General surgery Exam Prep

What organ systems are commonly involved in general surgery?

General surgery most commonly involves the abdominal cavity and organs contained within it, as well as the breast, head and neck, blood vessels, digestive tract, injuries, deformities, and other conditions.

What organs are contained within the abdominal cavity?

The abdominal cavity contains the stomach, liver, gallbladder, spleen, pancreas, appendix, kidneys, ureters, small intestine (duodenum, jejunum, ileum), cecum, large intestine (ascending, transverse, descending colon), rectum, and anus.

What is the difference between omentum and mesentery?

Omentum is a fold of the peritoneum that surrounds the stomach and other organs, while mesentery attaches the intestines to the abdominal wall, preventing them from collapsing.

What factors influence the choice of incision in surgery?

Factors include access desired/procedure to be performed, surgeon's preference, ability to lengthen the incision, and wound security and healing.

What are some basic instruments used in general surgery?

Basic instruments include poole suction tip, debakey forceps, mayo scissors, metz scissors, hemostats, mosquitoes, criles, kellys, kocher, army/navy, richardsons, ribbon retractors, allis, babcocks, tonsil clamps, right angle clamps, deavers, Balfour, and Bookwalter.

What is the purpose of atraumatic instruments in surgery?

Atraumatic instruments are designed to cause minimal tissue damage and promote healing.

What types of surgical staplers are used in bowel anastomoses?

Types include linear cutting stapler, transverse anastomosis (TA) linear non-cutting stapler, laparoscopic articulating linear cutting stapler, PI linear non-cutting stapler, and circular end-to-end anastomosis (EEA) stapler.

Why is it important to know about surgical staplers?

Each size and shape of stapler is designed for a different area to staple off, which is crucial for successful surgical outcomes.

What does the term 'laparotomy' mean?

Laparotomy refers to a surgical opening through the skin and abdominal wall, performed to examine abdominal organs and aid in diagnosis.

What is the purpose of an exploratory laparotomy?

An exploratory laparotomy is used to find the cause of problems by exploring the abdominal cavity to look for bleeding or other issues.

What are the layers of the abdominal wall?

The layers include skin, subcutaneous tissues (Camper's fascia and Scarpa's fascia), external oblique muscle, internal oblique muscle, transversus abdominis muscle, transversalis fascia, preperitoneal fat, and peritoneum.

What is the alimentary canal?

The alimentary canal consists of the digestive organs, including the mouth, pharynx, esophagus, stomach, small intestine, large intestine, rectum, and anus.

What is esophagitis?

Esophagitis refers to inflammation or injury to the esophageal mucosa.

What are the types of procedures performed in general surgery?

Procedures include surgeries on the esophagus, stomach, small intestines, large intestines, appendix, rectum, spleen, pancreas, liver (biliary system), thyroid, parathyroid, breast, and lymphatic system.

What is the role of the mesentery in the abdomen?

The mesentery holds the intestines in place, preventing them from collapsing, and contains lymph nodes and blood supply for the intestines.

What is the significance of the midline incision in laparotomy?

The midline incision is commonly used for exploratory laparotomy to provide access to the abdominal cavity.

How does the structure of the digestive tract influence surgical procedures?

The tubular anatomical structure of the digestive tract means many surgeries are variations on a common theme, often performed by general surgeons.

What are the common types of incisions used in abdominal surgery?

Common types of incisions include midline, paramedian, and transverse incisions, chosen based on the procedure and access required.

What is the function of bowel clamps in surgery?

Bowel clamps, such as Payr, Allen, Doyen, Glassman, or Best, are used to occlude the bowel during surgical procedures.

What is the importance of understanding basic anatomy in general surgery?

A solid understanding of basic anatomy is crucial for performing surgeries safely and effectively, as it informs surgical techniques and approaches.

What is the role of instrumentation trays in surgery?

Instrumentation trays, such as major general or minor general trays, provide the necessary instruments and supplies for various surgical procedures.

What is gastroesophageal reflux disease (GERD)?

A condition in which excessive stomach acid moves back into the esophagus, causing inflammation and potentially leading to erosive esophagitis.

What is a hiatal hernia?

A condition where part of the stomach or other organs push through the diaphragm into the chest.

What are esophageal motility disorders?

Disorders of the esophagus that may cause swallowing difficulties, spasms of pain, or regurgitation of food.

What is dysphagia?

Difficulty in swallowing that may result from neurologic deficits, muscular disorders, or mechanical obstructions.

What are the potential causes of dysphagia?

Neurologic deficits, muscular disorders, mechanical obstructions, and neoplasms.

What are neoplasms?

Tumors that can be benign (not cancer) or malignant (cancer), formed by rapidly dividing flawed cells.

What types of trauma can affect the esophagus?

Blunt trauma (e.g., from motor vehicle accidents), penetrating trauma (e.g., gunshot or stab wounds), foreign objects, and caustic substances.

What is laparoscopic Nissen fundoplication?

A minimally invasive surgical procedure that treats GERD and hiatal hernias by wrapping the upper portion of the stomach around the esophagus.

What is gastritis?

An inflammation of the stomach that can be acute or chronic, with varying severity.

What is gastroenteritis?

An inflammatory process involving the stomach and intestines, usually caused by infection or allergic reactions.

What are peptic ulcers?

Sores that develop in the stomach lining or duodenum, commonly caused by an imbalance of digestive juices.

What is pyloric stenosis?

Narrowing and obstruction of the pyloric sphincter, which may be congenital or acquired.

What is gastric cancer?

Cancer that arises primarily in the mucous glands of the stomach, often asymptomatic in early stages.

What is the significance of early gastric carcinoma?

It is confined to the mucosa and submucosa, but eventually can extend to the serosa and lymph nodes.

What are the common locations for gastric cancer tumors?

Most tumors occur in the antrum or pyloric area of the stomach, and some affect the lesser curvature or cardia.

What are the symptoms of gastric ulcer disease?

Sores in the stomach lining or duodenum that can cause pain, discomfort, and digestive issues.

What can cause gastric ulcers?

An imbalance of digestive juices and factors that protect the stomach lining.

What are the treatment options for esophageal conditions?

Medical treatment or surgical intervention, including open, minimally invasive, or robotic procedures.

What is the role of the diaphragm in relation to the esophagus?

The diaphragm separates the chest from the abdomen and can be involved in conditions like hiatal hernia.

What are the consequences of ingesting caustic substances?

They can cause significant damage to the esophagus.

What are the symptoms of trauma to the esophagus?

Symptoms can include pain, difficulty swallowing, and potential life-threatening injuries.

What is the typical treatment for GERD when medications are ineffective?

Surgical intervention, such as laparoscopic Nissen fundoplication.

What is the prognosis for gastric cancer if diagnosed early?

Early diagnosis is crucial as it is often asymptomatic, leading to a poor prognosis if not treated.

What is the primary cause of ulcers in the stomach?

Infection by bacteria called Helicobacter pylori (H pylori).

What is leiomyosarcoma?

A malignant (cancerous) tumor found in smooth muscle.

What are gastric polyps?

Growths on the inner lining of the stomach usually caused by certain medications.

What is a bezoar?

A ball of swallowed foreign material, most often composed of hair or fiber, that collects in the stomach.

What is a leiomyoma?

A benign tumor made up mostly of smooth muscle cells.

How is obesity defined?

As a chronic disease occurring when the body accumulates too much fat, defined as a body mass index (BMI) of 30 or higher.

What are some health complications associated with obesity?

Cardiovascular disease, Diabetes, Musculoskeletal disorders, Fatty liver disease, Gallstones.

What is morbid obesity?

Class III obesity, defined as a BMI of 40 or higher, or being 100 pounds or more above ideal body weight.

What health complications can arise from morbid obesity?

High blood pressure, Diabetes, Heart disease, Sleep apnea, Cancer, Arthritis, Gastroesophageal reflux disease (GERD), Urinary incontinence, Venous problems of the legs, Lower back pain.

What is the purpose of a gastrostomy?

To insert a feeding tube into the stomach, providing a route for tube feeding and venting the stomach.

What is a gastrectomy?

A surgical procedure to remove part or all of the stomach.

What is the difference between total gastrectomy and partial gastrectomy?

Total gastrectomy involves removing the entire stomach, while partial gastrectomy involves removing only part of the stomach.

What is a sleeve gastrectomy?

A procedure that removes most of the stomach, leaving a banana-shaped section to reduce food intake.

What is gastric bypass?

A procedure that creates a small pouch in the upper stomach and attaches the lower part of the small intestine directly to the pouch, bypassing most of the stomach.

What is the gastric band procedure?

Also known as LAP-Band, it involves placing a band around the top portion of the stomach to decrease its size.

What is the duodenal switch?

A weight-loss surgery that combines a sleeve gastrectomy with an intestinal bypass, effective for severe obesity and Type 2 diabetes.

What is diverticular disease?

A group of conditions in which tiny pouches called diverticula form in the colon, bulging out through weak spots.

What is the difference between the bowel and colon?

The bowel refers to the small intestine, while the colon refers to the large intestine.

What are the health implications of obesity?

Obesity can lead to serious health complications including cardiovascular disease, diabetes, and musculoskeletal disorders.

What is the role of bariatric surgery?

To help people lose weight by modifying the digestive system to reduce calorie intake and absorption.

What are some common gastric procedures in bariatric surgery?

Gastric sleeve, gastric bypass, gastric band, and duodenal switch.

What is the purpose of a Billroth I procedure?

To remove the pylorus of the stomach and perform an end-to-end anastomosis of the remaining stomach and duodenum.

What is the purpose of a Billroth II procedure?

To close the cut ends of the duodenum and anastomose the jejunum to the stomach.

What is a neoplasm?

An abnormal growth of tissue that can be benign (non-cancerous) or malignant (cancerous).

What is ulcerative colitis?

A chronic inflammatory bowel disease (IBD) that causes ulcers and inflammation in the colon and rectum.

What characterizes Crohn's disease?

A chronic inflammatory bowel disease (IBD) that can affect the entire digestive tract, characterized by inflammation of the intestinal walls.

What is a volvulus?

A condition where part of the intestine twists around itself.

What is intussusception?

A serious condition in which part of the intestine slides into an adjacent part.

What is impaction in the context of bowel health?

Lodgment of a large lump of dry, hard stool that stays stuck in the rectum, often seen in prolonged constipation.

What is appendicitis?

Inflammation of the appendix, which can fill with pus and is attached to the large intestine.

What is Meckel's diverticulum?

A small pouch in the wall of the intestine, near the junction of the small and large intestines.

What distinguishes benign neoplasms from malignant neoplasms?

Benign neoplasms are noncancerous, while malignant neoplasms are cancerous tumors.

What is bowel obstruction?

Blockage of a passageway in the bowel.

What are the four types of bowel anastomosis?

1. End to End: attachment of two ends of similar-sized structures. 2. End to Side: attachment of the end of one bowel section to the side of another. 3. Side to Side: creation of parallel openings in two bowel sections. 4. Roux-en-Y: used in various surgeries including gastric bypass.

What is the purpose of bowel technique in surgical procedures?

To isolate contaminated instruments and supplies from clean ones to prevent postoperative surgical site infections.

What does confinement and containment refer to in bowel technique?

Keeping dirty and clean instruments and supplies separate to avoid contamination during gastrointestinal procedures.

What is a stoma?

An opening created to divert the fecal stream, connecting a section of bowel to the outside of the abdominal cavity.

What are the types of stomas?

1. Ileostomy: located in the right lower quadrant. 2. Colostomy: located in the left lower quadrant. 3. Urostomy: located in the lower right side.

What is the typical appearance of a stoma?

Shaped, pink or red in color, slightly shiny, and has no nerve supply, so it doesn't hurt.

What are some reasons for creating a stoma?

To protect a recent intestinal anastomosis, avoid potential abdominal spillage postoperatively, or as an end result of bowel resection.

What is the role of a sterile basin in bowel technique?

To contain instruments, sponges, and supplies used during bowel procedures.

What should be done after completing an anastomosis in bowel technique?

Check for leaks, change gloves and/or gown, and replace any dirty supplies or instruments.

What is the significance of the appendix in relation to appendicitis?

The appendix plays a role in mammalian mucosal immune function and can become inflamed and filled with pus.

What is the cause of Crohn's disease?

The cause is unknown.

What is the definition of obstruction in the gastrointestinal context?

A blockage that prevents the normal flow of contents through the digestive tract.

What can happen if the bowel is inflamed during an anastomosis?

The bowel can break down or the incisions can rip apart.

What determines if a stoma is permanent or temporary?

A doctor can usually inform a patient before surgery if the stoma will be permanent, especially in cases of bowel cancer or serious injury.

How long after the original surgery can a temporary stoma be reversed?

Surgery to reverse a temporary stoma can be done three months to a year after the original surgery.

What is pruritus ani?

Pruritus ani, or anal itching, is a common condition causing intense itching and irritation around the anus, potentially caused by infections, hemorrhoids, diarrhea, or dermatitis.

What causes anal warts?

Anal warts are caused by the human papillomavirus (HPV), a sexually transmitted disease.

What are some causes of anal pain?

Anal pain can be caused by infections, trauma from straining or anal penetration, anal fissures, hemorrhoids, anal fistulas, or anal cancer.

What is pilonidal disease?

Pilonidal disease is a chronic skin condition occurring in the crease of the buttocks, usually near the tailbone, caused by plugged hair follicles.

What is ulcerative colitis?

Ulcerative colitis is a chronic inflammatory bowel disease that causes ulcers and inflammation in the colon and rectum, peaking at ages 15 to 30 and again at ages 50.

What factors may contribute to ulcerative colitis?

Factors may include genetics, immune system responses, environmental influences, and changes in the gut microbiome.

What is an anorectal abscess?

An anorectal abscess originates from an infection in the cryptoglandular epithelium lining the anal canal, potentially related to conditions like Crohn's disease or trauma.

What are hemorrhoids?

Hemorrhoids are swollen veins in the anus and rectum that can cause discomfort and bleeding, often caused by straining, constipation, or prolonged sitting.