotomy

Nerves of Latarjet

The right colic artery is a branch of what structure. This artery supplies the ascending colon. See A on the diagram.

Superior mesenteric artery

There are two methods for creation of a pneumoperitoneum: open and closed. The closed method involves blind puncture using a Verres needle. What can be performed to help the surgeon know if he/she is within the abdominal cavity

Use a syringe with saline

A ruptured appendix with no visual bowel contents represents what wound classification

Class IV - Dirty Infected Perforated viscera indicate a class IV wound.

Identify A in the diagram. The cystic duct arises from this structure.

Right Hepatic Artery

Trace urine from kidney to the bladder

Bowman's capsule, collecting ducts, renal calyx, renal pelvis, and ureter

The main nerve of the perineum

Pudendal nerve

What artery serves as principal blood supply to the splenic flexure of the colon

Inferior Mesenteric Artery

The anatomic region boarded by the cystic duct, the common hepatic duct, and the cystic artery is referred to as:

Calot's Triangle

Identify A in the diagram. These structures provide blood supply to the pancreas

Superior Mesenteric Artery/Vein

Identify A in the diagram. Branch of the external carotid artery, and supplies blood to the thyroid

Superior Thyroid

The major parenchymal cells in the liver, are responsible for a variety of cellular functions including carbohydrate, lipid and protein metabolism, detoxification and immune cell activation to maintain liver homeotasis. Recent studies show hepatocytes play a pivotal role in liver inflammation

Hepatocytes

Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.

From the neck to midthigh; bedline to bedline

When both direct and indirect hernias are present, the defect is called:

Pantaloon Hernia Also known as a saddlebag hernia

Patient has a hernia with a short, wide neck, and a thick-walled sac, what type of hernia:

Congenital In a congenital hernia, the hernia sac has a small neck , is ... In an acquired indirect hernia the neck is wide, and the sac is both short and thick walled.

The characteristic “reducible” hernia:

Visceral contents can be returned to the abdomen

What's the problem with prolonged Trendelenburg

Decreased pulmonary compliance and functional residual capacity

A procedure to closely examine your cervix, vagina and vulva for signs of disease, often performed on patients who have an abnormal Pap smear

Colposcopy

Identify A in the diagram, renal artery and vein enter and exit the kidney on the medial side

Hilum

Surgical method of treating benign obstructive enlargement of the prostate gland

TURP

What kind of urology catheters include the open-ended, whistle tip, cone tip, and olive tip

Ureteral

Identify A in the diagram, a branch of the vagus nerve, innervates the intrinsic muscles of the larynx. During surgery, care is taken to identify and protect this nerve.

Recurrent Laryngeal Nerve

The most common form of malignant thyroid nodule is a poorly encapsulated. Patient will have total thyroidectomy

Papillary carcinoma

Breast surgery procedure is also called the nipple-sparing technique (NSM)

Subcutaneous mastectomy

What part of the colon is the anvil of the EEA is inserted into

Sigmoid

What angle of scope is most often used for a laparoscopic cholecystectomy

30 degree lens

Involves resection of the head of the pancreas, duodenum, and segments of the stomach and jejunum

Pancreaticoduodenectomy Segments of the stomach and jejunum with reconstruction of the duct of Wirsung, duct of Santorini, and Common bile duct

The most common structure involved in a sliding left indirect hernia

Sigmoid Colon

Identify A in the diagram, this muscle may be retracted during a thyroidectomy

Sternocleidomastoid

During a cholecystectomy, it is important to isolate this ligament, consisting of the common bile duct, hepatic artery, and portal vein

Hepatoduodenal Be sure to look at picture to see where the ligament is located

During a rectocele repair this muscle can be used to build up the perineum Identify A

Levator ani

Complication of steep reverse Trendelenburg position

Deep Vein Thrombosis

Identify A in the diagram. This structure can be injured in Lithotomy position, with the buttocks too far over the edge

Obturator Nerve

Identify A in the diagram. During an abdominal hysterectomy, the surgeon initially isolates the uterus by separating it from this structure

Round Ligaments

Identify A in the diagram. This is usually repaired in conjunction with a Nissen or Toupet Fundoplication

Hiatal Hernia

Identify A in the diagram. The tissue expander is placed below this muscle.

Pectoralis Major

Identify A in the diagram. Injury to this nerve can result in paralysis of the serratus anterior muscle, causing patient to have a winged scapula

Long Thoracic

Using the diagram, identify the purple triangle area. During a laparoscopic cholecystectomy, the infundibulum of the gallbladder is retracted to expose this structure

Triangle of Calot