Surgical Technology - General Surgery

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Chapter 14

Absorption

To take in or soak up

Anastomosis

Pathological, surgical, or traumatic formation of an opening between two normally separate organs

Ascites

Abnormal collection of fluid in the abdominal cavity

Bile

A secretion of the liver that breaks down fats, preparing them for digestion & absorption in the small intestine

chole-

Bile, gall

Chyle

A white liquid that consists of products of digestion, chiefly emulsifies fats, that passes through the small intestine into the lymphatic system

Chyme

The thick, semifluid contents of the stomach formed during digestion

-cysto

Cyst, urinary bladder, sac of fluid

-docho

Intestine

-ectomy

To remove/Removal of

Excision

Surgical removal

Incision

Cut made with a sharp instrument

lysis

Breaking down/Dissolving

Necrosis

Tissue death

-oma

Tumor, growth, neoplasm

-ostomy

Surgically creating a new opening or mouth

-otomy

Surgical incision, to cut

Parietal

1) Refers to the outer portion of a cavity or organ.
2) Pertaining to the parietal bone of the cranium.
3) Pertaining to the parietal lobe of the cerebrum

Peristalsis

Rythmic contractions of smooth muscle layers that force food through the GI tract urine through the ureters, and bile through the common bile ducts

Peritoneum

A thin serous membrane that lines the abdominal cavity

Portal venous system

Venous system that carries blood to a second capillary bed prior to returning blood to the general circulation

-stasis

Controlling/Stopping the flow of

stenosis

Narrowing/Tighting

Ulcer

A crater-like lesion that is usually circular in shape & penetrates the skin; may be very deep, resulting from infection

Viscera

Any organ of a body cavity

Nine regions of the abdomen

...

Which section contains the majority of the small intestines:

Hypogastric Region

Four Quadrants of the abdomen

Splenic Flexure

LLQ

Appendix

RLQ

Most of the stomach

LUQ

Liver

RUQ

Head of pancreas

RUQ

Sigmoid Colon

RLQ

Tail of pancreas

LUQ

Spleen

LUQ

Duodenum

RUQ

Cecum

RLQ

Gallbladder

RUQ

Left ovary

LLQ

Linea alba literally means_____ ____ and will be found in the ______ abdominal wall.

white line; rectus

Identify where the bilateral abdominocrural creases are located

Between the thigh & abdomen

Identify the two layers of the peritoneum

Parietal & Visceral

What is the primary function of the peritoneum

Provide a slippery surface of which the viscera can glide

Identify the three regions of the retroperitoneal space and the organs that are located in each

Anterior pararenal; Pancreas and parts of the duodenum and colon.
Parirenal; Holds structures of the ruologic & vascular concern
Posterior pararenal; Contains NO organs

Trace the alimentary pathway

Mouth; Uvula; Pharynx; Epiglottis; Esophagus; Cardiac sphincter; Fundus of stomach; Cardia of stomach; Body of stomach; Pylorus of stomach; Pyloric sphincter; Duodenum; Jejunum; Ileum; Ileocecal valve; Cecum; Ascending colon; Hepatic flexure; Transverse colon; Splenic flexure; Descending colon; Sigmoid colon; Rectum; Anus.

Lower GI tract

Ileocecal valve; Cecum; Ascending Colon; Hepatic flexure; Transverse colon; Splenic flexure; Descending colon; Sigmoid colon; Rectum; Anus

Biliary tree

Structures & Segments of the stomach

Identify the five major segments of the stomach and the purpose of each section

Cardia; secretes mucous to ease passage of food. Fundus; produces hydrochloric acid. Corpus; produces acid & secretes pepsinogen & mucous. Antrum; non-acid producing secretes mucous & gastrin. Pylorus; food storage area before is passes in the duodenum.

The folds of the stomach are called

Rugae

Parasympathetic innervation to the stomach is provided by the ______ nerve. This nerve and the main left and right gastric arteries run primarily along ________ of the stomach. The left gastroepiploic artery is located primarily along the _____ of the stomach.

Vagus;

The four layers of the wall of the digestive tract are

Mucousa; Submucousa; Muscularis External; Serosa

The enzyme amylase secreted in the oral cavity begins digestion of the food substance_____

Starch

The enzyme pepsinogen secreted in the stomach begins digestion of the food substance_____

Protein

Bile secreted in the duodenum works to emulsify the food substance_____

Fat

Emulsification

The breaking down of large fat globules into the intestines into smaller, uniformly distributed particles

The enzyme lipase begins digestion of the food substance_____

Fat

The small intestine is responsible for the digestion and absorption of_____

Food & nutrients

The large intestine is responsible for absorption of_____

Water & electrolytes

The movement of food through the intestines by the muscles of the alimentary canal is called______

Parastalis

What is the purpose of the mesentary?

Contain blood vessels, nerves, and lymph vessels that serve the adjoining organs.

Describe the typical location of the appendix.

RLQ; Attached to the cecum

What is the purpose of the mesoappendix?

It supplies blood to the appendix

Gallbladder, bile ducts, and porta hepatic

The three segments of the gallbladder manipulated during removal include:

Fundus, body, Hartman's Pouch

The biliary tree outlined during an intraoperative cholangiogram my include:

R & L Hepatic ducts, Common hepatic duct, Cystic duct, Common bile duct.

What is the function of the Sphincter of Oddi?

Controls the flow of bile into the duodenum

Identify the duct(s) that transport enzymes from the pancreas to duodenum.

Duct of Santorini, Duct Wirsung

The pancreas is classified as both an________and_________gland.

Exocrine; Endocrine

Where are the islets of Langerhans located and what is their function?

In the pancreas for the production of insulin.

What is the largest parenchymal organ in the normal abdominal cavity. Identify the blood supply of this organ.

Liver; Hepatic portal vein

List the functions that are performed by the cells of the liver.

Produce bile; Metabolize carbs, fats, & proteins; Store sugar as glycogen; Store fat soluble vitamins, A,D,E & K, plus iron & copper; Detoxify harmful substances via phagocytosis.

List the significant tissues and landmarks of the groin area.

Skin & subcutaneous tissues, Scarpa's fascia, interparietal fascia, internal oblique muscle, transverse abdominus muscle, transversalis fascia, Cooper's ligament, rectus abdominus muscle and peritoneum.

An indirect hernia occurs at the_______ring and may extend to the______ring.

...

Indirect inguinal hernia

Direct inguinal hernia

A direct hernia occurs withing

the Hesselbach's triangle;

Femoral hernia

A femoral hernia occurs as a defect in the

Abdominal wall

Inguinal hernias occur_____the abdominocrural crease; femoral hernias occur_____the abdominocrural crease

...

Varicose veins

Normal veins that become elongated, dilated and tortous

Where can varicose veins occur?

Lower extremity, but can also be; lower esophagus, spermatic cord, and in anorectal region.

What is the major function of the thyroid gland?

Makes, stores and releases the hormones, T4 & T3.

What nerve requires careful dissection during thyroid surgery?

The laryngeal nerve

Describe the parathyroid glands

Number from 2-6 and are small, flat, oval structures lying on the dorsal side of the thyroid gland.

What happens if all parathyroid glands are removed?

Tetany

Sac or pouch/enlargement of intestinal wall

Diverticulum

Mucosal growth considered a precursor to dysplasia

Polyp

Telescoping of intestine within itself

Intussception

Twisting of bowel

Volvulus

Occurs in the sacrococcygeal area with sinus formation

Pilonidal disease

Difficulty swallowing due to motility disorder

Dysphagia

Hiatal hernia causing mucosal trauma

Reflux disease

Perianal abscess

Fistula-in-ano

Congenital outpouching located in the ileum

Meckel's diverticulum

Chronic condition with weight loss, abscess, or bleeding

Crohn's disease

Surgical intervention for prolonged intubation

Tracheostomy

Splenomegaly

Splenectomy

Severely increased basal metabolic rate (BMR)

Thyroidectomy

Elevated WBC count, rebound tenderness

Appendectomy

Multicentric ductal carcinoma, male or female

Radical mastectomy

Severe Crohn's disease

Right hemicolectomy

Cancer in the head of the pancreas removed

Whipple

Stage I or Stage II cancer without axillary node involvement

Mastectomy

Laceration of the spleen

Splenorrhaphy

Defect in abdominal wall affecting structures of spermatic cord, Scarpa's fascia, cremaster muscle

McVay repair

What are the two types of choleliths, and what is the composition of each?

Cholesterol stones; by-product of liver bile.
Pigment stones; composed of calcium biliruinate, bilirubin polymers, bile acids, irons & phosphors

Peptic ulcers are most frequently found in which location?

Inside the lining of the esophagus, stomach and the upper portion of small intestines.

Includes both direct and indirect hernias

Pantaloon hernia

Occurs usually at esophageal haitus

Diaphragmatic hernia

A direct or indirect hernia usually in men

Inguinal hernia

Acquired defect that occurs in Hesselbach's triangle

Direct hernia

Occurs congenital or acquired due to obesity or pregnancy

Umbilical hernia

Entrapment of organs, which cannot be returned to abdomen

Strangulated hernia

Most common in females/may entrap lymph nodes

Femoral hernia

Occurs on anterior abdominal wall

Ventral hernia

Usually congenital along spermatic cord

Indirect hernia

Entrapment that compromises vascularity

Incarcerated hernia

Thrombocytopenia is a deficiency of______in the blood.

Platelets

Which diagnostic tools will be useful in determining liver pathology?

Biopsy

Four causes of varicose veins of the lower extremity.

Heredity; Obesity; Pregnancy; Hypertension

Define gynecomastia, and describe the surgical treatment.

Development of breast tissue on a male; can be function and develop cancer.

Overatcivity of the thyroid gland is referred to as

Hyperthyroidism/Thyrotoxicosis

What is meant by the term "staging" in reference to malignant tumors?

...

Biopsy needle or Tru-Cut for liver biopsy.

Franklin Silverman

Maintains or enlarges size of esophagus

Maloney dilators/bougie

Manipulates vagus trunk during vagotomy

Nerve hook

Grasps bowel such as appendix

Babcock tissue forcep

Liver resection or liver laceration ---Yankauer tip

Cell saver required

Direct visualization placement of umbilical port

Hasson Trocar

Enlarges size of cystic duct and CBD

Bakes dilator

Decompress an engorged gallbladder

Ochsner GB trocar

Used for insertion of vascular access device

Hasson Trocar

Extends incision in vessel or duct

Potts Smith scissors

Removal of stones from duct

Randall forceps

Fistula incision guide

Prove/grooved director

Premoistened to manipulate spermatic cord/esophagus

Penrose drain

Clamps for occlusion on intestines

Allen clamp

Grasping hemorrhoids

Buie Pile forceps

Cholecystectomy

Supine AND Reverse Trendelenburg

Esophagectomy

Lateral

Pilonidal cystectomy

Kraske

Herniorrhaphy/Mastectomy

Supine

Endoscopic hernia repair

Supine AND Trendelenburg

A. RU Paramedian
B. LL Paramedian
C. R Subcostal
D. R Midline Transverse
E. Pfannenstiel

F. U Longitudinal midline
G. L Longitudinal midline
H. McBurney's
I. R Inguinol Oblique

J. R Thoracoabdominal

Closure mucosal layer of intestinal anastomosis

3-0 absorable continuous suture

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