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Flashcards in Surgical Procedures Deck (101)
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1

What are the 2 classifications of people in the OR?

Sterile and nonsterile

2

Who is part of the sterile team?

Surgeon, surgical assistant, physician assistant, scrub nurse, CST(Certified surgical tech)

3

Who is part of the non sterile team?

Anesthesia provider, circulator, radiographer, others

4

What clothing/items may be worn in surgery?

protective eyewear, masks, shoe covers, caps, gloves, radiation and ID badges, lead aprons

5

What is the purpose of wearing specific things in surgery?

To maintain a sterile environment

6

When a person is sterile there are parts of them that are sterile and parts that are not. You need to be able to describe these parts.

Their back, shoes, everything waist down is nonsterile

7

What are some rukes you should follow in the OR if you are not sterile to keep from breaking sterile field?

Don't reach over a sterile field, cover nonsterile items, move back to back with sterile persons, watch front of clothing don't lean over and let it get close to anything sterile

8

What must be done if a sterile field is broken?

The field will have to be made sterile again. Basically start the process over

9

What are the steps of making an IR sterile and unsterile?

To make an IR sterile:
Step 1: A sterile person (CST) will open a sterile bag.
Step 2: You (a non-sterile person) will carefully place the IR in the bag. DO NOT touch any part of the bag with the exception of the inside!!!
Step 3: The CST will carefully wrap the bag around the IR.
Getting the exposed IR back:
Step 1: The radiographer puts on gloves!
Step 2: The radiographer carefully takes the IR in the bag.
Step 3: The radiographer carefully removes the IR so as not to get body fluids/blood on themselves or the equipment.
Step 4: Properly dispose of the contaminated bag.
Step 5: Use a hospital approved disinfectant to wipe down the outside of the IR before leaving the OR.

10

Be able to name some things that increase the risk of a sterile field becoming contaminated

long procedure, crowded room, poor lighting, staffing levels(too high or too low), don't place anything sterile on the floor

11

Why should a radiographer be familiar with the equipment they will use in the OR?

Smoother flow and less mistakes

12

What are some types of equipment used in surgery?

C_arms, portable, In room urologic equipment (not mobile), Stereotactic equipment (not mobile)

13

What do you clean the surgery equipment used in surgery?

hospital approved cleaner

14

How often should surgical equipment be cleaned

after each surgical case

15

How far should the radiographer stand from the radiation source?

As far as possible. Minimum of 6ft

16

Where should the tube of the C arm be placed in respect of the patient?

Under the patient

17

Who in the surgical suite should wear lead and radiation doses

Everyone other than the patient

18

Where in respect to the primary beam is there less scatter radiation?

right angle

19

What are the 2 parts of the digestive system?

Accessory glands and alimentary canal

20

What are the accessory glands?

Liver and gall bladder, pancreas, salivary glands

21

The alimentary canal extends between what two structures

Mouth and anus

22

What are the 4 layers of the alimentary canal?

fibrous, muscular, submucosal, mucosal

23

The junction where the esophagus meets the stomach is termed as

cardiac sphincter

24

What is the cardiac antrum?

terminal end of the esophagus

25

The esophagus is ____ the spine.

Anterior

26

What are the four parts of the stomach

cardia, fundus, body, pylorus

27

What is ruggae?

folds

28

What is the lesser curvature?

right border of stomach

29

What's the greater curvature?

left border of the stomach

30

What is chyme?

food after the stomach has processed it

31

What is the pyloric sphincter?

Between the stomach and small intestine

32

What is the cardiac sphincter?

Between esophagus and stomach

33

The small intestine extends from what two points?

Pyloric sphincter to ileocecal valve

34

Absorption of nutrients occurs in what part of the alimentary canal?

Small intestine

35

what's the length of the small intestine is?

22 feet

36

What are villi??

finger-like projections

37

What are the three parts of small intestine?

Duodenum, jejunum, ileum

38

What are gyri?

free moving loops in the jejunum and ileum

39

The head of the pancreas is cradled in the ____ of the duodenum.

C loop or 2nd portion

40

The duodenal bulb is what part of the duodenum?

first of the four parts

41

What is the hepatopancreatic ampulla? Where is it located?

It is where the common bile duct and pancreatic duct meet on the 2nd portion of the duodenum

42

What are the 4 parts of the large intestine?

cecum, colon, rectum, anal canal

43

How long is the large intestine?

5 feet long

44

What is the haustra?

pouches within the large intestine

45

What is the ileocecal valve?

located between small intestine and large intestine

46

What is the vermiform appendix?

Attached to cecum

47

What are the subdivisions of the colon?

Ascending, right colic flexure, left colic flexure, transverse, descending

48

What is the largest organ of the body?

liver

49

What is the function of the liver?

produces bile and stores it in the gall bladder

50

What divides the liver into right and left halves?

falciform ligament

51

What is the smallest lobe of the liver?

caudate lobe

52

BE able to describe how the ducts converge in the biliary system?

The right and left hepatic ducts combine together to create the common hepatic duct which combines with the cystic duct to create the common bile duct.

53

What is the sphincter of Oddi?

muscle that controls bile at the hepatopancreatic ampula

54

What is the gall bladder?

thin walled pear shaped sac that holds bile until cholecystokinin stimulates release of bile for digestion

55

____ stimulates the gall bladder to contract and release bile.

Cholecystokinin

56

Does the pancreas aid in digestion?

Yes it creates digestive enzymes

57

What are the parts of the pancreas?

Head, neck, body, tail, uncinate process

58

What are the parts of the urinary system?

2 kidneys, 2 ureters, urethra, urinary bladder

59

What is the smallest functioning unit of the urinary system?

nephron

60

Where do the kidneys and ureters lie?

in the retroperitoneium

61

Urinary system functions?

Removes waste, maintains fluid balance, controls blood pressure and other body functions

62

What are the draining branches of the urinary system?

calyces

63

Where is the renal pelvis located?

Immediately before ureter

64

What is the renal capsule?

outer covering

65

What is the renal cortex?

outer tissue

66

What is the renal medulla?

inner tissue contains collecting tubules

67

Renal pyramids are located where?

In the renal medulla

68

What is the uretropelvic junction?

Located between the ureter and the renal pelvis. Common place for stones to lodge.

69

What's the ureterovesical junction?

Where the ureter joins the bladder (part of trigone)

70

What's the trigone?

Two ureteral openings and internal urethral orifice

71

The urethra passes through what organ on a male?

Prostate

72

Does the bladder have rugae?

Yes

73

When is surgical cholangiography performed?

during biliary tract surgery

74

What does surgical cholangiography show? Be specific.

The ducts in and out of the liver(intrahepatic and extrahepatic)

75

Can surgical cholangiography be done in the presence of obstruction?

NO

76

What things might the doctor be looking for in surgical cholangiography ?

Tiny calculi that may not otherwise be seen, neoplasms within the duct, stricture of dilation of the ducts, function of the ampulla of vater/sphincter of oddi

77

surgical cholangiography is usually done in conjunction with what other surgical procedure?

Cholecystectomy

78

surgical cholangiography is usually performed these days by?

By using a T-tube, needle, or small catheter

79

In surgical cholangiography the patient may need to be tilted in a certain position to aid in filling of the ducts.. What position is it?

Trendelenburg

80

What is ERCP used to diagnose?

Biliary and pancreatic pathology

81

Can ERCP be done when biliary ducts are dilated or obstructed?

NO

82

How do you do surgical ERCP?

How is it done?
A fiberoptic scope is passed down the patient’s throat and down into the duodenum.
Fluoroscopy is used to guide its way.
No food or drink 1 hour post procedure since the pharynx is paralyzed from the anesthetic.
Food may be held up to 10 hours to decrease irritation to stomach and small bowel

83

What is cystography?

A bladder examination

84

What is cystourethrography?

bladder examination includes inspection of urethra

85

What is retrograde urography?

Contrast is introduce against the normal flow of urine

86

What type of contrast is utilized for these studies?

Same as IVU may use reduced concentration
Denser=ducts well seen, but stones may be missed.
Diluted=stones better seen

87

What type of lab test should be done prior to these studies?

Kidney function/diabetic
BUN and creatine

88

Prep?

NPO after midnight

89

How do they inject the contrast for these studies?

Catherization-contrast is injected directly into the pelvicaliceal system

90

What are some indications for retrograde urography?

Vesicoureteral reflux
Recurrent lower urinary tract infections
Posterior urethral valves(only happens in males)

91

What are some contraindications for retrograde urography?

If the patient has a reason they cannot be catheterized

92

What position is the patient in for retrograde urography?

modified lithotomy position

93

What images are taken for retrograde urography?

AP scout, AP pyelogram, AP ureterogram

94

In retrograde urography what might need to be done to better fill the pelvicalceal system? What if you want to better see the ureters?

-Head of bed may need to be lowered 10-15 degrees to keep contrast within the kidneys and not let it go down into the ureters-- AP pyleogram
-Head of table may be raised 35-40 degrees for the ureters to be well filled and the kidneys to be allowed to move. -- AP ureterogram

95

An AP ureterogram demonstrates what 2 things?

tortuosity of ureters and mobility of kidneys

96

In cystography what projections are taken?

AP, AP axial, AP Oblique(60 degree rotation), Lateral

97

AP Bladder or AP Axial Urinary Bladder
Patient Position:
CR:
Structures Seen:

Patient Position: Supine on table with legs stretched out.
CR: 10-15 degrees caudal; enters 2” above the pubic symphysis. –or- Perpendicular same entrance.
Structures Shown: AP Axial projection –or- AP projection of the bladder filled with contrast. If reflux is present then the distal ureters are also visualized.

98

AP Oblique Projection


Patient Position: Rotated in an RPO or LPO position (40-60 degree rotation).
Central Ray: Perpendicular; enters 2” above the pubic symphysis and 2” medial the up ASIS.
Structures Shown: Oblique projections of the bladder filled with contrast. If reflux is present then the distal ureters will be seen too.

99

Lateral Projection


Patient Position: Lateral Recumbent
Central Ray: Perpendicular; 2” above the pubic symphysis on MCP.—can use greater trochanter
Structures Shown: Lateral contrast filled bladder. Distal ureters when reflux is present. Lateral and Posterior bladder walls and the base of the bladder

100

Males: AP Oblique Projection (RPO/LPO)


Patient Position: Patient rotated 35-40 degrees so that the urethra can be seen without superimposition.
The radiographer will take the image as the physician is injecting contrast so that the urethra can be fully seen.

101

Female: AP Voiding Projection


Patient Position: Supine
Angle tube 5 degrees caudal to see bladder neck elongated.
The physician will fill the bladder with contrast and images are taken as the patient voids.