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Surgical Technology - General Surgery

Chapter 14
STUDY
PLAY
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
Circular GI anastomosis--check donuts
Pursestring stitch
Used to reinforce defect (stapled or sutured in place)
Mesh
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
Muscle biopsy
Gastroduodenostomy (antrectomy)
Billroth I
Reconstruction of gastric sphincter to release chyme
Pyloroplasty
Repair of the diaphragm and fundus wrapping
Nissen fundoplication
Removal of breast, pectoralis major, and axillary nodes
Radical mastectomy
Lobectomy--careful of recurrent laryngeal nerve
Thyroidectomy
Omental wrap, stapling/suture repair
Splenorrhaphy
Gastrojejunostomy (antrectomy/duodenectomy)
Billroth II
Preferred method--also known as parietal cell
Roux-en-Y
Use of self-retaining Foley, Pezzer for feeding
Gastrostomy
Obliteration of varicose veins
Sclerotherapy
Mobilization of jejunum--anastomosis/side branch
Highly selective vegotomy
Creation of permanent stoma for breathing
Tracheostomy
Removal of breast tissue and axillary nodes
Modified radical mastectomy
Pancreaticojejunostomy with gastrojejunostomy and choledochojejunostomy
Whipple
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
...
Right hemicolectomy
Transverse colectomy
Left colectomy
Left hemicolectomy
Abdominoperineal 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?
Drainage
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?
CBD dilators
Paramedial incision; heals stronger
Sigmoid surgery
Right subcostal/Kocher
Cholecysectomy
Thoracoabdominal
Esophagoduodenostomy
Inguinal oblique incision
Herniorrhaphy
Median incision, more likely to be herniated
Trauma--quicker
Bassini-Shouldice repair is performed to correct which condition?
Inguinal hernia repair
Separation of clean and dirty; clean closure necessary
Bowel resection
Have extra laps ready and cell saver for immediate use
Liver laceration
Pass scissors with T-tube for possible alteration
Cholecystectomy with IOC
Trach tray available for possible swelling postop
Thyroidectomy
As soon as received from surgeon prepare for reuse
Use of linear stapler
No air bubbles in contrast media
CBDE
Check balloon; send obturator with patient postop
Tracheostomy
Lubrication required for instrumentation entering orifice
Hemorrhoidectomy
Have culture tubes ready; anaerobic to medium quickly
Appendectomy
Care with instruments/tissue to prevent seeding; keep sharp blade
Mastectomy
Richardson Eastman retractor
Kelly Retractor - Loop Handle
Kelly Retractor - Hollow Grip Handle
Balfour Retractor
Deaver Retractor
Harrington/Sweetheart Retractor
Army-Navy Retractor
Goelet Retractor
Green retractor
Senn Retractor
Crile Retractor
Mathieu Retractor
Gelpi Retractor
Beckman-Weitlaner Retractor
Adson forcep
Adson-Brown forcep
Thumb tissue forcep
Mosquito forceps
Crile Hemostat
Rochester-Pean clamp
Kocher clamp
Babcock tissue clamp
Allis clamp
Pennington clamp
Foerster sponge holding forcep
Backhaus towel clamp
Probe & grooved director
Frazier suction
Radical mastectomy
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
Simple mastectomy
removal of a breast leaving the underlying muscles and the lymph nodes intact
Segmental resection
Removes only the tumor and a reasonable margin of healthy tissue.
Lumpectomy
surgical removal of a tumor without removing much of the surrounding tissue or lymph nodes
Hesselbach's Triangle
Inferior epigastric artery, Lateral border of the rectus abdominus, and Inguinal ligament
Cremaster Muscle
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
Genitofemoral nerve
Motor fibers that cause the cremaster muscle to contract, elevating the testis
Ductus Deferens
a duct that carries spermatozoa from the epididymis to the ejaculatory duct
TAPP
Transabdominal Preperitoneal
TEP
Total Extra Peritoneal
Pneumoperitoneum
inflation of the peritoneal cavity with carbon dioxide gas to prevent injury to abdominal structures during laparoscopic surgery
Nonpalpable
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.
Pectoralis
either of two large muscles of the chest
Latissimus Dorsi
Prime mover of arm extension; adducts and medially rotates arm
Small intestine
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
Colon
Cecum; appendix; ascending colon; transverse colon; descending colon; rectum; anus
Esophagus
Hollow tube; connects the pharynx above (pharyngoesophageal sphincter); connects the stomach below (cardiac sphincter)
Stomach
*Fundus; Hydrochloric acid
*Cardia; Muscus secretions
*Corpus; acid, pepsinogen, mucus
*Antrum; mucus, gastrin
*Pylorus; storage area
*Rugae; gastric pits
Lesser/Greater curvature
Greater curvature: Three layers; Inner, Middle, Outer
Mesentary
Peritoneal folds - Contain: Blood vessels, Nerves, Lymph vessels
Colon
Cecum (pouch, appendix), Ascending, Transverse, Descending, Sigmoid, Rectum, Anus, Compaction of fecal waste, Production of vitamin K, Absorption of water/Electrolytes, Left colon is for storage
Omenta
Lesser omentum - Continous with peritoneum
Greater omentum - Four layers, Stores fat, Limits peritoneal infection
Pancreas
Both Endocrine & Exocrine
Endocrine - Islets of Langerhans (Alpha cells, Glucagon; Beta cells, Insulin)
Exocrine - Duct of Wirsung (Breaks down: fats, rotein, carbs, nucleic acids
Spleen
Lymphatic tissue, Left Upper Quadrant, Filtration, White pulp; Lymphocytes, Red pulp; Erythrocyte storage
Liver
Larges organ; Produces bile; Metabolizes, carbs, fats, proteins; Detoxifies; Stores suger as glycogen; Synthesizes, prothrombin, Fibrinogen; stores vitamins, A, D, E, K, Iron & Copper
Biliary Tract
Communicates between the liver and the duodenum; Gallbladder; Cystic duct; Common hepatic duct; Common bile duct; Sphincter of Oddi
Gallbladder
Stores bile; Aids in digestion; Absorption of fats; Inferior surface of the liver
Cystic duct
Connects the gallbladder to the CBD; Joins pancreatic duct in the ampulla of Vater
Laparotomy
surgical incision into the abdominal wall
Hiatal hernia
hernia resulting from the protrusion of part of the stomach through the diaphragm
Esophagectomy
the surgical removal of all or part of the esophagus
Gastrostomy
surgical creation of an opening through the abdominal wall into the stomach
Gastrectomy
surgical removal of all or part of the stomach
Abdominoperineal resection
removal of the colon and rectum through both abdominal and perineal approaches; performed to treat colorectal cancer and inflammatory diseases of the lower large intestine
Laparoscopy
laparotomy performed with a laparoscope that makes a small incision to examine the abdominal cavity (especially the ovaries and Fallopian tubes)
Small bowel resection
removal of a portion of the small intestines
Colon resection
procedure whereby a section of the large intestine is removed and its continuity is restored
Appendectomy
surgical removal of the appendix
Fistulas
abnormal passage from one organ or cavity to another
Pilonidal cyst
closed sac located in the sacrococcygeal area of the back; sometimes noted at birth as a dimple
Cholecystectomy
surgical removal of the gall bladder (usually for relief of gallstone pain)
Splenectomy
surgical removal of the spleen
Whipple
Extensive surgical technique whereby the head of the pancreas, duodenum, part of the jejunum and part of the stomach are removed. Usually done in cases of early pancreatic cancer.
Pancreatic cysts
Growths characterized by fluid sacs in the pancreas
Biliary instruments
Randall stone forceps, Scoops, Potts scissors, Bakes dilators, Gallbladder trocar
Laparoscopic instrumentation
Trocars, Veress needle, Laparoscope, Grasping forceps, Laparoscopic Babock, Laparoscopic scissors, Electrocauter
Abdominal layers
Skin
Subcutaneous fat
Scarpa's fascia
Muscle; External/External oblique Transversus abdominus
Transversalis fascia
Peritoneum
Laparoscopic Cholecystectomy
removal of the gall bladder through small punctures in the abdomen to permit the insertion of a laparoscope and surgical instruments
Common types of Anastomosis
End-to-end
Side-to-side
End-to-side
Vagotomy
The surgical dissection of branches of the vagus nerve to reduce acid secretion in the stomach
Anatomy of the Groin
Skin
Subcutaneous tissue
Scarpa's fascia
External oblique muscle
Inguinal ligament
Internal oblique muscle
Transverse abdomonius muscle
Transversalis fascia
Cooper's ligament
Rectus abdominus muscle
Peritoneum
Inguinal canal
Superficial inguinal ring
Deep inguinal ring
Passage for the spermatic cord
Types of hernias
Ventral hernia
Hernia that occurs at the site of a previous incision
Incisional hernia
postoperative hernia caused by a weakness in the abdominal wall from the incision or postoperative complications
Diaphragmatic hernia
hernia resulting from the protrusion of part of the stomach through the diaphragm
Reducible hernia
is a hernia in which the contents of the hernial sac can be returned to their normal position. (Inguinal Hernia)
Incarcerated hernia
is an irreducible hernia in which the contents of the hernial sac are entrapped or stuck in the groin
Strangulated hernia
occurs when a portion of the intestine is constricted inside the hernia and its blood supply is cut off.
Sliding hernia
A hernia in which the stomach and a section of esophagus which joins the stomach slide up into the chest through what is called the hiatus
Pantaloon hernia
direct and indirect inguinal hernia together
Inguinal hernia
hernia in which a loop of intestine enters the inguinal canal; most common type in males
Thyroid/Parathyroid anatomy
Two lobes
Superior thyroid artery
Inferior thyroid artery
Recurrent laryngeal nerve
Four parathyroid glands
Thryoid anatomy
Produce, store, and release thyroxine and tri-iodothyronine hormone
Regulations of metabolism
Secrete calcitonin
Maintain calcium homeostasis
Parathyroid anatomy
Two pairs
Dorsal side of the thyroid
Produce parathormone
Maintains blood calcium levels
Thyroidectomy
surgical removal of the thyroid gland
Dorsal cavity
along the posterior side of the body made of the cranial cavity and the spinal cavity
Ventral cavity
Diaphragmatic Cavity/Thoracic Cavity; heart, lungs, blood vessels/Pericardium Cavity; heart
Mediastinum
the part of the thoracic cavity between the lungs that contains the heart and aorta and esophagus and trachea and thymus
Abdominopelvic cavity
Contains: Abdominal; most of the intestines, liver, gallbladder, spleep, pancreas, stomach, kidneys. Pelvic cavities; Urinary bladder, rectum, reproductive system.
Mesenteric arteries
Numerous arteries that go into the remainder of the small and all of the large intestines; come off the dorsal aorta.
GIA stapler
Staples and cuts
TA stapler
Staple only; for colon resection, intestines
Needle localization biopsy
a small wire or needle is placed into breast lesion using mammography
Retroproperitoneum
Anterior pararenal: Contains; pancreas, parts of the duodenum & colon.
Parirenal: Holds structures of urologic and vascular concern.
Posterior pararenal: Contains NO organs.