Chapter 14 General Surgery
What is Absorption?
The process or action by which one thing absorbs or is absorbed by another
What is Anastomosis?
A cross-connection between adjacent channels, tubes, fibers, or other parts of a network
What is Ascites?
The accumulation of fluid in the peritoneal cavity, causing abdominal swelling
What is Bile?
Dark green to yellowish-brown fluid produced by the liver of most vertebrates that aids the digestion of lipids in the small intestine
What is Chole?
A combining form meaning "bile", "gall", used in the formation of compound words: Cholestrol
What is the Common bile duct (CBD)?
A small, tube-like structure formed where the common hepatic duct and the cystic duct join. Carry-outs bile from the gallbladder and empty it into the upper part of the small intestine (duodenum)
What is a Cystic artery?
Supplies oxygenated blood to the gallbladder and cystic duct
What is a Cystic Duct?
Short duct that joins the gallbladder to the common hepatic duct
What is Docho?
Combining forms meaning the ductus choledochus (CBD)
What is -ectomy?
Denoting surgical removal of a specified part of the body
What is Excision?
Surgical removal, as in the excision of a tumor. The removal as if by surgery, as in excision of a tumor; implying at least partial; if not complete, removal
What is a Falciform ligament?
A ligament that attaches the liver to the front body wall, and separates the liver into left medial lobe and left lateral lobe
What is Femoral?
Refers to the femur bone
What is Glisson's capsule?
Layers of fibrous connective tissue that surrounds and protects the liver, as well as ensheathing the hepatic artery, portal vein, and bile duct within the liver
WHat is Hasselbach's triangle?
Anatomical triangle formed by the inguinal ligament, inferior epigastric vessels, and lateral border of the rectus abdominis
What is a Hiatal hernia?
Esophageal hiatus is weak that allows the abdominal esophagus and superior portion of the stomach to protrude into the thoracic cavity
WHat is an Incision?
Cut made with sharp instrument
What is Inguinal?
Term that refers to the groin area
What is Lysis?
Dissolution, loosening, or destruction of something
What is Necrosis?
What does -oma mean?
Suffix meaning tumor
What does -ostomy mean?
Suffix meaning to create a new opening
What does -otomy mean?
Suffix meaning to make an incision into
What does Parietal mean?
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
What is Peritoneum?
A thin serous membrane that lines the abdominal cavity
What is the Portal Venous System?
Venous system that carries blood to a second capillary bed prior to returning the blood to general circulation
What is the Pringle maneuver?
During liver surgery involves clamping a large thermostat across the lesser momentum to temporarily interrupt the flow of blood through the hepatic artery and the portal vein to help control bleeding from the liver
What is the Rule of 5's?
Sentinel node biopsy with isosufan blue dye, 5mL of dye is injected at 5 sites within a 5cm diameter and the site is massaged for 5 minutes
What does -stasis mean?
Suffix meaning stoppage or reduction of the flow of bodily fluid
What is Stenosis?
Narrowing or constriction
What is an Ulcer?
A crater-like lesion that is usually circular in shape and penetrates the skin; may be very deep, resulting from infections or malignant disease processes
What is Viscera?
Any organ of a body cavity; usually refers to the abdominal organs
What is Peristalis?
The involuntary constriction and relaxation of the muscles of the intestine or another canal, creating wave-like movements that push the contents of the canal forward
What is Aponeurosis?
A sheet of pearly-white fibrous tissue that takes the place of a tendon in flat muscles having a wide area of attachment
What does Ipsilateral mean?
Belonging to or occurring on the same of the body
What is Mesentery?
Double layer membrane of peritoneum attached to back wall of abdominal cavity that supports the small intestine
What is Strangulated?
Type of hernia in which tissues are caught within a fascial defect; may become strangulated if not reduced
What is Lithotripsy?
Noninvasive electro-generated shock waves used to break up calculi in the urinary or biliary system
What is Dysphagia?
Difficulty swallowing or feeling of food sticking in the esophagus
What is Ulcerative colitis?
Inflammatory bowel disease that causes erosions in the lining of the large intestine
What is Jaundice?
Yellowish of the skin and eyes due to buildup of bilirubin; visible sign of certain cancers and diseases of the organs of the biliary system
What is Rebound pain?
Being on or affecting the same side of the body
What is Billroth I?
Removal of pylorus of the stomach and an end-to-end anastomosis of the remaining stomach and duodenum
What is Billroth II?
Removal of pylorus of the stomach and cut ends of the duodenum are closed and the jejunum is anastomosed to the stomach
What is a Neoplasm?
Polyps that protrude inward instead of outward on large intestine
What is a Gastrostomy?
Surgical creation of an opening from the gastric mucosa to the skin and is performed to provide nutrition "feeding" to the patient or to decompress and drain the stomach
4 ways Gastrostomy can be performed
Open, Percutaneous, Endoscopic, and Laparotomy
Examples of Large hand-held retractors are:
Richardson-Eastman, Kelly, Balfour, Deaver, Harrington, Army-Navy, Goelet
Examples of Large self-retaining retractors are:
Balfour, Tompson, Omni, and Bookwalter
Examples of Small hand-held retractors are:
Green, Crile, Gelpi, Senn, Mathiew, Beck-Weitlaner
Examples of Small self-retaining retractors are:
Gelpi, Right upper-hand, Weitlaner
Examples of Intestinal instruments are:
Doyen intestinal clamp, Allen intestinal clamp
What is lysis of adhesions?
Removal of adhesions (scar tissue)
What is Diverticular disease?
Cause small bulges/sacs to form in the large intestine
What is a Bezoar?
Mass of indigestible vegetable fiber
What is Intussusception?
Telescoping a portion of the intestine into another portion
What is Ulcerative Colitis and Cron's disease?
Inflammatory bowel disease that causes erosions in the large intestine
What is a stoma?
A diversion is done to temporarily to protect a recent intestinal anastomosis, to avoid potential spillage postoperatively, or as an end (permanent) result of bowel resection
What is a loop-type stoma?
Stomas that have an afferent functioning aperture and an efferent nonfunctioning aperture, and may be created with the bowel in continuity or separated.
How is a stoma created?
A site is selected at a point below the costal margin, above the beltline, and usually at the appropriate lateral edge of the rectus abdomen muscle.
Where is the gallbladder located?
In the fossa on the inferior surface of the right lobe of the liver above the transverse colon and next to the duodenal cap.
What are the four regions of the gallbladder?
Fundus, body, infundibulum, and neck
What instruments are needed for an Open Cholecystectomy with Cholangiogram?
Harrington, long and deep instruments, Gallbladder instrument set that includes CBD exploration and stone extraction instruments, Upper hand or Thompson retractor
What supplies is needed for an Open Cholecystectomy with Cholangiogram?
Hemoclip appliers with ligating clips
What equipment is needed for an Open Cholecystectomy with Cholangiogram?
How many stages of Breast Cancer are there?
What are some special considerations when performing a Modified Radical Mastectomy?
If the mastectomy is following a biopsy separate setups should be used, the patient should be prepped again, the surgical team should re-gown and re-glove, and the mastectomy instrumentation should be brought up to the OR table.
During a Modified Radical Mastectomy what is dissected?
Dissection of the fascia from the lateral edge of the pectoralis major muscle and serratus anterior muscle is complete.
Great care is taken to identify and preserve the long thoracic and thoracodorsal nerves in which surgical procedure?
Modified Radical Mastectomy
What dressings are used during a Modified Radical Mastectomy?
Bulky dressing with Kerlix. Some surgeons may use Ace wrap to secure the chest dressing by wrapping upon placement of the contact dressing layer.
What is used to preserve the nerves during a Modified Radical Mastectomy?
What is the life threatening condition associated with the parathyroid glands?
What will happen if all four glands (Thyroid and Parathyroid) are removed?
The patient will experience hypoparathyroidism which causes hypocalcemia that leads to the neuromuscular symptoms of Tetany.
What is one complication of Thyrotoxicosis?
What causes Tetany?
Can be caused by an abnormally low level of calcium or Clostridium tetani that invades a surgical wound, is a severe complication.
What incision is made during a Thyroidectomy?
Asymmetrical, transverse incision following the Langer lines is made over the thyroid.
What is retracted and dissected during a Thyroidectomy?
The superior poles are retracted caudally with Lahey thyroid clamps and the tissue between the trachea and superior poles is dissected with Metz.
What complications can occur during a Thyroidectomy?
Hemorrhage, SSI, Tetany, Damage to nearby structures in particular nerves that can cause horse-sounding voice-temporary or permanent.
What stoma type is created from the descending colon and sigmoid?
What equipment is used during Hemorrhoidectomy?
CO2 laser may be used for vaporization and coagulation of hemorrhoid tissue.
What is the patient position for a Hemorrhoidectomy?
Kraske (most often used)
Lithotomy; Lateral position (rarely used)
During a Laparoscopic Appendectomy how can the appendix be transected?
1. Endoscopic linear stapler
2. Ligating loop instrument
3. Suturing instrument
What is the vessel cutting sequence?
What incision is made during an Appendectomy?
What retractors are used when making the incision during a Appendectomy?
What suture is used to identify the Cecum and appendix during an Appendectomy?
A 3-0 absorbable suture on a small taper needle may be passed through the cecum, around the base of the appendix, in a purse-string manner.
What tie is used to ligate the crushed base of the appendix?
0 absorbable tie
What does the ST need to say when unclamping a hemostat on a vessel?
Coming off and slowly remove
What highly vascular organ has vessels that subdivide many times?
When using the Pringle maneuver how long before tissue damage occurs?
How many segments is the liver divided into?
8 segments, each with its own arterial supply, venous drainage, and ductal system.
What is established by inserting the Veress needle through the incision and the CO2 is introduced into the peritoneal cavity?
What is another name for the Whipple Procedure?
The Whipple Procedure requires what two things?
Resection and Reconstruction
What is the single largest mass of lymphatic tissue in the body?
What type of hernia is present on the anterior abdominal wall at any point other than the groin and may be present along the linea alba?
What hernia cases are emergent?
What type of hernia presents within Hesselbach's Triangle?
What type of hernia follows congenital defects that dilate the internal inguinal ring and passes through the deep inguinal rin to the scrotum?
What type of hernia has both direct and indirect hernias present?
What type of hernia is more common in females than males?
What stage of breast cancer has a tumor of any size, with or without regional spread, and evidence of distant metastases?
Stage IV (4)
What is the skin prep for a Breast Biopsy?
Start at the site of the level of the clavicle to the sternum downward, including a wide margin of the abdomen and laterally as far as possible to include the axilla.
When is the surgical scrub not completed for a Breast Biopsy?
In order to avoid spreading cancer cells.
What surgical position is used to specifically for anorectal surgical procedures?
A typical end-to-end bowel anastomosis is accomplished with what suture technique?
Two-layer, interrupted technique for seromuscular approximation with silk; continuous for mucosa with absorbable suture
What does TEP stand for in general surgery?
Totally Extraperitoneal Patch
What abdominal incision would the linea alba be opened down to the peritoneum?
What endocrine-secreting glands of the pancreas make up only 1% of the organ?
Islets of Langerhens
What is a laparotomy?
Surgical opening of the abdominal or peritoneal cavity.
What is Intussusception?
Type of intestinal obstruction that involves a telescoping of a portion of the intestine into another portion.
A Maloney Bougie Dilator is used in what?
Why are bifurcated drains and fluffy pressure dressings used following a mastectomy?
Primarily to prevent formation of hematoma and seroma
Triangle of Calot is an anatomical space bounded by structures in which surgical procedure?
Where are the parathyroid glands located in relation to the thyroid?
Dorsal, superior, and inferior
A Whipple procedure is done for the treatment of a tumor in what abdominal organ?
What suture needle is used due to vascular and friable nature of the liver?
What is the first lymph node in the axillary chain that is frequently biopsied in conjunction with Breast Biopsy, Lumpectomy, or Mastectomy?
What is the incision used for an Open Cholecystectomy?
In what procedure will Buile Pile forceps be used?
Which handheld retractor is used to retract tissue during a Thyroidectomy?
In what part of the large intestine is the Hepatic and Splenic flexure located proximally and distally?
Vagotomy is a surgical treatment for?
What is another name for acquired vertical hernia through the linea semilunaris?
The bowel teachnique steps are taken by the surgical team to prevent what?
What suturing technique is used on an appendical stump?
HBV, HCV, and alcohol abuse are precursors to what disease?
What is the dilation of submucosal and subcutaneous venous plexus that lines the anal canal called?
The conversion from Laparoscopic procedure to an open procedure is always a possibility that the ST should be prepared for.
Where is the gallbladder located in relation to the liver?
Inferior surface of the right lobe
What the most common permanent Colostomy?
What type of hernia repair could a Penrose drain be used as a method of gentle retraction of the spermatic cord?
McVay Inguinal Herniorrhaphy
What skin incision will follow the anatomical lines in a Thyroidectomy procedure?
What incision will be made for excisional biopsy of cantrolly located breast mass involving lactiferous ducts?
What is the patient position used for a Anorectal surgical procedure?
What handheld retractor is specifically designed for use in an Open Chole to elevate the liver?
What is the surgical removal of the entire breast without lymph nodes?
An ST may run or operate the laparoscopic camera during a minimally invasive procedure to free up the surgeons hands and surgical first assist?