Exam VI (Chapter 16 and 14 Notes)

Surgical Specimens

The pathology department analyzes specimens of excised tissue (histology) or aspirated fluid (cytology) to determine the nature of the disease.

Biopsy

The procedure performed to collect the tissue or fluid specimen.

Tissue Biopsies

Can be obtained by a number of ways, including percutaneous and core needle; fluid washings and brush sampling; incisional and excisional, including frozen sections and centesis.

Blood Specimens

Often obtained using a vacuum blood collection tube.

Needle Biopsy

The least invasive type of biopsy is a percutaneous fine needle biopsy. The amount of tissue cells is extremely small and may not be sufficient for diagnosis.

Washings and Brush Specimens

Pelvic 'washings' are obtained during open or laparoscopic surgery by irrigation of the pelvic cavity and aspiration of the fluid.

Incisional Biopsy

Entails the removal of a portion of the tissue mass or lesion for pathological study.

Excisional Biopsy

Is a removal of the entire mass or lesion.

Permanent Sections

Are placed in a preservative fluid such as formalin.

Frozen Sections

Are performed to provide an immediate diagnosis to determine if it is necessary to excise more tissue or to initiate postoperative therapy as soon as possible.

Centesis

Placement of a needle into a body cavity for removal of fluid for diagnostic or therapeutic purposes.

Paracentesis

Removal of ascites fluid from the peritoneal cavity, which develops as a result of cirrhosis or cancer.

Thoracentesis

Placement of a needle into a posterior portion of the pleural space for the analysis of pleural effusion.

Amniocentesis

Placement of a needle through the abdomen into the uterus and amniotic sac in pregnancy for sampling of the amniotic fluid.

Pericardiocentesis

Percutaneous insertion of a needle into the pericardial sac to treat cardiac tamponade or to sample pericardial effusion fluid.

Spinal Tap

Lumbar puncture involves needle aspiration of cerebrospinal fluid (CSF) from the lumbar area of the spinal column for analysis.

Endoscopy

Endoscopes can be used preoperatively or intraoperatively to directly visualize internal structures for diagnostic purposes.

Fetal Demise

The loss of a fetus at any stage.

Products of Conception

Refers to tissue that remains in the uterus after a pregnancy has ended and is considered a surgical specimen.

Loss of Specimen

This can have devastating effects for the patient and could lead to having the need for a second biopsy, therefore delaying treatment.

Correct Labeling

All specimens with more than one possible anatomic site must be labeled with the proper designation.

Specimen Marking

Orientation or original anatomical position of the specimen in the body is important for examining the tissue margins (edges).

MOHS Surgery

May require placing a suture marker or using special tissue dyes as it would be nearly impossible to determine which part of the specimen is superior, inferior, medial, or lateral once removed from the surgical wound.

Foreign Bodies as Evidence

Care of bullets or ammunition fragments must prevent alteration of forensic markings.

Legal Chain of Evidence

The circulator or person who turns over the foreign body to the law enforcement officials must follow the Legal Chain of Evidence procedures and receive a written receipt or record of the individual taking custody of the specimen.

Specimen Containers

Containers should be large enough to contain the specimen end tissue preservative that might cause fixed tissues to swell.

CALCULI

Gallstones, Kidney Stones must be sent to pathology dry. If a preservative is added, it will dissolve the stones or permanently alter them.

Amputated Limbs/Extremities

Sent to the pathology department carefully bagged and wrapped for transfer.

Orthopedic Implants or Hardware

Prostheses and other hardware (such as plates and screws) used to support a healing bone fracture should be kept dry and sent to pathology for documentation.

Surgical Specimens

Errors that can occur when handling specimens include incorrect information on the label, loss of specimen, and placing the specimen in formalin or other preservative fluid when it should be treated as a dry specimen.

Angina

Intermittent or continuous cardiac pain caused by anoxia of the myocardium.

Ascites

Abnormal collection of fluid in the abdominal cavity.

Auscultation

Use of the unaided ear or a stethoscope to listen to sounds within the body.

Biopsy

Removal of tissue or fluid from the body for pathological examination to determine a diagnosis.

Presentation

Original anatomical position of the specimen.

Type of specimen

Classification of the specimen based on its nature or purpose.

Instructions for handling the specimen

Guidelines for the proper management of the specimen, such as frozen section.

Name of surgeon

The identity of the surgeon who performed the procedure.

Circulator signature

Signature of the circulator who assists in the surgical procedure.

Patient's medical record number (MRN)

Unique identifier assigned to a patient for tracking their medical history.

Origin of specimen

Anatomical site from which the specimen is obtained.

Date and time specimen is prepared

Specific date and time when the specimen was collected.

Name of specimen

Specific name or description of the specimen collected.

Cholangiography

A preoperative and intraoperative diagnostic tool in which a catheter is inserted into the common bile duct and contrast medium is injected to outline potential calculi under fluoroscopy.

Contrast Media

Solution injected into arteries, veins, subarachnoid space, or ducts during a radiographic exam that is radiopaque and therefore stands out in contrast to the surrounding tissues.

Cystoscopy

The insertion of an endoscope through the urethra and into the bladder for the purpose of viewing for treatment and diagnosis.

Ejection Fraction

The amount of blood that is expelled when the ventricle contracts compared to the total volume of blood that fills the ventricle.

Electrocardiogram (ECG)

A record of the heart's electrical activity.

Electroencephalography (EEG)

Display and recording of the brain's electrical activity by measurement of changes in electric potentials.

Frozen Section

A pathological method of diagnosis that involves freezing a tissue sample, slicing it into thin sections, staining it, and then viewing it under a microscope.

Gram Stain

Laboratory method of identifying bacteria; bacteria that stain purple are referred to as gram-positive, and bacteria that do not retain the stain and appear red in color are referred to as gram-negative.

Orthopedic Implants or Hardware

Metal plates, rods, screws, and wires that are surgically implanted for the repair of bone fractures and other bone disorders.

Palpation

Examining by touch.

Pigtail Catheter

A multi-holed catheter that has a coiled end that upon insertion helps to keep the catheter in place; it is frequently used for abscess drainage, particularly hepatic abscesses.

Ionizing Radiation

X-Ray.

Radiographs

X-rays of the internal structures of the body used for diagnostic purposes.

Radiolucent

Refers to materials that allow X-rays to penetrate and/or pass through.

Radiopaque

Blocks radiation rather than allowing it to pass through so the anatomical structures can be viewed.

Radiotracers

Radioactive isotope that is introduced into the body to study the compound's metabolism, distribution and passage through the body by means of a radiation detector.

History and Physical Examination

The first step in determining the etiology of a patient's condition is gathering information to create a personal historical record.

Patient Data Sources

Information about a patient's condition can be obtained in several ways from many sources including: History and physical examination (H&P) findings, Telemedicine consultations, Invasive and noninvasive diagnostic imaging studies, Laboratory and pathology results, Electrodiagnostic recordings, Endoscopic procedures, Pulmonary capacity and sufficiency measurements, Peripheral vascular assessments.

Vital Signs

Vital signs including pulse, temperature, oxygen saturation, and blood pressure.

Height and Weight Measurements

Height and weight measurements will be recorded.

Physical Examination

Physician performs a physical examination focusing on all body systems.

Direct Visualization

Direct or indirect visualization (pharyngeal mirror).

Enhanced Visualization

Enhanced visualization (otoscope, ophthalmoscope).

External Palpation

Palpation: external (abdominal, thyroid, lymph nodes, breast, or hernia).

Palpation: external

Assessment method involving physical examination of areas such as abdominal, thyroid, lymph nodes, breast, or hernia.

Palpation: internal

Assessment method involving physical examination such as pelvic exam or digital rectal or prostate exam.

Auscultation

The act of listening to internal body sounds, typically using a stethoscope.

Diagnostic Imaging

A term that refers to the various techniques now available for producing images of the human body.

X-rays

Radiographic imaging technique used to view skeletal and other internal structures for diagnostic purposes.

Pre-operative plain x-rays

X-rays of the chest frequently ordered by the anesthesia provider to identify lung abnormalities that may interfere with gas exchange during anesthesia.

Portable X-ray machines

Devices used in hospitals to diagnose bone fractures, verify placement of catheters, and locate abnormalities or foreign bodies.

CST - Diagnostic Imaging

The primary goal of the CST during intraoperative radiography is to protect the sterile field from contamination.

Mammography

Imaging technique that utilizes traditional or digital X-rays to locate tumors of the breast in their early stages.

Needle aspiration biopsy

A procedure where a very fine, long needle is used to biopsy a tumor after it is located on the X-ray.

Radiopaque Contrast Media Imaging

Imaging technique using contrast media with varying concentrations of iodine to enhance radiodensity.

Computed Axial Tomography (CAT) Scan

Specialized X-ray machine that produces pictures of a body part in slices for evaluation by a radiologist.

CT scanner slice thickness

The thickness of slices produced by a CT scanner can be adjusted, typically ranging from 2 to 10 mm.

Fluoroscopy

Imaging technique that utilizes ionizing radiation to project images of body structures onto a monitor in real time.

C-arm

A portable image intensifier used in fluoroscopy, named for its configuration.

Fluoroscopy intraoperative applications

Includes angiography, cholangiography, retrograde urography, and verification of catheter placement.

Myelography

Imaging technique for the spinal cord, nerve roots, and discs, often replaced by MRI but still used in some cases.

Contrast medium injection

In myelography, a contrast medium is injected into the subarachnoid space in the lumbar area.

Magnetic Resonance Imaging (MRI)

Imaging technique that has largely replaced myelography but may not be suitable for all patients.

Allergic reaction to contrast medium

A rare occurrence where a patient may be allergic to a contrast medium used in imaging.

Hypertonic contrast media

Most contrast media are hypertonic, viscid solutions, some with high sodium and high iodine content.

Radiolucent table

An operating room table that allows X-rays to pass through it.

Verification of catheter placement

Fluoroscopy is used to confirm the correct placement of catheters such as CVP and epidural.

Bone realignment

Fluoroscopy aids in the realignment of bones during surgical procedures.

Contrast Medium

Outlines the spinal cord and nerve roots on X-ray film.

Angiography

Flexible, atraumatic guidewires protected the intima of the vessel from the catheter tip and 'guide' the catheter to the proper location within the cardiovascular system.

Angiography - Rapid Film Changers

Rapid serial film changers capable of at least two films per second are essential for areas of high-velocity blood flow.

Angiography - Common Size

The most common size is 18 French.

Angiography - Guidewire

The typical guidewire is called a J-wire; the floppy curve at the end of the guidewire is useful for passage through tortuous, sclerotic vessels.

Cardiac Catheterization

Complex minimally invasive technique that evaluates heart function, visualization of coronary arteries and cardiac chambers, and the measurement of pressures within the cardiac chambers.

Cut-Down

Refers to making an incision and dissecting through the tissue layers to expose the vessel and making a small incision into the vessel for the introduction of the catheter.

Ejection Fraction

Refers to the percentage of blood that is pumped out of a filled ventricle with each heartbeat.

Ejection Fraction - Indicator

This is a good indicator of the heart's health.