General Surgery Chapter 14 Nissen to Hemorrhoidectomy

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1

What does TEP stand for

Totally Extraperitoneal Patch
•Class 1: Clean

2

What is a surgical procedure that is performed to correct a hiatal hernia

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Laparoscopic Nissen Fundoplication
•Class 1: Clean

3

Who inserts the bougie dilator for a Laparoscopic Nissen Fundoplication because they cannot be passed from the sterile field

Anesthesia

4

What can also treat gastroesophageal reflux disease (GERD)as well as a hiatal hernia

Laparoscopic Nissen Fundoplication

5

Laparoscopic Nissen Fundoplication unique supplies

Abdominal Lap drape
Maloney (bougie dialators)
#11 and #15 blades

6

What occurs when the esophageal hiatus is weak, which allows the abdominal esophagus and superior portion of the stomach to protrude into the thoracic cavity.

Hiatal hernia

7

What surgery does the surgeon wraps (plicates) the top of the stomach (fundus) around the bottom of the esophagus and stitches it in place (wrap)

Laparoscopic Nissen Fundoplication

8

What is the surgical creation of an opening (fistula tract) from the gastric mucosa to the skin and is performed to provide nutrition “feeding” to the patient or to decompress and drain the stomach

A gastrostomy
•Class II: Clean-contaminated

9

What is the timeline for a gastrostomy

Long term or temporary depending on technique and condition

10

What are the layers of the stomach:
Serosa
Muscle
Submucosa
Mucosa

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serosa

11

What is the main purpose of a gastrostomy

Create an opening to bypass the esophagus

12

What type of suture pattern do they use for a PEG procedure

Pursestring

13

Often tumors of the larynx, pharynx, esophagus, and proximal stomach, as well as esophageal stricture, dictate the timeline for a .........

A gastrostomy

14

What are the ways a gastrostomy can be created

Open
Percutaneous
Endoscopic
Laparoscopic

15

What gastrostomy is a surgically placed feeding tube in the stomach

Stamm Gastrostomy
Usually performed through a small (6-8 cm) upper midline incision

16

What does PEG stand for

Percutaneous Endoscopic Gastrostomy
Push method

17

What type of feeding tube is used for patients on a ventilator, who may have a spinal cord injury, dementia, or cerebral palsy

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Percutaneous Endoscopic Gastrostomy

18

What is a tube that is passed through the nose and down through the nasopharynx and esophagus into the stomach

Nasogastric tubes

19

What is the removal of part or all of the stomach

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Gastrectomy

20

What is the surgical removal of the distal portion of the stomach and the pylorus

Reanastomosis is to the duodenum

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Gastroduodenostomy Billroth I
(Picture A)

21

What is the surgical removal of the distal portion of the stomach and the pylorus.

Reanastomosis is to the jejunum

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Gastrojejunostomy Billroth II
(Picture B)

22

Stomach anatomy

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23

What involves removal of the stomach and re-constitution of the alimentary tract

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Total gastrectomy
•Class II: Clean-contaminated

24

What requires an upper midline incision, bilateral subcostal incision (chevron), or thoracoabdominal incision

Total gastrectomy

25

When doing abdominal cases what is the best technique to employ

Bowel technique

26

What is a term used to describe the contraction of the muscles that mix and propel contents in the gastrointestinal tract

Motility disorders

27

Pathology of the Esophagus - what causes
•Dysphagia
•Regurgitation of undigested food

Motility disorders

28

What is a disease of the muscle of the esophagus

Achalasia

29

What is a condition where the pea-sized, bulging pouches in the inner lining of the bowel become inflamed

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Diverticulitis

30

What is the medical or biological term for an outpouching of a hollow (or a fluid-filled) structure in the body

Diverticula

31

What is connected to the lesser curvature of the stomach and extends to the posterior surface of the liver to hold the stomach in place.

The lesser omentum

32

What extends from the diaphragm to the cardia of the stomach to also help keep the stomach in normal anatomic position

The gastrophrenic ligament

33

What is the inferior border of stomach called

The greater curvature.

34

What is the attachment of two ends of approximately the same sized structures
2 layer closure technique with sutures or staples

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End-to-end anastomosis

35

What is the attachment of the end of one section of bowel into the side of another section (T-like)
Not used that often, if so typically in patients with multiple revisions, or cancer patients

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End-to-side anastomosis

36

What is the creation (attachmen) of parallel opening in two sections of bowel with anastomosis
2 different sizes coming together
parallel opening

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Side-to-side anastomosis

37

What is a specific technique of anastomosis that allows for a variety of applications in gastric, intestinal, biliary, and pancreatic surgery often referred to as gastric bypass

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Roux-en-Y

Attaches to duodenum

38

What is inspected to ensure good blood flow to the remaining segments of bowel

card image

The mesentery
(being inspected for blood flow)

39

The mesentery is a fold of membrane that attaches the intestine to the abdominal wall and holds it in place

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The mesentery

40

An elevated white blood cell count and fever are common symptoms for

Appendectomy

41

After which surgery are all instruments placed in a basin and removed from the immediate field. The basin is placed in a predefined area on the back table and left there until the case is completed. Instruments and needles are counted by pointing, not by touching. This includes any specimens removed

Appendectomy
•Class 2: Clean-contaminated

42

Where are the appendix located

Right lower quadrant

43

What incision is used for an open appendectomy

McBurney's

44

After the appendix has been removed what suture is used and procedure performed to the stump

Stump is sutured with a purse string suture and inverted inside itself

45

Appendectomy:
(A) Cecum and appendix identified,
(B) mobilization of appendix
(C) appendiceal artery ligated,
(D) excision of appendix

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46

What is the anatomy of the colon:
Cecum
Ascending colon
Transverse Colon
Descending Colon
Sigmoid Colon
Rectum
Anal Canal

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47

What begins at hepatic flexure, travels across top of abdominal cavity, and ends at splenic flexure

Transverse colon

48

What occurs (in toddlers) when a portion of the intestine folds inside another part. This causes a blockage in the colon

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Intussusception

49

Colon resection options:
(A) Right colectomy,
(B) right hemicolectomy,
(C) transverse colectomy,
(D) left colectomy,
(E) left hemicolectomy,
(F) abdominoperineal resection

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50

What is a section of bowel that communicates with the outside of the abdominal cavity that is created to divert the fecal stream

A stoma (“ostomy”)

51

What is a surgically created opening to divert feces to the outside temporarily or permanently

A Stoma

52

What are created from either an end section or loop of the ileum (ileostomy) or colon (colostomy).

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Stomas

53

What is the name for the colostomy that the bowel is pulled out onto the abdomen and held in place with an external device. The bowel is then sutured to the abdomen and two openings are created in the one stoma: one for stool and the other for mucus.

Loop colostomy (Diversion)

54

What is the name for the stoma that is created from one end of the bowel. The other portion of the bowel is either removed or sewn shut

End colostomy (End)
Hartmann's procedure

55

What is constructed from a terminal portion of ileum, can be temporary or permanent

End ileostomy

56

What is primarily a TEMPORARY stoma for fecal diversion

Loop ileostomy

57

What is a modification of the loop method in which the loop is divided with a linear cutter and both ends are brought out through the skin incision

End-loop ileostomy

58

What is created from the descending COLON and sigmoid

End colostomy

59

What utilizes the transverse COLON
•Not generally used as a permanent colostomy because it discharges a semiliquid stool
•The most frequently used method of stoma creation for temporary fecal diversion

Loop colostomy

60

What is a modification of the loop method in which the loop is divided with a linear cutter and both ends are brought out through the skin incision

End-loop colostomy

61

What is the most common type of permanent colostomy
•Created at the time of A/P resection
•Created as an end colostomy in the lower left quadrant

Sigmoid colostomy

62

What is a chronic form of perianal abscess that fails to heal after draining and becomes an inflammatory tract

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Fistula-in-ano

63

What is a tear in the lining of the lower rectum

Anal fissure

64

What is a cyst or abscess near or on the natal cleft of the buttocks that often contains hair and skin debris

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Pilonidal disease

65

What are the most common anal lesions, can be internal or external vascular structures in the anal canal

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Hemorrhoids

66

What is the membranous layer of subcutaneous tissue of the abdomen, it is attached to iliac crest, linea alba, pubis

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Scarpa’s fascia

67

What separates aponeurosis of external oblique muscle from overlying tissues and contains the intercrural fibers

Interparietal fascia

68

What separates aponeurosis of external oblique muscle from overlying tissues and contains the intercrural fibers

Innominate fascia

69

What is a thin layer of fascia lining the transversus abdominis muscle

Transversalis fascia

70

Where do we see the following fascia:
Scarpa’s fascia
Innominate fascia
Interparietal fascia
Transversalis fascia

McVay (Cooper Ligament) Inguinal Herniorraphy

71

What is an anatomic triangle formed by cystic duct, common hepatic duct, and inferior borderof liver; used to locate the cystic artery, which is usually within the triangle

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Triangle of Calot

72

What is performed for managing tumors of the head of the pancreas, the most common site of pancreatic cancer

The Whipple procedure

73

What is the medical name for a Whipple

Resection is an en bloc excision of the head of the pancreas, the distal one-third (antrum and pylorus) of the stomach, all of the duodenum, the proximal 10 cm of the jejunum, the gallbladder, the cystic and common bile ducts, and the peripancreatic and hepatoduodenal lymph nodes

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Pancreaticoduodenectomy

74

What is the surgical cutting of the vagus nerve to reduce acid secretion in the stomach

card image

Vagotomy

75

Mouth
The Pharynx and Esophagus
The Stomach and Small Intestine
The Colon (Large intestines), Rectum, and Anus

Basic steps through the alimentary canal

76

What is the largest parenchymal organ in the abdominal cavity

Liver

77

It's function is to reabsorb fluids and process waste products

Colon

78

What organ is the single largest mass of lymphatic tissue in the abdominal cavity

Spleen

79

What organ is responsible for both the storage and purification of red blood cells

Spleen

80

What means in a direction towards the head

Cephalad

81

What means in a direction towards the feet

Caudal

82

What is the semifluid mass of partly digested food that is expelled by the stomach into the duodenum

Chyme

83

What is a solid mass of indigestible material that accumulates in your digestive tract, sometimes causing a blockage

Bezoar

84

What is difficulty swallowing

Dysphagia


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