Pre-op 101 & Procedures

Question 1

When can a patient eat prior

to major surgery?

Answer 1

Patient should be NPO after midnight
the night before or for at least 8 hours
before surgery

Question 2

What risks should be discussed
with all patients and
documented on the consent
form for a surgical procedure?

Answer 2

Bleeding, infection, anesthesia, scar;
other risks are specific to the individual
procedure (also MI, CVA, and death if
cardiovascular disease is present)

Question 3

If a patient is on antihypertensive
medications, should
the patient take them on the
day of the procedure?

Answer 3

Yes, (remember clonidine “rebound”)

Question 4

If a patient is on an oral
hypoglycemic agent (OHA),
should the patient take the
OHA on the day of surgery?

Answer 4

Not if the patient is to be NPO on the

day of surgery

Question 5

If a patient is taking insulin,
should the patient take it on
the day of surgery?

Answer 5

No, only half of a long-acting insulin
(e.g., lente) and start D5 NS IV; check
glucose levels often preoperatively,
operatively, and postoperatively

Question 6

Should a patient who
smokes cigarettes stop
before an operation?

Answer 6

Yes, improvement is seen in just 2 to

4 weeks after smoking cessation

Question 7

What laboratory test must
all women of childbearing
age have before entering
the O.R.?

Answer 7

-HCG and CBC because of the possibility

of pregnancy and anemia from menses

Question 8

What is a preop colon

surgery “bowel prep”?

Answer 8

Bowel prep with colon cathartic (e.g.,
GoLYTELY), oral antibiotics (neomycin
and erythromycin base), and IV antibiotic
before incision

Question 9

Has a preop bowel prep
been shown conclusively to
decrease postop infections
in colon surgery?

Answer 9

No, there is no data to support its use

Question 10

What preoperative
medication can decrease
postoperative cardiac events
and death?

Answer 10

-blockers!

Question 11

What must you always order
preoperatively for your
patient undergoing a major
operation?

Answer 11

1. NPO/IVF
2. Preoperative antibiotics
3. Type and SCREEN blood (PRBCs)

Question 12

What electrolyte must you
check preoperatively if a
patient is on hemodialysis?

Answer 12

Potassium

Question 13

Who gets a preoperative

ECG?

Answer 13

Patients older than 40 years of age

Question 14

Roux-en-Y limb

Answer 14

Jejunojejunostomy forming a Y-shaped
figure of small bowel; the free end can
then be anastomosed to a second hollow
structure (e.g., esophagojejunostomy)

Question 15

Brooke ileostomy

Answer 15

Standard ileostomy that is folded on
itself to protrude from the abdomen
2 cm to allow easy appliance placement
and collection of succus

Question 16

CEA

Answer 16

Carotid EndArterectomy; removal of atherosclerotic

plaque from a carotid artery

Question 17

Bassini herniorrhaphy

Answer 17

Repair of inguinal hernia by approximating
transversus abdominis aponeurosis
and the conjoint tendon to the reflection
of Poupart’s (inguinal) ligament

Question 18

McVay herniorrhaphy

Answer 18

Repair of inguinal hernia by
approximating the transversus abdominis
aponeurosis and the conjoint tendon to
Cooper’s ligament (which is basically the
superior pubic bone periosteum)

Question 19

Lichtenstein

herniorrhaphy

Answer 19

“Tension-free” inguinal hernia repair using

mesh (synthetic graft material)

Question 20

Shouldice herniorrhaphy

Answer 20

Repair of inguinal hernia by imbrication
of the transversalis fascia, transversus
abdominis aponeurosis, and the conjoint
tendon and approximation of the transversus
abdominis aponeurosis and the
conjoint tendon to the inguinal ligament

Question 21

Plug and patch hernia

repair

Answer 21

Prosthetic plug pushes hernia sac in and
then is covered with a prosthetic patch to
repair inguinal hernias

Question 22

APR

Answer 22

AbdominoPerineal Resection; removal
of the rectum and sigmoid colon through
abdominal and perineal incisions (patient
is left with a colostomy); used for low
rectal cancers 8 cm from the anal verge

Question 23

LAR

Answer 23

Low Anterior Resection; resection of
low rectal tumors through an anterior
abdominal incision

Question 24

Hartmann’s procedure

Answer 24

1. Proximal colostomy
2. Distal stapled-off colon or rectum that
   is left in peritoneal cavity

Question 25

Mucous fistula

Answer 25

Distal end of the colon is brought to the abdominal skin as a stoma (proximal end is brought up to skin as an end colostomy)

Question 26

Kocher (“koh-ker”) | maneuver

Answer 26

Dissection of the duodenum from the right-sided peritoneal attachment to allow mobilization and visualization of the back of the duodenum/pancreas

Question 27

Highly selective | vagotomy

Answer 27

``` Transection of vagal fibers to the body of the stomach without interruption of fibers to the pylorus (does not need pyloroplasty or other drainage procedure because the pylorus should still function) ```

Question 28

Enterolysis

Answer 28

Lysis of peritoneal adhesions

Question 29

LOA

Answer 29

Lysis Of Adhesions (enterolysis)

Question 30

Appendectomy

Answer 30

Removal of the appendix

Question 31

Lap appy

Answer 31

Laparoscopic removal of the appendix

Question 32

Cholecystectomy

Answer 32

Removal of the gallbladder

Question 33

Lap chole

Answer 33

Laparoscopic removal of the gallbladder

Question 34

Nissen

Answer 34

Nissen fundoplication; 360 wrap of the stomach by the fundus of the stomach around the distal esophagus to prevent reflux

Question 35

Lap Nissen

Answer 35

Nissen fundoplication with laparoscopy

Question 36

Simple mastectomy

Answer 36

Removal of breast and nipple without | removal of nodes

Question 37

Choledochojejunostomy

Answer 37

``` Anastomosis of the common bile duct to the jejunum (end to side) ```

Question 38

Graham patch

Answer 38

Placement of omentum with stitches over a gastric or duodenal perforation (i.e., omentum is used to plug the hole)

Question 39

Heineke-Mikulicz | pyloroplasty

Answer 39

Longitudinal incision through all layers of the pylorus, sewing closed in a transverse direction to make the pylorus nonfunctional (used after truncal vagotomy)

Question 40

Pringle maneuver

Answer 40

Temporary occlusion of the porta hepatis (for temporary control of liver blood flow when liver parenchyma is actively bleeding)

Question 41

Modified radical | mastectomy

Answer 41

``` Removal of the breast, nipple, and axillary lymph nodes (no muscle is removed) ```

Question 42

Lumpectomy and | radiation

Answer 42

Removal of breast mass and axillary lymph nodes; normal surrounding breast tissue is spared; patient then undergoes postoperative radiation treatments

Question 43

I & D

Answer 43

Incision and Drainage of pus; the wound | is then packed open

Question 44

Exploratory laparotomy

Answer 44

Laparotomy to explore the peritoneal cavity looking for the cause of pain, peritoneal signs, obstruction, hemorrhage, etc.

Question 45

TURP

Answer 45

TransUrethral Resection of the Prostate; removal of obstructing prostatic tissue via scope in the urethral lumen

Question 46

Fem pop bypass

Answer 46

FEMoral artery to POPliteal artery bypass using synthetic graft or saphenous vein; used to bypass blockage in the femoral artery

Question 47

Ax Fem

Answer 47

Long prosthetic graft tunneled under the skin placed from the AXillary artery to the FEMoral artery

Question 48

Triple A repair

Answer 48

Repair of an AAA (Abdominal Aortic Aneurysm): Open aneurysm and place prosthetic graft; then close old aneurysm sac around graft

Question 49

CABG

Answer 49

``` Coronary Artery Bypass Grafting; via saphenous vein graft or internal mammary artery bypass grafts to coronary arteries from aorta (cardiac revascularization) ```

Question 50

Hartmann’s pouch

Answer 50

Oversewing of a rectal stump (or distal colonic stump) after resection of a colonic segment; patient is left with a proximal colostomy

Question 51

PEG

Answer 51

``` Percutaneous Endoscopic Gastrostomy: Endoscope is placed in the stomach, which is then inflated with air; a needle is passed into the stomach percutaneously, wire is passed through the needle traversing the abdominal wall, and the gastrostomy is then placed by using the Seldinger technique over the wire ```

Question 52

Ileoanal pull-through

Answer 52

Anastomosis of the ileum to the anus | after total proctocolectomy

Question 53

Hemicolectomy

Answer 53

Removal of a colonic segment | i.e., partial colectomy

Question 54

Truncal vagotomy

Answer 54

``` Transection of the vagus nerve trunks; must provide drainage procedure to stomach (e.g., gastrojejunostomy or pyloroplasty) because after truncal vagotomy, the pylorus does not relax ```

Question 55

Antrectomy

Answer 55

Removal of stomach antrum

Question 56

Whipple procedure

Answer 56

``` Pancreaticoduodenectomy: Cholecystectomy Truncal vagotomy Pancreaticoduodenectomy—removal of the head of the pancreas and duodenum Choledochojejunostomy Pancreaticojejunostomy (anastomosis of distal pancreas remnant to the jejunum) Gastrojejunostomy (anastomosis of stomach to jejunum) ```

Question 57

Excisional biopsy

Answer 57

``` Biopsy with complete excision of all suspect tissue (mass) ```

Question 58

Incisional biopsy

Answer 58

``` Biopsy with incomplete removal of suspect tissue (incises tissue from mass) ```

Question 59

Tracheostomy

Answer 59

Placement of airway tube into trachea | surgically or percutaneously