Chapter 16 - Exam VI

General surgery

Involves many organ systems, but most commonly involves the abdominal cavity and the organs contained within the cavity.

Esophagus

A muscular tube that connects the throat (pharynx) with the stomach.

Stomach

A hollow organ that holds food while it is being mixed with stomach enzymes and acids.

Small intestine

A long, coiled tube where most of the digestion and absorption of food occurs.

Large intestine

The last part of the digestive system, responsible for absorbing water and electrolytes.

Appendix

A small, tube-like structure attached to the large intestine.

Rectum

The final section of the large intestine, terminating at the anus.

Spleen

An organ involved in filtering blood and recycling iron.

Pancreas

A gland that produces digestive enzymes and hormones such as insulin.

Liver and biliary system

Includes the liver, gallbladder, and bile ducts, responsible for producing bile and processing nutrients.

Hernias

Protrusions of an organ or tissue through an abnormal opening.

Inguinal hernia

A type of hernia that occurs in the groin area.

Femoral hernia

A hernia that occurs when tissue pushes through a weak spot in the femoral canal.

Umbilical hernia

A hernia that occurs when tissue protrudes through the abdominal muscles near the belly button.

Ventral hernia

A hernia that occurs through the abdominal wall.

Incisional hernia

A hernia that occurs at the site of a previous surgical incision.

Diaphragmatic hernia

A hernia that occurs when abdominal contents move into the chest cavity through a defect in the diaphragm.

Vein ligation and stripping

A surgical procedure to remove varicose veins.

Thyroid surgery

Surgical procedures performed on the thyroid gland.

Parathyroid surgery

Surgery involving the parathyroid glands, often to remove tumors.

Breast surgery

Surgical procedures performed on the breast, including mastectomy and lumpectomy.

Lymphatic system surgery

Surgical procedures involving the lymphatic system.

Laparotomy

A surgical opening through the skin layer and abdominal wall into the peritoneal cavity.

Exploratory laparotomy

A procedure listed on the schedule when the surgeon is not completely sure of a diagnosis.

Hiatal hernia

Occurs when the esophageal hiatus is weak, allowing the abdominal esophagus and superior portion of the stomach to protrude into the thoracic cavity.

Laparoscopic Nissen fundoplication

A procedure performed to correct a hiatal hernia by folding the upper stomach around the esophagus.

Gastric ulcer disease

A condition characterized by sores on the lining of the stomach.

Gastritis

Inflammation of the stomach lining.

Gastric polyp

A rare growth on the lining of the stomach.

Bezoar

A mass of indigestible vegetable fiber.

Carcinoma

A type of cancer that begins in the skin or in tissues that line or cover internal organs.

Lymphoma

A cancer that begins in the lymphatic system.

Leiomyoma

A benign tumor of smooth muscle.

Leiomyosarcoma

A malignant tumor of smooth muscle.

Gastrostomy

Surgical creation of an opening from the gastric mucosa to the skin.

Total gastrectomy

Removal of the stomach and reconstitution of the alimentary tract.

Subtotal gastrectomy

Referred to as a Billroth I or II procedure.

Billroth I

A gastroduodenostomy procedure involving removal of the pylorus of the stomach and an end-to-end anastomosis of the remaining stomach and duodenum.

Billroth II

The procedure where the cut ends of the duodenum are closed and the jejunum is anastomosed to the stomach, known as gastrojejunostomy.

Volvulus

A pathological condition where the bowel twists on itself, causing obstruction.

Intussusception

A condition where part of the intestine slides into an adjacent part, causing obstruction and cutting off blood supply to the affected part.

Bowel Resection

The surgical removal of a portion of the bowel.

Anastomosis

The surgical connection between two segments of the bowel.

Common Principles of Bowel Resection and Anastomosis

Principles that apply regardless of the area resected or anastomosed, including mobilization of affected bowel, removal of pathological tissue with healthy margin, ensuring adequate blood supply, sewing equal diameter segments, creating tension-free and leak-proof anastomosis, closing mesenteric defect, and maintaining functional and anatomical continuity.

End-to-End Anastomosis

A type of bowel anastomosis where two ends of the bowel are joined together.

End-to-Side Anastomosis

A type of bowel anastomosis where one end of the bowel is attached to the side of another bowel segment.

Side-to-Side Anastomosis

A type of bowel anastomosis where two segments of bowel are joined side by side.

Roux-en-Y

A surgical procedure that creates a Y-shaped connection of the bowel.

Stoma

A communication of a section of bowel with the outside of the abdominal cavity created to divert the fecal stream.

Ileostomy

A stoma created from the end section or loop of the ileum.

Colostomy

A stoma created from the colon.

End Colostomy

A type of colostomy created from the sigmoid colon following abdominoperineal resection.

Bowel Technique Principles

Guidelines for maintaining cleanliness during bowel anastomosis, including keeping clean and dirty areas separate.

Mayo Stand

A separate stand used for instruments and supplies during bowel resection and anastomosis.

Dirty Instruments

Needle holders, forceps, suture needles, and scissors used during resection/anastomosis considered dirty and kept separate.

Curved Mayo Scissors

Scissors used during the dirty part of the procedure, while straight scissors are reserved for clean wound closure.

Dirty Sponges

Sponges used for wiping devices or for hemostasis on open bowel, considered dirty and kept separate.

Knife Handles and Blades

Instruments used to enter the bowel for stapler insertion, considered dirty and kept separate.

Sterile Towels

Towels used to surround the exposed bowel and cover the drape near the incision site for protection.

Stoma Creation Timing

The creation of a stoma occurs during the dirty part of the procedure.

Bowel Technique Completion

The technique ends once resection and anastomosis are completed and checked for leaks.

Handling Dirty Items

Dirty non-disposable items should be placed in a basin and handed off to the circulator, while disposables go in the biohazard trash.

Sterile Gown and Gloves Change

The CST should change into a new sterile gown and gloves after bowel technique.

Clean Sterile Towels Placement

Clean sterile towels should be placed around the surgical site before abdominal wound closure.

Stoma

An opening created surgically to allow waste to exit the body.

Colon Resection

Surgical removal of a portion of the colon.

Appendectomy

Surgical procedure to remove the appendix, often performed for acute appendicitis.

Acute Appendicitis

Inflammation of the appendix usually caused by an obstruction.

Perforation of the Appendix

A serious condition where the appendix bursts, potentially leading to gangrene.

Anorectal Pathology

Conditions affecting the anal and rectal areas, often treated conservatively before surgery.

Fistula in Ano

A chronic form of perianal abscess that fails to heal.

Anal Fissure

Tears in the epidermis of the anal canal.

Pilonidal Disease

An acute abscess in the sacrococcygeal area that ruptures.

Hemorrhoids

Congestion and dilatation of the veins in the anal canal.

Anal Sphincter Injury

Injury to the anal sphincter, commonly occurring in females during childbirth.

Obstetric Anal Sphincter Injuries (OASIS)

A specific type of anal sphincter injury resulting in fecal incontinence.

Pathology of the Liver and Biliary Tract

Includes conditions like malignancy, hepatic adenoma, and hepatic cysts.

Liver Resection

Surgical excision of a hepatocellular tumor, may involve up to 80-90% of the liver.

Gallbladder Disease

Conditions affecting the gallbladder, including cholelithiasis.

Cholelithiasis

The presence of gallstones in the gallbladder.

Cholecystectomy

Surgical excision of the gallbladder.

Intra-operative Cholangiogram

A procedure involving dye injection into the common bile duct to visualize stones.

Extracorporeal Shockwave Lithotripsy (ESWL)

A non-invasive procedure using shock waves to fragment gallstones.

Ideal Patient for ESWL

A patient with a single gallstone less than 2cm in diameter.

Pancreatectomy

Surgical removal of the pancreas, often part of a Whipple procedure.

Whipple Procedure

A surgical procedure for tumors of the head of the pancreas, involving removal of both the pancreas and duodenum.

Splenectomy

Emergency surgical removal of the spleen to prevent excessive blood loss.

Hernia

A protrusion of a viscus through an opening in the wall of the cavity in which it is contained.

Reducible Hernia

Manual manipulation can return the hernia contents to the abdominal cavity.

Irreducible Hernia

Manual manipulation CANNOT return the hernia contents to the abdominal cavity and can become strangulated.

Strangulated Hernia

Hernia with viscera entrapment that compromises the blood supply, leading to necrosis of viscera if untreated.

Inguinal Hernia

Hernia located above the inguinal crease, occurring in more than 95% of males.

Femoral Hernia

Hernia located below the inguinal crease, occurring in 97% of females.

Ventral Hernia

Hernia present on the anterior abdominal wall at any point other than the groin.

Incisional Hernia

Hernia at sites of previous surgery and at stoma sites.

Diaphragmatic Hernia

Hernias in the diaphragm, usually at the esophageal hiatus.

Richter's Hernia

Incarcerated or strangulated bowel that spontaneously reduces, possibly overlooking the gangrenous portion during repair.

Sliding Hernia

Hernia where the abdominal viscera forms part of the hernia sac.

Direct Hernia

Inguinal hernia that presents within Hesselbach's triangle.

Indirect Hernia

Inguinal hernia generally confined to the spermatic cord.