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Terms in this set (188)
You may suspect pancreatitis in a patient who is an alcoholic and is complaining of severe epigastric and mid abdominal pain
You can confirm pancreatitis with amylase and lipase levels
A patient with chronic pancreatitis may present with diabetes and severe pain that is constant
During a laparoscopic nissen fundoplication, the first trocar should be placed 2 hand breaths below the costal margin
*2 finger breaths
The patient should be placed in reverse trendelenburg position for adequate exposure during a laparoscopic nissen fundoplication
What is the simplest abdominal incision to perform?
Where is the vertical midline incision made commonly?
Below sternal notch, distal around the umbilicus, down to symphysis pubis
What layer is incised during a vertical midline incision?
What ligament may be divided when using the vertical midline incision?
Round ligament of the liver
During closure of the vertical midline incision, which layers are commonly sutured in a single layer?
Peritoneum and posterior fascia
What incision can be closed using figure-of-eight, monofilament, nonabsorbable sutures for one layer of peritoneal and fascial closure?
Vertical midline incision
What incision is used for an open appendectomy?
How long is the McBurney incision?
The McBurney incision allows good exposure and is easy to extend
What vessels are ligated if the McBurney incision must be extended?
What incision is made for operations on the gallbladder, common duct, and pancreas?
What nerve is commonly cut when using the subcostal incision?
Eighth intercostal nerve
What ligament is closed when using a subcostal incision?
Interrupted, nonabsorbable sutures are utilized for the deep subcostal closure
What are the oblique incision options?
McBurney and subcostal
What are the transverse incision options?
Pfannenstiel's, midabdominal transverse, thoracoabdominal, and upper inverted-u
What incision is used frequently for pelvic surgery?
When using a Pfannenstiel incision, the rectus muscles are separated in the midline
What incision is used on the right or left sided or for retroperitoneal approach?
Midabdominal transverse incision
What incision begins slightly above the umbilicus, then carried laterally to the lumbar region at an angle between the ribs and iliac crest?
Midabdominal transverse incision
The intercostal nerves are severed during the midabdominal transverse incision
The midabdominal transverse incision is closed with interrupted sutures
What incision is used for operations on the proximal portion of the stomach and the distal section of the esophagus?
Which incision begins at a point midway between the xiphoid process and the umbilicus, then extends across to the seventh or eighth intercostal space?
What incision is rarely used, but can be used for a gastrectomy, transverse colon resection, transverse colostomy, and biliary/pancreatic procedures?
Upper inverted-u abdominal incision
What surgical procedures involve the removal of diseased portions of the stomach and esophagus through a thoracoabdominal incision in the left chest?
Esophagectomy and intrathoracic esophagogastrostomy
Why are esophageal surgeries performed?
Remove distal esophageal strictures or remove tumors in the cardia of the stomach or distal esophagus
What stapler is utilized in esophageal surgeries?
What is Zenker's diverticulum?
Out pouching of the posterior hypopharynx that causes regurgitation of undigested food several hours after eating
What is the removal of a weakening in the wall of the esophagus that collects small amounts of food, causing a sensation of fullness in the neck?
Excision of esophageal diverticulum
What muscle is recognized during the excision of Zenker's diverticulum?
What is done to restore the cardioesophageal junction to its correct anatomic position in the abdomen to correct gastroesophageal reflux?
A hiatal hernia can be congenital or accidental
What hernia in the diaphragm permits a portion of the stomach to enter the thoracic cavity?
What are the two kinds of hiatal hernia?
Paraesophageal and sliding
What laparoscopic procedure is performed to repair a hiatal hernia?
Laparoscopic Nissen Fundoplication
During a esophageal hiatal hernia repair, what part of the stomach is wrapped around the esophagus?
What study is done following a lap nissen?
Upper GI series
What is the establishment of a permanent communication, either between the proximal jejunum and the anterior wall of the stomach or between the proximal jejunum and the posterior wall of the stomach, without removing a segment of the Gl tract?
Why is a gastrojejunostomy performed?
Treat benign obstruction at the pyloric end of the stomach or an operable lesion of the pylorus
What is the resection of a diseased portion of the stomach to anastomose the stomach and duodenum?
Why is the Billroth I procedure performed?
Remove benign or malignant lesions located in the pylorus, or upper half of the stomach
During a Billroth I, what arteries and veins are ligated to free the greater curvature of the stomach?
Right and left gastroepiploic arteries
What is the resection of the distal portion of the stomach to establish an anastomosis between the stomach and jejunum, to remove benign or malignant lesions in the stomach or duodenum?
What is the complete removal of the stomach with an anastomosis between the jejunum and esophagus?
Why is a total gastrectomy performed?
Remove malignant lesions of the stomach and metastases in the adjacent lymph nodes
What surgery is performed to remove certain tumors, a gangrenous portion of the intestine, herniation, or volvulus in the small intestine?
Small bowel resection
What procedure involves the resection of the right half of the colon - including a portion of the transverse colon, the ascending colon, and the cecum-and a segment of the terminal ileum and mesentery?
Right hemicolectomy and ileocolostomy
Why are right hemicolectomy procedures performed?
Remove malignant lesions of the right colon or inflammatory lesions of the ileum, cecum, or ascending colon
What is the excision of the transverse colon to remove malignant lesions?
What procedure involves removal of the lower sigmoid and rectosigmoid portions of the rectum, to treat lesions in the lower portion of the bowel?
Anterior resection of the Sigmoid Colon
What is the mobilization and division of a diseased segment of the lower bowel?
When performing a laparoscopic Nissan fundoplication, sutures are passed through the 5mm port to place a row of interrupted sutures to join the ______ stomach around the esophagus
The McBurney incision is a muscle-sparing incision used for removal of the appendix
False - muscle-splitting
Total gastrectomy is the complete removal of the stomach
The transverse colectomy is performed for malignant lesions of the descending colon
False - transverse colon
To close a vertical midline incision the peritoneum and posterior fascia are usually sutured in a single layer
How many ports are used in a laparoscopic Nissan fundoplication?
The lateral position is not used for esophageal surgery
In a right hemicolectomy, an end to end, side to side, or end to side anastomosis is performed between the colon and the _____
Abdominoperineal resection is the mobilization and division of a diseased segment of the _______ through a midline incision
Lower colon & rectum
When the subcostal incision is made on the right side of the patient it is used for gallbladder, pancreatic, and splenic surgical procedures?
False - spleen is on the left
During a total gastrectomy, a lateral _____ anastomosis is completed to permit irritating bile and pancreatic fluids to bypass the anastomosis line
When performing a total gastrectomy, the incision may be long transrectus
Hiatal herniorrhaphy is performed to restore the _____ to its correct anatomic position in the abdomen
When dividing the stomach during esophagectomy, what artery is ligated
In an abdominoperineal resection as well as lower anterior colon resection, often times the patient is placed in the position versus the supine position?
When performing a gastrojejunostomy, a loop of _____ is grasped with Babcock forceps and freed from the mesentery
During esophagectomy, after the chest cavity is opened, ribs are spread, and lung is retracted, what is then incision?
Excision of a Zenker's diverticulum is removing a weakening in the wall of the _____
During an esophagectomy, the esophagus must be dissected free of the aorta?
During a Billroth II, the proximal portion of the stomach is resected
False - proximal
During a right hemicolectomy, a side to side anastomosis can be performed by inserting the GIA stapler into both _____ segments and firing the device
During a Billroth II, the right and left _____ arteries and veins are divided
A Billroth I gastrectomy is the resection of the diseased portion of the stomach
During a lower anterior resection, after the anastomosis is done, the surgeon observes for air leaks from the anastomosis
What is the treatment for patient with gallbladder disease?
What test is performed to document the presence or absence of gallstones?
What test is performed for patients with a history of peptic ulcer disease?
What test is performed in patients to have suspected ductal stones?
What position is the patient placed for a laparoscopic cholecystectomy?
What is the surgical opening into the peritoneum and placement of the operative sleeve to create pneumoperitoneum?
Where does CO2 diffuse?
If the intra abdominal pressure during a laparoscopic case exceeds 15mmHg, what may result?
What is dissected and freed during a lap chole?
Cystic duct and artery
What is the establishment of continuity by creating an anastomosis between the gallbladder and duodenum?
What is the establishment of continuity by creating an anastomosis between the gallbladder and jejunum?
What can cause an obstruction of the ducts involving the head of the pancreas, ampulla of Vater?
Tumors, inflammatory lesion, stricture of the common duct, or presence of stones
What is the serosa of the duodenum or loop of jejunum sutured full thickness to?
Fundus of the gallbladder
What is the anastomosis between the common duct and duodenum?
What is the anastomosis between the common duct and the jejunum?
What vessels arise from the external iliac vessels and enter the inguinal canal proximal to the internal ring?
Deep epigastric vessels
What are the markers for Hesselbach's triangle?
Deep epigastric vessels laterally, inguinal ligament inferiorly, and rectus abdominis muscles medially
Where do direct inguinal hernias occur?
Where do indirect inguinal hernias occur?
Lateral to inferior epigastric vessels
With both direct and indirect inguinal hernias, where do they tear?
Where do direct hernias protrude into?
Inguinal canal, but not the cord; rarely into the scrotum
What is a pantaloon hernia?
Combination of direct and indirect hernia
What inguinal hernia repair approximates transversalis fascia superior to the inferior insertion of the transversalis fascia along Cooper's ligament?
McVay or Coopers ligament repair
What is the sensory nerve that innervates the medial thigh and the scrotum?
What muscle forms an envelope around the spermatic cord and represent the continuation of the internal oblique muscles?
What is used to retract the spermatic vessels and vas deferens?
When is a vaginal repair required?
-Correct cystocele or rectocele
-Reestablish support of anterior and posterior vaginal wall
-Restore bladder and rectum to correct anatomic position
What is a herniation of the bladder that causes the anterior vaginal wall to bulge downward?
What is a protrusion of the anterior rectal wall (posterior vaginal wall) into the vagina?
If a rectocele is present, what muscles are stretched or torn?
What is a herniation of Douglas's cul-de-sac and almost always contains loops of the small intestine?
What ligaments are shortened when performing an anterior vaginal wall repair?
What is the removal of the uterus through an incision made in the vaginal wall and the pelvic cavity?
During a vaginal hysterectomy, what are the first ligaments identified and ligated?
During a vaginal hysterectomy, what are the second ligaments that are identified and ligated?
During a vaginal hysterectomy, what arteries are clamped, cut, and ligated?
During a vaginal hysterectomy, what are the third ligaments that are identified and ligated?
What is found between the rectum and vagina that is approximated with a continuous suture?
What is sutured to obliterate the retroperitoneal cul-de-sac?
Vaginal wall, infundibulopelvic ligament, round ligament, cardinal ligament, then out the vaginal wall
What is the name of the procedure for a radical hysterectomy?
What procedure is performed to remove the pelvic lymph nodes, uterus, tubes, ovaries, supporting ligaments, and upper vagina in the presence of cervical carcinoma?
Radical hysterectomy (Wertheim)
What is freed from the cervix and vagina?
During a Cesarean section, what is done to displace the uterus and prevent aortocaval compression?
Elevation of the right side
What is administered IV after the fetus is delivered to contract the uterus?
20 units of oxytocin/L of fluid
What is the enucleation of hypertrophic prostatic tissue through an incision in the anterior prostatic capsule by an extravesical approach?
Simple retropubic prostatectomy
What is the area lying between the bladder and symphysis pubis?
Space of Retzius
What is the removal, through a transvesical approach, of benign periurethral glandular tissue obstructing the outlet of the urinary tract?
If a suprapubic prostatectomy is being performed, what procedure may be performed to decrease the postop incidence of epididymoorchitis?
What procedure may be performed in the penile meatus is too small to accommodate a foley?
What nerve during a thyroidectomy should be preserved?
Recurrent laryngeal and superior laryngeal
What are the first lymph nodes along the lymphatic channel from the primary tumor site?
What is injected for sentinel node detection?
Isosulfan blue dye or metastable technetium 99
What is the removal of the axillary nodes through an incision in the axilla?
Axillary node dissection
What muscle is divided during an axillary node dissection?
What is the removal of all breast tissue with the overlying skin and nipple left intact?
Subcutaneous mastectomy (Adenomammectomy)
What is the removal of the entire involved breast without lymph node dissection, to remove extensive benign disease?
What procedure is performed after a tissue biopsy with positive diagnosis of malignancy, removing the involved breast and all axillary contents?
Modified Radical Mastectomy
Underlying pectoral muscles are removed before or after removal of axillary nodes during a modified radical mastectomy.
False - not removed
What surgery is done in the presence of cervical node metastasis from cancer of the head and neck?
Radical neck surgery
What is the removal of neck contents, except for the sternocleidomastoid muscle, internal jugular vein, and eleventh cranial nerve?
Modified neck dissection
Bone diseases can be metabolic, infectious, or degenerative.
What bone disease are disorders of bone remodeling?
What are the most common metabolic diseases?
Osteoporosis, osteomalacia, and Paget's disease
What is the most common infectious process?
What is the most common and serious bone disease?
What is characterized by excessive loss of calcified matrix, bone mineral, and collagenous fibers, causing reduction of total bone mass?
What is a metabolic bone disease characterized by inadequate mineralization of bone as a result of vitamin D deficiency?
What disease is characterized by proliferation of osteoclasts and compensatory increased osteoblastic activity, resulting in rapid, disorganization bone remodeling?
What is a break in the continuity of a bone?
Fractures are classified in two main groups: closed and open/compound fractures
What fractures are those in which there is no communication between bone fragments and the skin surface?
What fracture is when the whole thickness of the bone is not broken, but bent or buckled?
Incomplete closed fracture
What is an example of an incomplete closed fracture?
What fractures exist when the break in the bone communicates with a wound in the skin, usually considered contaminated?
What fracture line runs at a right angle to the longitudinal axis of the bone?
What fracture line runs the length of the bone?
What fracture is when the bone twists apart?f
Oblique and spiral fracture
What fracture occurs when the bone fragments splinter into more than two pieces?
What fracture occurs when one fragment is driven into the other end and is relatively fixed in that position?
What fracture occurs when a bone will fracture easily because it is weakened by disease?
What occurs when a fracture passes through or lies within the growth plate of a bone?
What fracture results in a ligamentous attachment remaining intact on a separated bone fragment?
What is a complete displacement of one articular surface from another?
What is a partial dislocation, often indicated by ligamentous instability?
What method of fracture management provides rigid fixation and reduction with the ability to manage severe soft-tissue wounds?
What bone screws have threads that are close together and narrower than other types of threads?
What bone screws have broader threads that are farther apart?
Cancellous screws are commonly used when fractures occur at the condylar ends of the shaft
Where are semitubular plates utilized?
Non-weight bearing bones
Where do most rotator cuff tears occur through?
Insertion of the tendinous fibers of the supraspinatus muscle that attaches onto the greater tuberosity of the proximal humerus
What tendons of the rotator cuff are damaged in a severe tear?
Supraspinatus, subscapularis, infraspinatus, and teres minor
What is also known as "impingement syndrome"?
Patients with rotator cuff tears my not be able to initiate what motion?
What is the resection of the undersurface of the acromion, that is the primary treatment for impingement syndrome?
How long after a large rotator cuff repair are patients immobilized for?
What fractures are most frequent in older patients?
What are complications of a femoral neck fracture?
Nonunion or avascular necrosis
What bone is the largest principal load bearing bone in the body?
The stability of the knee depends on the integrity of the cruciate and collateral ligaments
What is the terrible triad?
Injury to ACL, MCL, and medial meniscus
Which ligaments reinforce the knee capsule medially and laterally?
Which ligaments control AP stability?
What is performed to restore motion of the joint and function to the muscles and ligaments?
Total joint arthroplasty
What metals make up total joint implants?
Cobalt-chromium and stainless steel
What is an incision into the skull to expose and surgically treat intracranial disease?
What is the removal of one or more of the vertebral laminae to expose the spinal canal?
What procedure is done to relieve pain in the neck, shoulder, and arm caused by cervical spondylosis or a herniated disk?
Anterior cervical diskectomy with fusion
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