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Absorption

To take in or soak up.

Anastomosis

Pathological, surgical, or traumatic formation of an opening between two normally seperate organs or spaces.

Ascites

Abnormal collection of fluid in the abdominal cavity.

Bile

Secreation of the liver that emulsifies fats, preparing them for further digestion and absorption in the SI.

Chole-

Combining form that means bile

Chyle

White liquid, consisting of products of digestion, mostly emulsified fats, passes in SI to lymphatics.

Chyme

Thick, semifluid contents of the stomach formed during digestion.

-cysto

Bladder

-docho-

Intestines

-ectomy

Removal of

Excision

Surgical removal

Incision

Cut made w/a sharp instrument ie scapel.

lysis

Dissolution, loosening, or destruction of something.

Necrosis

Tissue death

-oma

Tumor

-ostomy

Create a new opening.

-otomy

Make an incision into.

Parietal

Outer portion of a cavity or organ.

Peristalsis

Rythmis contractions of smooth muscle layers that force food through the GI tract/

Peritoneum

A thin serous membrane that lines the abdominal cavity.

Portal venous system

System that carries blood to a second capillary bed prior to returning blood to general circulation.

-stasis

Stoppage or decrease of flow of bodily fluids.

Stenosis

Narrowing or constriction.

Ulcer

Crator-like leison that is usually circular in shape and penetrates the skin; may be deep.

Viscera

Any organ of a body cavity; usually refers to the abdominal organs.

What organs are located in the RUQ?

Rt lobe of the liver, gallbladder, transverse colon, hepatic flexure, Rt. kidney (back), duodenum, and head of the pancreas.

What organs are located in the LUQ?

Lt. lob of the liver, stomach, transverse colon, splenic flexure, Lt. kidney (back), spleen, and tail of the pancreas.

What organs are located in the RLQ?

Cecum, appendix, ascending colon, small intestines, Rt. ureter, Rt. ovary and tube, and Rt. spermatic cord.

What organs are located in the LLQ?

Small intestines, sigmoid colon, descending colon, Lt. ureter, Lt. ovary and tube, and Lt. spermatic cord.

What are the 9 regions in the abdomen?

From R-L: R hypochondriac region, Epigastic region, L hypochondriac region, R lumbar region, Umbilical region, L lumbar region, R iliac region, Hypogastic, L iliac region.

What are the tissue layers from superficial - deep?

Skin, subcuticular, subcutaneous, fascia, muscle (rectus abdominis, internal and external oblique), peritoneum, abdominal organs.

The 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 and abdomen.

Identify the two layers of the peritoneum.

Parietal and visceral.

What is the primary function of the peritoneum?

Provide a slippery surface over which the viscera can freely glide.

ID the 3 regions of the retroperitoneal space and the organs that are located in each.

1) Anterior pararenal: Pancreas, and parts of the duodenum and colon. 2) Parirenal: Holds structures of the urologic and vascular concern. 3) Posterior pararenal: contains NO organs.

What is the pathway of the Upper Gastrointestinal Tract?

Mouth-Uvula-Pharynx-Epiglottis-Esophagus-Cardiac sphincter-Fundus of the stomach-Cardia of stomach-Body of the stomach-Pylorus of the stomach-Pyloric sphincter- Duodenum(Biliary tree connects here)-Jejunum-Ileum-Ileocecal valve.

What is the pathway of the Lower Gastointestinal Tract?

Ileocecal valve-Cecum-Ascending colon-Hepatic flexure-Transverse colon-Splenic flexure-Descending colon-Sigmoid colon-Rectum-Anus.

The xiphoid process is the____portion of the sternum.

Distal

The Gallbladder is found in the____abdominal quadrant.

Right upper

Another name for the iliac region of the abdomen is____.

Inguinal

The linea alba is found_____.

medially where the abdominal aponeuroses join.

The long, vertical, straplike muscle of the abdominal wall is the_____.

Rectus abdominis.

Another name for the alimentary canal is the______tract.

Digestive.

The inner layer of the digestive tract is called the_______.

Mucosa.

Parasympathetic innervation to the stomach is provided by the______nerve.

Vagus

The 3 portions of the SI are the_______.

Duodenum, ileum, and jejunum.

The appendix is attached to the______.

Cecum

Which of the following is a function of the omenta?

Limit peritoneal infection

What gland has both exocrine and endocrine functions?

Pancreas

What is the largest parenchymal organ in the abdominal cavity?

Liver

The outer layer of the digestive tract wall is called the______.

Serosa

Which of the following is a function of the colon?

Production of vitamin K

The beta cells of the islets of Langerhans are responsible of the production of_______.

Insulin

Which organ is the single largest mass of lymphatic tissue in the body?

Spleen

Bile is produced by the_______.

Liver

Which of the following are functions of the liver?

Produces bile

The biliary tract terminates at the_______.

Sphincter of Oddi

In what position is the patient placed when a McBurney's incision will be used?

Supine

A diaphragmatic hernia is located_______.

in the diaphragm

Which type of hernia is loacted w/i Hesselbach's triangle?

Direct.

Nissen fundoplication is the procedure performed to correct a(n)_______.

Hiatal hernia

Gastrostomy is the_______.

Creation of an opening from the stomach to the skin.

Gastroscopy is accomplished by inserting the gastroscope through the_______.

Mouth

The term dysphagia means difficulty______.

Swollowing

Which incisional approach is most common for appendectomy?

McBurney's

The term chyme refers to______.

A mixture of partially digested food.

Removal of the gallbladder is called_______.

Cholecystectomy

The condition of gallstones is called______.

Cholelithiasis.

In addition to a major general surgical instrumentation set, which of the following will also be needed for an open cholecystectomy?

CBD exploration instruments

What position is used to displace the abdominal contents to enhance the surgeon's view of the lower abdominal region?

Trendelenburg

Modified radical mastectomy involves removal of_______.

the breast and axillary lymph nodes.

Removal of all parathyroid glands leads to_______.

tetany

What position will be the patient be placed in to facilitate thyroidectomy?

Supine w/the neck hyperextended.

Tracheotomy is the________.

creation of an opening into the trachea.

The flow of food and liquids from the stomach to the SI is controlled by_______.

Pyloric sphincter

Indications for a cholecystostomy include________.

Traumatic rupture of the gallbladder.

Which hormone increases the CA levels in the blood?

Parathyroid

What are the symptoms of hypothyroidism?

Fatigue or weakness, weight gain, decreased appetite, change in menstrual periods, loss of sex drive, feeling cold when others don't, constipation, muscle aches, puffiness around the eyes, brittle nails, and hair loss.

During a thyroidectomy, it is important to preserve the________.

Recurrant laryngeal nerve.

List two methods for occluding a blood vessel.

1) Ties (free ties) and 2) suturing

List one difference between a laparoscopic procedure and a endoscopic procedure.

Laproscopic~ go in through a hole you make w/a scope. Endoscopic~ go in through a natural oriface (mouth, nose, rectum).

What muscle is first encountered in a longitudinal abdominal incision?

Abdominus rectus

What scissors would you use to bluntly free up a structure or vessel?

Metzembaum

Name a focep you would use w/the Metz?

Debakey

Which retractor might be used on the fascia/muscle layer to assist in exposure or closure of an abdominal incision?

Army-navy

What type of suture is used to close Peritoneum?

Vicryl

What type of suture is used to close Fascia?

PDS II, Vicryl

What is the most common surgical disorder in pediatric aged patients?

Inguinal hernia

Where is the Midline/Longitudinal incision made?

A vertical incision centered above or below umbilicus. Ex~ all surgeries.

Where is the paramedian incision made?

A vertical or horizontal made lateral to the midline on either side in the upper or lower abdomen. Ex~ biliary tract, pancreas, and sigmoid colon.

Where is the Subcostal/Oblique(Kocher) incision made?

Just below the ribs on the L or R side. Ex~ gallbladder and spleen.

Where is a Transverse incision made?

A horizontal incision slightly above or below the umbilicus. Ex~ Choledochojejunostomy and transverse colostomy.

Where is a McBurney incision made?

RLQ incision just below umbilicus and aprox. 2 inches medial from anterior superior iliac spine. Ex~ appendix.

Where is a Pfannenstiel incision made?

A curved transverse incision across lower abdomen slightly above the pubis. Ex~ abdominal hysterectomy and cesarean.

Where is a Inguinal/Groin incisions made?

An oblique incision of the R or L inguinal region. Ex~ inguinal herniorrhaphy.

What are some predisposing factors to developing a hernia?

Strain (type of enviroment, varicose veins, pregnancy, wt gain), Chronic cough (smoking, COPD), Urinary Obstruction, Constipation (hemorrhoids), and Congential defects.

Reducible hernia

Use of manipulation returns the hernial contents to their normal cavity.

Irreducible/Incarcerated hernia

Inability to return hernial contents to the normal cavity w/manipulation.

Strangulated hernia

An incarcerated hernia that lacks adequate blood supply and may become obstructed. This becomes a surgical emergency to prevent necrosis and gangrene of the strangulated tissue.

Direct Inguinal hernia

Occurs when the peritoneal SAC containing intestines protrudes through the inguinal ring and passes down the inguinal canal. It's usually congenital and common in males.

Direct Inguinal hernia

A protrusion through a weakness in the abdominal wall in a region known as Hesselbach's triangle, NO SAC. Usually acquired due to straining, heavy lifting, and chronic coughing. Most difficult type to repair and more common in males.

Umbilical hernia

A protrusion of the peritoneum through the umbilical ring. Most common congenital defect in children and sometimes aquired in females after childbirth.

Femoral hernia

A defect in the transversalis fascia below the inguinal ligament, as well as the protrusion of the peritoneal sac through the femoral ring. Most common in females.

Ventral (Incisional) hernia

A protrusion of peritoneal contents due to weakness in the abdominal wall, usually due to impaired healing of a previous surgical incision.

Hiatal (Diaphragmatic) hernia

Either fixed or sliding, a portion of the stomach protrudes through the hiatus of the diaphragm.

Pantaloon hernia

Both a direct and indirect hernia found during inguinal hernia repair.

Recurrent hernia

Occurs in 5-10% of cases w/i 5 years of first occurance.

TAPP

Transabdominal Perperitoneal Laparoscopy~ Uses a pnuemoperitoneum (Veres needle w/CO2) and the inguinal canal in entered via the abdominal cavity.

TEP

Total Extraperitoneal Surgery~ Avoids pneumoperitoneum by inflating and entering the preperitoneal space w/a balloon dissector which acts as a tissue expander.

What are some complications of Herniorrhaphy?

Recurrence,strangulated bowel, nerve injury, ischemic orchitits and testicular atrophy, loss of bowel or urinary function, infection, and damage to the contents of the sac

What is the landmark for a breast procedure?

Tail of spence~border of the sternum to the anterior axillary line.

Breast anatomy

What are some important considerations in breast surgery?

Size, location, type of diseased tissue, and stage of malignancy.

Stage 0

Cancer cells are present in either the lining of the glands that make milk (lobules) or the tubes (ducts) that link these glands to the nipple. But cancer cells have not spread to the nearby fatty tissue.

Stage I

Cancer has spread from the lobules or ducts to nearby tissue in the breast. Cancer cells have not spread to surrounding lymph nodes, stays in the lining.

Stage II

Cancer has spread from the lobules or ducts to nearby tissue in the breast. Sometimes cancer cells have also spread to the lymph nodes.

Stage III

Later stage of breast cancer (locally advanced). Tumors have spread to lymph nodes under the arm, chest or above or below the collarbone. Tumors that have spread to other tissues near the breast may also be considered stage III.

Stage IV

Advanced stage of breast cancer (Metastatic). Cancer has spread from the breast and lymph nodes to other parts of the body such as the bone, liver, lungs, or brain.

Ductal carcinoma

Breast cancer that occurs in the milk ducts.

Lobular carcinoma

Breast cancer that forms in the lobules where breast milk is made.

In situ cancer means?

in place, does not move or spread out.

If ductal or lobular carcinoma spreads into nearby tissue it is said to be________.

Invasive or infiltering.

Mammography

Radiography for cancer

Xerography

Dry imaging radiography

Ultrasonography

Inaudible sound waves to outline the shape of tissues and organs.

Thermography

Detection of "hot" and "cold" spots in tissue. Associated w/circulation.

Tissue biopsy

Tissue sample for microscopic examination.

Why is breast biopsy done?

To determine the exact nature of a mass in the breast. It involves the removal of breast tissue for pathologic examination.

Fine Needle Aspiration (FNA)

22 or 25 gauge needle and syringe are inserted into the mass and a few cells are aspirated and sent to pathology to cytologic studies.

Core biopsy

A large bore trocar (True-cut needle) is inserted into the mass and a core of suspended tissue is w/d for histologic examination.

Sterotactic

A computer-guided system used to digitally loacte and pinpoint nonpalpable breast leisons.

Sentinel Node

The breast mass in injected w/a radioisotope dye several hours before the procedure. The dye is taken up by the lymph nodes of the breast. The nodes are excised before the mass and a Geiger counter is used to locate the areas of radioactivity.

Fiberoptic ductoscopy

A flexable 0.9mm scope w/a 0.2mm working channel is used in the ductal lumens of the breast.

The R lateral portion of the breast has the_______percentage of cancer at_____%.

highest, 41%

Lumpectomy

A partial mastectomy that consists of removal of the entire tumor mass along w/a least 1 to 2 cm surrounding nondiseased tissue.

Segmental Mastectomy

A wedge or quadrant of breast tissue is removed including the tumor mass and the lobe in which it is growing.

Simple Mastectomy

The entire breast in removed w/o lymph node dissection.

Modified Radical Mastectomy

Includes the removal of the entire breast along w/all the axillary nodes. Pectoralis major muscle is left in place.

Radical Mastectomy

The entire breast is removed along w/axillary lymp nodes, the pectoral muscles, and all adjacent tissues.

TRAM Flap procedure

Transrectus Abdominus Muscle Procedure~ The most popular of all reconstruction options, you get a new breast and a tummy tuck.

Complications from a Mastectomy procedures include...

Hemorrhage, wound infection, frozen shoulder, skin flap necrosis, seromas,lymphedema, phatom breast syndrome, cellulitis, hematoma formation.

What does the Thyroid gland produce?

Makes, stores, and releases T4 and T3.

The thyroid gland is controlled by the__________loacted within the brain which makes_____________.

Pituitary gland, TSH

Tests for diagnosing Thyroid disease

Blood tests (T4 and T3), Ultrasound exam (during pregnancy, tells is a thyroid humor is solid or cystic), Thyroid scan (tells if the tumor os functioning or nonfunctioning, Radioactive Iodine uptake (hyperthyroid), and TSH assay (increase for hypo and decrease intake for hyper).

Euthyroid (well) goiter

If dietary iodine is slightly inadequate, too little thyroxin will be secreated, and the pituitary will sense the deficiency and produce more TSH. The thyroid gland will enlarge to make sufficient thyroxin.

Hypothyroid goiter

If dietary iodine is severely reduced, the gland will keep growing under the influence of TSH, but it may never be able to make enough thyroxin.

Symptoms of Hyperthyroidism

Fatigue, wt loss, nervousness, rapid heart beat, increased sweating, feeling hot when others don't, changes in menstrual periods, more frequent bowel movements, and tremors.

Exophthalmos

Increased fatty deposits behind the eyes causing the eyes to push foward. Usually seen in Graves Disease in someome w/Hyperthyroidism.

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