M5 EAL General Surgery Comprehensive Study Guide

Retractors and Clamping Instruments: * Richardson retractor * Deaver retractor * Kocher (spelled "nocner" in transcript) clamp * Allis clamp * Harrington retractor * Babcock clamp * Weitlaner (spelled "weltlaner" in transcript) self-retaining retractor * Balfour self-retaining retractor * Bookwalter retractor system
Suction Tips: * Poole suction tip (often used for abdominal irrigation) * Yankauer suction tip
Specialized Dilators: * Bakes gallbladder dilators are used during biliary tract procedures.
Surgical Supplies: * Surgical mesh is the standard material used for most hernia repairs to provide structural reinforcement.
Procedural Considerations for High Vascularity: * The liver, biliary system, pancreas, and spleen contain many ducts and blood vessels. * Because of this high vascularity, right-angle clamps and "tie-on-passers" should be readily available during these procedures to manage ligation of vessels.

Abdominal Cavity: * The abdominal cavity contains the viscera, which are the internal organs.
Abdominal Peritoneum: * The peritoneum is the serous membrane that lines the walls of the abdominal cavity.
Hesselbach's Triangle: * This is a critical anatomical landmark in hernia surgery. * It is bounded by three structures: 1. The rectus abdominis muscle. 2. The inguinal ligament (spelled "inugual" in transcript). 3. The inferior epigastric vessels.

General Definition of Hernia: * A hernia is defined as the protrusion of tissue through a defect or weakness in the abdominal wall.
Indirect Inguinal Hernia: * This results in the protrusion of the abdominal viscera into the inguinal canal (spelled "inaguai canal" in transcript) starting from the deep inguinal ring.
Femoral Hernia: * A femoral hernia arises from a defect in the transversalis fascia located inferior to the inguinal ligament.
Incisional Hernia: * This is a post-operative complication where tissue herniates into the tissue layers surrounding a previous abdominal incision site.
Ventral Hernia: * This refers to any hernia occurring in the abdominal wall, excluding the groin and inguinal area.
Evisceration: * This is the protrusion of the viscera outside of the body, typically resulting from significant wound disruption or dehiscence.

TAPP Laparoscopy: * Transabdominal Preperitoneal (spelled "petifonctoneal" in transcript) Laparoscopy.
TEP Surgery: * Total Extraperitoneal surgery.

Esophagus: * A tubular structure extending from the pharynx to the stomach.
Small Intestine: * Extends from the pylorus of the stomach to the proximal end of the large intestine.
Large Intestine: * Extends from the distal ileum to the rectum.
Mobilization: * The clinical process of freeing up tissue (such as the bowel) from its attachments prior to performing an anastomosis or resection.
EGD (Esophagogastroduodenoscopy): * A diagnostic endoscopy used to visualize the esophagus, stomach, and proximal duodenum.
Colonoscopy: * Referred to as a "lower GI," this is an endoscopy performed on the large intestine.

Laparotomy: * An open surgery of the abdominal cavity used to gain access to the abdominal organs. * Exploratory Laparotomy: A laparotomy performed specifically to confirm a diagnosis or to detect a specific pathological condition.
Nissen Fundoplication: * Commonly performed to treat Gastroesophageal Reflux Disease (GERD).
Vagotomy: * A procedure performed to reduce gastric enzymes (acid) by severing the nerves (vagus nerves) that control their release.
PEG (Percutaneous Endoscopic Gastrostomy): * A common method for providing long-term access to the stomach through a flexible tube inserted through the abdominal wall.
Billroth I (Gastroduodenostomy): * A surgical anastomosis between the stomach and the duodenum.
Billroth II (Gastrojejunostomy): * A surgical anastomosis between the stomach and the jejunum.
NG Tube (Nasogastric Tube): * A flexible tube inserted through the nose and advanced into the stomach.

Morbid Obesity: * A clinical condition in which the patient's Body Mass Index (BMI) is at least $40$ .
Roux-en-Y Gastric Bypass: * Performed to bypass the distal stomach and reestablish continuity from the stomach to the jejunum.
Ostomy (Colostomy): * A procedure where a portion of the intestine is divided and the open end is secured to the skin (stoma).
Appendectomy: * The surgical removal of the appendix, a blind, narrow, elongated pouch attached to the cecum (spelled "leaum" in transcript). * Positioning: For a laparoscopic appendectomy, the patient is placed in the Trendelenburg position.
Hemorrhoidectomy: * The surgical removal of hemorrhoids.
Pilonidal Cyst: * A congenital defect in which epithelial tissue develops below the surface of the skin in the area of the sacrum and the coccyx.
Anal or Rectal Fistula: * Often arises from an infected fissure in the anal sphincter.

The Liver: * A large, vascular organ that aids in digestion and the filtration of toxic substances from the body. * Cirrhosis: A disease of the liver in which tissue hardens and venous drainage becomes blocked. * Segmental Resection: Involves the surgical removal of one or more of the liver segments.
The Spleen: * A kidney-bean-shaped organ that is extremely vascular and relatively soft. * Splenectomy: Surgical removal of the spleen to stop hemorrhage caused by trauma or to treat specific diseases.
Cholecystectomy: * The surgical removal of a diseased gallbladder.
Operative Cholangiography: * Imaging studies where contrast medium is injected into the biliary ducts to detect gallstones or other obstructions.
Whipple Procedure: * Performed for the curative or palliative treatment of pancreatic cancer.