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
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.
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_____
The enzyme pepsinogen secreted in the stomach begins digestion of the food substance_____
Bile secreted in the duodenum works to emulsify the food substance_____
The breaking down of large fat globules into the intestines into smaller, uniformly distributed particles
The enzyme lipase begins digestion of the food substance_____
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______
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.
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.
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?
Sac or pouch/enlargement of intestinal wall
Mucosal growth considered a precursor to dysplasia
Telescoping of intestine within itself
Twisting of bowel
Occurs in the sacrococcygeal area with sinus formation
Difficulty swallowing due to motility disorder
Hiatal hernia causing mucosal trauma
Congenital outpouching located in the ileum
Chronic condition with weight loss, abscess, or bleeding
Surgical intervention for prolonged intubation
Severely increased basal metabolic rate (BMR)
Elevated WBC count, rebound tenderness
Multicentric ductal carcinoma, male or female
Severe Crohn's disease
Cancer in the head of the pancreas removed
Stage I or Stage II cancer without axillary node involvement
Laceration of the spleen
Defect in abdominal wall affecting structures of spermatic cord, Scarpa's fascia, cremaster muscle
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
Occurs usually at esophageal haitus
A direct or indirect hernia usually in men
Acquired defect that occurs in Hesselbach's triangle
Occurs congenital or acquired due to obesity or pregnancy
Entrapment of organs, which cannot be returned to abdomen
Most common in females/may entrap lymph nodes
Occurs on anterior abdominal wall
Usually congenital along spermatic cord
Entrapment that compromises vascularity
Thrombocytopenia is a deficiency of______in the blood.
Which diagnostic tools will be useful in determining liver pathology?
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
What is meant by the term "staging" in reference to malignant tumors?
Biopsy needle or Tru-Cut for liver biopsy.
Maintains or enlarges size of esophagus
Manipulates vagus trunk during vagotomy
Grasps bowel such as appendix
Babcock tissue forcep
Liver resection or liver laceration ---Yankauer tip
Cell saver required
Direct visualization placement of umbilical port
Enlarges size of cystic duct and CBD
Decompress an engorged gallbladder
Ochsner GB trocar
Used for insertion of vascular access device
Extends incision in vessel or duct
Potts Smith scissors
Removal of stones from duct
Fistula incision guide
Premoistened to manipulate spermatic cord/esophagus
Clamps for occlusion on intestines
Buie Pile forceps
Supine AND Reverse Trendelenburg
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
Circular GI anastomosis--check donuts
Used to reinforce defect (stapled or sutured in place)
Vessel or duct closure using applier to place clip(s)
Hemoclip or ligating clip
Securely closes tissue around a catheter/inverts stump
EEA or intraluminal stapler
Closure serosal layer of intestinal anastomosis
3-0 silk interrupted suture
Single application for resection of diseased bowel
GIA or linear stapler
Clamp, clamp, cut,______to control bleeding
Tie (2-0 or 3-0 silk)
Used to reestablish negative pressure after procedure
Chest tube secured with silk
Liver laceration or biopsy to control bleeding
Large chromic blunt needle
Diagnosis neuromuscular diseases
Reconstruction of gastric sphincter to release chyme
Repair of the diaphragm and fundus wrapping
Removal of breast, pectoralis major, and axillary nodes
Lobectomy--careful of recurrent laryngeal nerve
Omental wrap, stapling/suture repair
Preferred method--also known as parietal cell
Use of self-retaining Foley, Pezzer for feeding
Obliteration of varicose veins
Mobilization of jejunum--anastomosis/side branch
Highly selective vegotomy
Creation of permanent stoma for breathing
Removal of breast tissue and axillary nodes
Modified radical mastectomy
Pancreaticojejunostomy with gastrojejunostomy and choledochojejunostomy
Is the Maloney dilator inserted under sterile conditions? Why?
No. It is used by the anesthesiologist who is not sterile.
Explain what is meant by the phrase "mobilize the bowel."
Detach it from its support structures in prep for resection or anastomosis
List the three basic configurations for intestinal anastomosis
End to End End to Side Side to Side
What ligament is sued as an anatomical landmark to identify the end of the duodenum and the beginning of the jejunum
Ligament of Treitz
Describe the technique used to care for instrumentation and supplies that have been exposed to the inside of the intestinal tract.
Bowel technique; All instruments exposed are contained within the immediate field & when removed placed in a separate, but visible basin for subsequent counting.
Right colectomy resection
What is a stoma?
A communication of a section of bowel with the outside of the abdominal cavity that is created to divert the fecal stream
Describe the difference between and end colostomy and a loop colostomy.
"End" is created from the descending colon. "Leep" utilizes the transverse colon.
What is the purpose of a T-tube?
Why is it important to expel all air from the cholangiogram system prior to an intraoperative cholangiogram?
The air bubble can be mistaken for a gallstone.
What is the reason for providing a second setup to perform a breast reconstruction following a modified radical mastectomy due to a malignancy?
To keep any cancerous cells away from instruments that are going to be used for reconstruction.
Why is it important for STSR to maintain the sterile field until the patient is extubated and breathing freely following a thyroidectomy?
In case they start to bleed and need to come back to the OR.
What instruments and supplies will be needed to enter the common bile duct for CBDE?
Paramedial incision; heals stronger
Inguinal oblique incision
Median incision, more likely to be herniated
Bassini-Shouldice repair is performed to correct which condition?
Inguinal hernia repair
Separation of clean and dirty; clean closure necessary
Have extra laps ready and cell saver for immediate use
Pass scissors with T-tube for possible alteration
Cholecystectomy with IOC
Trach tray available for possible swelling postop
As soon as received from surgeon prepare for reuse
Use of linear stapler
No air bubbles in contrast media
Check balloon; send obturator with patient postop
Lubrication required for instrumentation entering orifice
Have culture tubes ready; anaerobic to medium quickly
Care with instruments/tissue to prevent seeding; keep sharp blade
Richardson Eastman retractor
Kelly Retractor - Loop Handle
Kelly Retractor - Hollow Grip Handle
Thumb tissue forcep
Babcock tissue clamp
Foerster sponge holding forcep
Backhaus towel clamp
Probe & grooved director
removal of a breast and the underlying muscles (pectoralis major and pectoralis minor) and lymph nodes in the adjacent armpit
Modified radical mastectomy
removal of a breast and the pectoralis minor and some lymph nodes in the adjacent armpit
removal of a breast leaving the underlying muscles and the lymph nodes intact
Removes only the tumor and a reasonable margin of healthy tissue.
surgical removal of a tumor without removing much of the surrounding tissue or lymph nodes
Inferior epigastric artery, Lateral border of the rectus abdominus, and Inguinal ligament
Muscle that pulls the scrotum closer to the body in cold temperatures and relaxes to let the testicles be farther away from the body in warmer weather
Motor fibers that cause the cremaster muscle to contract, elevating the testis
a duct that carries spermatozoa from the epididymis to the ejaculatory duct
Total Extra Peritoneal
inflation of the peritoneal cavity with carbon dioxide gas to prevent injury to abdominal structures during laparoscopic surgery
cannot be felt on clinical examination; this type of breast mass is one that is usually identified on screening mammogram and is too small to be felt as a breast lump on BSE or CBE.
either of two large muscles of the chest
Prime mover of arm extension; adducts and medially rotates arm
Begins at pyloric sphincter; duodenum (superior, descending transverse, ascending) terminates at the ligament of Treitz; jejunum (thicker walls, wider lumen, absorption); ileum; mesenteric small intestine. Terminates at the ileocecal valve
Cecum; appendix; ascending colon; transverse colon; descending colon; rectum; anus
Hollow tube; connects the pharynx above (pharyngoesophageal sphincter); connects the stomach below (cardiac sphincter)