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CST - Chapter 22 - General Surgery - main
viscera - The abdominal cavity contains the abdominal _______ (organs). pelvic - The ______ cavity contains structures of the reproductive, genitourinary, and lower GI systems. retroperitoneal - The _______ cavity contains the kidneys, adrenal glands, and ureters. This cavity is separated from the anterior abdominal cavity by the posterior abdominal peritoneum. mediastinum - The ______ contains these organs:
- Right lung
- Heart
- Trachea
- Right and left bronchi
- Esophagus
- Thymus gland
- Aortic arch and thoracic aorta
- Venae cavae
- Lymph nodes and thoracic duct Right upper - The ______ ______ quadrant contains these organs:
- liver
- gallbladder
- colon
- portions of the small intestines
Left upper - The ______ ______ quadrant contains these organs:
- stomach
- pancreas
- spleen
- colon
- portions of the small intestines
- kidneys
- adrenal glands
- descending aorta
- ureters pelvic cavity - The _______ _______ contains these organs:
- ureters
- uterus and adnexa (female)
- prostate gland (male)
- urethra
- urinary bladder
- rectum cranial, spinal - The dorsal body cavity contains the _______ cavity and ______ cavity. thoracic, abdominal, pelvic - The ventral cavity contains the ________, _________, and _________. subcutaneous - The _________ layer lies directly under the skin. It is composed of lobulated adipose, which varies in thickness from 1/4 inch to more than 8 inches.
Umbilical hernia - A hernia from an abdominal wall defect occurring in the linea alba at the umbilical ring seen in infants and adults Spigelian hernia - A rare hernia occurring between the transverse abdominis and rectus muscles. Hesselbach triangle - The ________ _________ is the area bounded by the rectus abdominis muscle, the inguinal ligament, and inferior epigastric vessels. This area is associated with an inguinal hernia. hernia - The most common pathology of the abdominal wall is a ________. This is the protrusion of tissue through a defect or weakness in the abdominal wall. The weakness may be caused by a congenital anomaly, previous surgery, or injury. inguinal, femoral - Hernias most often occur in the _______ and _______ regions. surgical - ______ mesh is used for most hernias. Mesh repair is to provide a bridge of strong material over the abdominal wall weakness and release tension on the tissue edges during repair and healing. During the remodeling phase of healing, scar tissue fills the spaces of the mesh. Ventral hernia - ______ ______ refers to any hernia in the abdominal wall, excluding the groin or Inguinal area. incisional - Ventral hernia often occurs as a result of previous abdominal surgery and sometimes referred to as an __________ hernia. abdominal - Causes of ________ wall weakness:
- Obesity
- surgical site infections
- strain on an incision
- poor tissue healing
- multiple surgeries in the same area Umbilical hernia - _____ ______ repair is performed to repair weakening of an abdominal wall around or under umbilicus [Periumbilical region]. linea alba - Umbilical hernia is a defect in the _____ _____ at the umbilical ring. This is most common in children and usually disappears by age 2. In adults, the hernia repair appears more frequently in individuals with a high body mass index. There is a high risk of tissue strangulation. transverse abdominis, rectus - A Spigelian hernia repair is performed to reduce protrusion of an abdominal viscera in the area of muscle attachment between the _________ _______ muscle and the lateral edge of the _________ muscle (known as the spigelian zone). Spigelian - A _____hernia is very rare, hard to diagnose and occurs mainly in people over the age of 60 and usually discovered during surgery for another reason. Gastrointestinal - ________surgery includes the esophagus, stomach, small intestine, large intestine, rectum and anus. Esophagus - The ______ is a tubular structure from the pharynx to stomach. Stomach - located under the diaphragm, it has three anatomical sections, the fundus, the body and antrum. Small intestine - extends from the pylorus of the stomach to the proximal end of the large intestine, it has three sections, duodenum, ileum and the jejunum. Large intestine - extends from the distal ileum to the rectum and is divided into five sections: cecum, ascending, transverse, descending, sigmoid and rectum.
Anastomosis - ________ is joining two hollow structures by sutures, Staples, or combination of both. Bowel - ________ surgery [isolation technique]: instruments and supplies while the bowel is open are kept in a separate male. Instruments on the back table are kept on contaminated. EsophagoduodenoscopyOpen closure of the bowel, contaminated instruments and supplies are removed from the field. Before abdominal closure, down and gloves are changed and fresh sterile drapes are placed over those use during the first part of procedure. Esophagoduodenoscopy - What does EGD stand for? LigaSure - Special equipment that may be used during G.I. surgery:
- high frequency vessel sealing system also called _______
- ultrasound scalpel
- vessel loops for large vessel dissection
- ultrasound probe
- bowel bag
- temporary ostomy bag Re-section - __________ a procedure in which a section of an organ is cut apart or removed. Example: a portion of the intestine is removed. If one of the free ends it surgically closed as a blind; it is called a stump. Division - _______ in surgery, a procedure in which one section of tissue is cut away from another. This differs from resection, in which a portion of the organ is removed. Example: when the omentum is dissected away from the intestines. Mobilization - ___________ the freeing up of tissue you from its attachments before anastomosis or resection.
Clamp and divide - ______ _______ _______ to both double clamp and divide tissue you. Example: during mobilization of the intestine, the surgeon repeatedly applies to hemostatic clamps, divides the tissue, and seals the tissue with the ESU or ties the cut ends. ESU, ties, suture - Tools needed when a surgeon is clamping and dividing:
- two hemostats
- ______ or tissue scissors two ____ and _____ scissors Endoscopy - _______ is an outpatient procedure, performed with the patient under IV sedation. Patients are able to respond to commands and maintain airway. Upper G.I. requires fasting and dietary restrictions. Lower G.I. it requires dietary restrictions and bowel prep/enema. Esophagoduodenoscopy - ________ (EGD) is diagnostic endoscopy of the esophagus, stomach and proximal duodenum. polyp, feeding tube, stent - EGD may be performed to:
- injection treatment of varices
- variocele banding
- ______ removal
- _____ _____ placement
- ______ placement, esophageal dilation. Sclerotherapy - _______ of esophageal varices is a method of reducing varices by injecting a sclerosing agent directly into the vein to shrink it.
Diverticulum - A pharyngoesophageal ________ is mucosa and submucosa that have herniated through the cricopharyngeal muscles. Usually occurs in patients older than 60, causes food particles to become trapped. Hyperextended, absorbable, subcuticular - For a pharyngoesophageal diverticulum the patient is placed in the supine position with the head and neck turned and ________ to the patients right. The diverticulum is dissected away from the surrounding tissue. The sack is ligated and the stump is invaginated into the pharyngeal wall. The pharyngeal muscle opening is closed with interrupted 2- 0 Absorbable sutures. The skin is closed with 4-0 _______, ________ sutures. Gastroesophageal reflux disease - GERD stands for: _____ ______ _____. Nissen fundoplication - ______ _______ (Transabdominal repair of a hiatal hernia). Is performed to treat GERd. The upper stomach is wrapped around the esophagus below the hiatus to act as sphincter to prevent backflow of stomach contents into the esophagus. Erosion, respiratory - GERD causes pain, esophageal ______, and ______ irritation and can lead to a esophageal cancer. Fundoplication, gastric Bougie - _______ is when the stomach is removed from its attachments to the omentum. Short gastric vessels are ligated. Immobilized portion then is grasped with atraumatic forceps around the esophagus. A _____ ______ [flexible tube] through the esophagus and into the stomach to gauge the diameter of the gastric sleeve. The stomach wrap is then secured with interrupted sutures and the sleeve is approximated with several interrupted sutures. Ethibond [synthetic braided suture] material is used for fundoplication. Vagotomy - _______ is performed to reduce gastric enzymes by severing the nerves that control the release. It is selective occlusion of portions of the Vegas nerve as it branches over the stomach. Traditionally this is used to treat peptic ulcer or and performed along with gastric resection.
Percutaneous endoscopic gastrostomy [PEG]: - ______ ______ ______common method of providing nutrition via a flexible tube inserted through the abdominal wall. The tube provides enteral feeding for patients who were unable to eat normally because of disease or trauma. gastrectomy - Partial ______ Billroth I and II [open]: a diseased portion of the stomach is removed, the remaining portion is anastomosed to the duodenum or the jejunum. gastric carcinoma, tumor, ulceration - A partial gastrectomy is usually performed to treat _____ ______, benign _____, or chronic ______. Gastroplasty - Laparoscopic adjustable banded______: performed for the treatment of morbid obesity it by restricting nutritional intake by creating a small pouch in the upper stomach, food passes slowly into stomach creating a feeling of fullness. 40 - Morbid obesity he is a condition in which the patient's body mass index is at least ____. Malabsorption, reversible - Adjustable gastric binding does not result in______, it is_______, and it can be performed as minimally invasive surgery. A 15 mm trocar is required for insertion of the band two or three 5 or 10 mm trocars are also needed. Roux-En-Y - --____ Gastric bypass: performed to bypass the distal stomach and reestablish continuity from the stomach to the jejunum, large portion of the stomach is bypassed, and a gastric pouch is created, anastomosis between the pouch and jejunum reduces the amount of food absorbed by the body. gastric ulcers, carcinoma - Roux-En-Y Gastric bypass: Traditionally has been used to treat ____ _____ and gastric _____and is currently used to treat morbid obesity. Transhiatal - _______ Esophagectomy: performed for Adenocarcinoma and squamous cell carcinoma for esophageal cancer, these cancers are treated surgically in the early stages. It is performed through
Partial colectomy - ________ __________: this is perforated to remove a section of diseased colon and to restore continuity to the intestine. Colostomy - _______ is removal of part or all of the large intestine. It treats carcinoma, ulcerative colitis, diverticulitis, and intestinal obstruction. Ileotransverse - _______ Colostomy is removal of a portion of the ileum and transverse colon with side to side anastomosis of the ileum and colon. Abdominoperineal resection [APR]: - ______ ______ anus, rectum and sigmoid colon are removed though combined abdominal and perineal incisions are made. A complete removal of the rectum and anus with pelvic dissection and removal of a portion of the colon for treatment of a cancer of the rectum. This requires two incisions and two surgical sites [one pelvic and one peroneal]. Appendectomy - ______ is the removal of the appendix, a blind, narrow, elongated pouch that is attached to the cecum. It is removed during acute infection to prevent rupture and peritonitis. It is sometimes removed as prophylactic procedure [incidental appendectomy]. It can be done as an open procedure or laparoscopic procedure. McBurney - Open appendectomy: the abdomen is entered through a _____incision. A purse-string suture is made around the base. This is used when perforation has occurred or risk of perforation. Laparoscopic - ________ appendectomy: this is more common than an open appendectomy. Pneumoperitoneum is established to extend the abdomen. Hemorrhoidectomy - _______ is removed for pain management and to prevent bleeding and infection. Hemorrhoids - _______ are classified as internal [inside the rectum], external [outside the rectum]. The venous plexus of the anal canal may become congested or distended, causing pain, bleeding and prolapse are outside the anal canal. This is most often caused by pregnancy, obesity, constant sitting or standing can also contribute.
Subcostal incision - This incision follows the lower rib margin in a semicurved shape; it is painful postoperatively. Exposes: right biliary system McBurney - This incision is made on the right side, at a oblique angle, in the flank below the umbilicus; it is a muscle-splitting incision and offers only limited exposure. Exposes: appendix Inguinal incision - This incision is used to gain access to the inguinal region for hernia repair; it also may be used for internal access to the spermatic cord. Destroys, stores blood, filters - The spleen is a kidney-shaped organ that is extremely vascular and soft, and lies under the diaphragm in the left upper abdomen. The spleen _____ aged red blood cells, ____ _____, ______ microorganisms from the blood and plays a major role in the immune system of the body. Splenic - The spleen is supplied by two major blood vessels; the _____ vein and artery. It is subject to trauma by direct blow during motor vehicle accidents. It can be safely removed without harming the bodies ability to function. Hemorrhage - A splenectomy is indicated whenever splenic ______ becomes a life-threatening. blood tests, imaging studies - Diagnostic procedures can include ____ _____ and ____ _____. Blood tests are performed according to symptoms. Enzymes - Liver function test measures liver ______and other chemicals. It also detects substances normally filtered by the liver and pancreas. contrast media - Imaging with ____ _____ are done to outline organs and observe the movement of bile through the biliary system. Pancreatic imaging is used to detect stones, tumors and ducts, if contrast media is used.
biliary system, pancreatic system and the G.I. tract or than reconstructed. The whipple procedure is performed for curative or palliative treatment of pancreatic cancer. distal pancreatectomy - Laparoscopic _____ ______: portion of the tail of the pancreas was removed for palliative treatment of a malignant tumor or to remove a benign lesion. 3, 5 - Cancer of the pancreas is usually well advanced at the time of diagnosis. The survival rate is less than ____ % in ____ years. Alcoholism, biliary reflux - ______ and _____ _____common causes of pancreatitis that leads to pancreatic endocarcinoma. Partial pancreatectomy offers treatment for metastasis. segmental resection, lobectomy - Surgical resection of the liver: Hepatic resection is performed to remove a portion of the liver to treat a benign or malignant tumor. A ____ ______ or ______ is the usual approach. malignant liver tumor - Most common indication for liver resection is a _____ ___ ____. Tumors may primary or metatastic [cancer that has spread from another location]. Metatastic - ______ liver tumor of the most common type. Primary liver tumors are rare. Cancer of the liver is usually will advance by the time it is diagnosed. Less common indications for resection are parasitic disease, infection, laceration, or tumor. Segmental resection is the removal of one or more of the 9 liver segments. lobectomy - A ______ is the removal of one or more of the major lobes of the liver. diseased, 10 - The goal of liver transplantation is to replace a _____ liver with the donor organ. It is performed in selected cases for conditions that result in end stage liver disease, cirrhosis, autoimmune disorder and neoplasms. Joint effort that involves organ procurement agency and host hospital and procedures for both donor and recipient our complex. Time between organ procurement and transportation is usually about ____ hours.
third, sixth, glandular - Breasts are typically located between the_____ and ____ribs. Breasts are composed of _____, connective, and fat tissue contained within extensions of fibrous ligaments. Each breast has about 15 to 25 separate sections. The tissue changes with the development of the individual, hormonal changes, pregnancy, and nutritional status of the patient. Invasive ductal carcinoma - The functional part of female reproductive system: provide milk for the infant, in response to hormonal changes. Breast cancer is the leading cause of death in women ages 20 to 59 in the US. ____ ______ _____ is the most common type. Breast cancer in men accounts for 0.8% of all breast cancers. Psychological considerations of breast cancer: can have affect on sexual identification body image. Surgery can produce anxiety and depression. Support and respect is critical components of patient care. Wire localization - ____ _____ and breast biopsy: fine wire is inserted into the breast during fluoroscopy, device is referred to hook wire hook needle. This is a specific technique used to identify the site of a suspected mass. Sentinel lymph node - : ____ ____ ____biopsy: this involves isofulfan blue dye in radioactive substance (technetium- 99) that is injected directly into the mass or nearby. Isofulfan - Sentinel lymph node biopsy: radioactive substance materials are used to track the lymph nodes visually and by gamma ray emission. Radioactive material may be inducted two hours or longer before surgery in the nuclear medicine department. _______ is injected at the time of surgery to provide greater visibility of nodes. axillary lymph - Sentinel lymph nodes are usually located at the proximal ____ ____chain. Breast conserving - _____ ______surgery for a mass: Breast masses removed to confirm a diagnosis what to trade malignancy. Mass is excised to ensure the margins are completely free of cancer cells. Skin sparing mastectomy's, overlaying tissue, areola and nipple are removed and implant may be placed immediately after procedure. Both malignancy and some benign breast neoplasms present can be seen with imaging studies or palpation.
Retroperitoneal - The _______ cavity contains kidneys, adrenal glands and ureters. Skin, Subcutaneous fatty tissue, fascia, muscle, peritoneum - What are the layers of the abdomen? External and internal oblique muscles, transversus abdominis muscle - What are the flanking muscles of the abdomen starting with the most superficial? Rectus sheath - The _____ ____ is a broad fascial layer that extends across the abdomen without interruption. Mesentery - The ______ is an extension of the peritoneum that attaches to the posterior abdominal wall and fans out to cover the small intestine. Greater omentum - The _____ _____ is an extension of the serous membrane covering the stomach, duodenum, and part of the colon. These extensions are often referred to as peritoneal reflections. Diaphragm, pubis - The abdominal cavity extends from the _____ to the ____. Muscles - The abdominal ______ assist in respiration, bearing down during defecation and childbirth. Spermatic cord - The _____ cord in males follows the inguinal canal and contains:
- Spermatic fascia
- Cremaster muscle
- Genitofemoral nerve
- Ductus deferens
- Lymph vessels
- Testicular vein and artery Inguinal canal - Indirect inguinal hernia surgery is performed to restore strength and prevent the abdominal viscera from entering the _____ ______. Indirect inguinal hernia - The _____ ______ _____ is when the viscera protrudes into the inguinal canal from the deep inguinal ring. In males the herniated tissue can extend into the scrotum. In females the tissue can protrude into the labia. Direct inguinal hernia - is a defect behind the superficial inguinal ring in the inguinal floor, through the transversalis fascia (Hesselbach triangle). Heavy lifting - Increased intraabdominal pressure "bearing down" with ______ _____ or pulling can precipitate, painful direct hernia. Transabdominal preperitoneal, direct inguinal - What does TAPP laparotomy stand for? And what kind of hernia repair is this used for? Total extraperitoneal - What does TEP surgery stand for? Transverse - A _____ incision is made when performing the TAPP approach to repairing a direct inguinal hernia. Periumbilical, balloon expander - For a TEP procedure to repair a direct inguinal hernia a ____ incision is made and a _____ ____ is introduced and inflated. Femoral - A _____ hernia is a defect in the transversalis fascia inferior (below) to the inguinal canal.
