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General Surgery - Anatomy and Procedures
Terms in this set (120)
Strip serosal tissues from anatomical structures
Operative maneuver to mobilize the duodenum
Folds produced when a membrane passes over the surface of an organ and then passes back to the body wall that it lines
A curve, turn, or fold in a tubular organ
Supply an organ, body part, or region with nerves
Where does digestion begin?
Where can peristalsis occur?
Esophagus, bowel, and ureter
Tubular, muscular structure that runs through 3 cavities (neck, posterior mediastinum, and abdomen); roughly 25-30 cm long
Where does the esophagus begin and end?
Base of the pharynx, ends at the cardia of the stomach
What are the two esophageal sphincters?
Pharyngoesophageal (UES) and esophagogastric (LES)
From inner to outer, what are the layers of the esophagus?
Mucosa, submucosa, muscularis, adventitia
What esophageal diverticulum is rare, but seen more commonly in elderly patients due to the loss of tissue elasticity?
What are the symptoms of Zenker's diverticulum?
Dysphagia, regurgitation, halitosis, and voice change
Swallowing with difficulties
A backward flowing of food or blood
The microscopic uneven surface of the tongue that can trap bacteria and produce an odor
What does GERD stand for?
gastroesophageal reflux disease
When does GERD occur?
When the LES becomes weak or relaxes when it shouldn't
What are the symptoms of GERD?
Heartburn, nausea, vomiting, enamel erosion, aspiration, halitosis
What is GERD commonly associated with?
How many types of hiatal hernias are there?
Which hiatal hernia occurs when the cardia of the stomach migrates back and forth between posterior mediastinum and the peritoneal cavity
Which types of hiatal hernias are referred to as paraesophageal hernias?
Types II and III
Which hiatal hernia occurs when the fundus and viscera of the stomach migrate through a larger hiatal defect?
Which hiatal hernia occurs when the cardia, fundus or other stomach viscera migrate through a large defect?
Parts of the stomach include:
fundus, body, pylorus, cardia, antrum
What are the three treatment options for hiatal hernia?
Nissan fundoplication, transoral incisionless fundoplication, Linx procedure
What procedure wraps the fundus of the stomach around the distal 2-3 cm of esophagus?
What procedure has no abdominal incision or dissection to repair a hiatal hernia?
TIF - transoral incisionless fundoplication
What develops in response to chronic GERD?
What is the cause of Barrett's esophagus?
Intestinal cells replace normal esophageal cells which make the distal esophagus more resistant to damage from GERD
What is the treatment for Barrett's esophagus?
Nissan, paraesophageal hernia repair or esophagectomy
Describe esophageal varices?
Abnormal, enlarged vessels in the distal esophagus where circulation is restricted causing an increase in blood flow through vessels not designed for the volume
What is the most common cause of esophageal varices?
Symptoms of esophageal and gastric varices?
Asymptomatic unless start to bleed, vomiting blood, tar-like stool, shock with severe blood loss
Treatment for esophageal/gastric varices
Non-invasive beta blockers, NG tube, rubber band ligation, therapeutic endoscopy, balloon tamponade, liver transplant or emoblization
How are type II gastric varices treated?
Layers of the stomach from inner to outer
Mucosa, submucosa, muscularis externa, and serosa
Which portion of the stomach secretes mucous to ease food passage?
Which portion of the stomach produces hydrochloric acid?
Which portion of the stomach produces acid and secretes pepsinogen and mucous?
Which portion of the stomach secretes mucous and gastrin?
Which portion of the stomach is the storage area for chyme before it passes through the pyloric sphincter into the duodenum?
Which curvature of the stomach is located on the superior border, the lesser omentum originates here and extends to the liver?
Which curvature of the stomach is located on the inferior border, the larger curve of the stomach, the greater omentum originates here?
What are bariatric surgeries?
Roux-en-y, lap banding, or gastric sleeve
What is a sore that develops in the lining of the stomach or intestine that can occur in any mucous membrane?
How are gastric ulcers treated?
Antibiotics for H.pylori, acid reducing meds or pump inhibitors
Surgical treatment that transects 1 or more branches of the vagus nerve to reduce acid secretion?
The procedure where the distal third of the stomach is excised
What cancer is the 14th most common in the US, affecting men in their 70's?
What is the treatment for gastric cancer?
Subtotal or total gastrectomy
What are the two procedures allowing anastomoses following a subtotal gastrectomy?
Bilroth I and II
What bilroth procedure uses an end to end gastroduodednostomy anastomoses?
What bilroth procedure uses an end to side or side to side gastrojejunostomy?
What is a Whipple in medical terms?
When is a whipple indicated?
Used to treat tumors in the pancreatic head
What does a whipple resection involve?
Head of pancreas, gallbladder, cystic duct, common bile duct, partial duodenectomy, pylorus (may be spared), pancreatic lymph nodes
What is reanastamosed following a whipple?
Pancreaticojejunostomy, hepaticojejunostomy, gastrojejunostomy
What are the 3 parts of the small bowel?
Duodenum, ileum, and jejunum
What is the appearance and length of the duodenum?
Horseshoe shaped, roughly 30 cm long
How many portions make up the duodenum?
Which portion of the duodenum is most mobile, after the pylorus, and the most frequent site for duodenal ulcers?
1st duodenal portion
Which portion of the duodenum ducks back into the RUQ that runs entirely retroperitoneal?
2nd duodenal portion
Which portion of the duodenum lies retroperitoneally, running horizontally rt-lt, lying directly over the descending aorta and the IVC?
3rd duodenal portion
Which portion of the duodenum ends at the ligament of trietz?
4th duodenal portion
What is an important landmark that is located where the small bowel re-enters the abdomen separating the duodenum from the jejunum?
Ligament of Treitz
What portion of the small bowel has no clear separation, totaling 5M in length?
What are the peritoneal folds that bind the small bowel to the posterior abdominal wall, serving the small intestine with blood, nerves and lymph vessels?
What is the most common congenital abnormality of the small bowel?
Which disease is the outpouching of the ileum due to gestational development issues?
Which disease primarily occurs in the small bowel, can occur anywhere from the mouth to anus, treated by incremental resections?
Which bowel disorder occurs when the bowel telescopes over itself, commonly in children under 3?
Which part of the bowel is responsible for H2O absorption, compaction of fecal waste, and vitamin K production?
Where does the ileum terminate?
Superior cecum. Ileocecal junction
Where does the appendix attach?
Which part of the large intestine has no mesenteric attachments?
How long is the ascending colon?
20 cm long
Where does the ascending colon run? Where does it end?
Right side of abdomen; hepatic flexure
What is the largest, most mobile portion of the large intestine, extending across the upper abdomen?
How long is the descending colon?
30 cm long
Where does the descending colon lie?
Downward along the left side of the abdomen
Where in the large intestine is the primary spot for cancer that is 15 cm long?
How long is the rectum?
10-12 cm long
How long is the anus?
3 cm long
What is the anus surrounded by?
Involuntary and striated muscles forming the internal and external anal sphincters
What disease is only found in the large intestine that has no cure, with an increased cancer risk?
What is the treatment for ulcerative colitis?
How does colon cancer usually begin?
How man stages of cancer are there?
What is stage 0 of cancer?
What is stage 1 of cancer?
Small tumor not grown deeply
What is stage 2 of cancer?
Small tumor spread into the wall more deeply
What is stage 3 of cancer?
Tumor is spread into wall and lymph nodes but no metastasis
What is stage 4 of cancer?
What is the first branch of the abdominal aorta that trifurcates to become the left gastric, splenic, and common hepatic arteries?
What is the blood supply to the head of the pancreas, all of the small bowel, ascending colon and 3/4 of the transverse colon?
Superior mesentary artery
What is the blood supply to 1/4 of the transverse, descending, sigmoid and part of rectum?
Inferior mesentary artery
What is the small intestine referred to in surgery?
What is the large intestine referred to in surgery?
What shape and length is the duodenum?
Horseshoe; 30 cm long
How many parts does the duodenum have?
What is the first portion of the duodenum?
"Cap" - comes off distal end of the stomach, right off the pylorus; only portion that is entirely intrabdominal; most mobile portion; most frequent site for ulcers
What is the second portion of the duodenum?
Runs anterior to posterior into the retroperitoneal space in the right upper quadrant
What is the third portion of the duodenum?
Entirely retroperitoneal, running right to left, lies anterior to the inferior vena cava and the descending abdominal aorta
What is the fourth portion of the duodenum?
Comes posterior to anterior without crossing over into the abdominal cavity, coming in through the ligament of Treitz
What is an important clinical landmark for general surgery?
Ligament of Treitz
In what quadrant is the ligament of Treitz?
Left upper quadrant (have to move the stomach out of the way)
What is the ligament of Treitz an extension of?
Right crus muscle
What is omentum attached to?
What is the mesentery attached to?
What is the most common congenital abnormality of the small intestine?
What is the rule of two's associated with Meckel's?
-found in 2% of the population (of that 2%, 2% will have symptoms)
-usually about 2 in long
-found 2 feet proximal to the ileocecal valve
What is a meckel's becomes symptomatic, what is it commonly mistaken with?
What is short gut syndrome?
A malabsorption process which can lead to chronic diarrhea
How much small bowel must be left behind in order to reduce the chance of short gut syndrome development?
What are the series of ridges produced by folding of the wall of an organ (most commonly the internal surface of the stomach?
What is the function of rugae?
Allow expansion of stomach volume to accommodate incoming food
What are the small segmented pouches of bowel separated by the haustral folds, formed by circumferential contraction of the inner muscular layer of the colon?
What are the three separate longitudinal ribbons of smooth muscle on the outside of the colon?
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