General Surgery Packet

Question 1

esophagus

Answer 1

• 10 inches in adult*
• extends pharynx to cardia of stomach
• transport ingested material by peristalsis from pharynx to stomach
• musculomembranous

Question 2

function of large intestine (4)

Answer 2

• reabsorb water/electrolytes
• form solid waste
• synthesize vitamin K and B-complex vitamins
• elimination by defecation

Question 3

large intestine: define haustra

Answer 3

sacculations that are outpouchings of the bowel wall

Question 4

large intestine: blood supply

Answer 4

superior and inferior MESENTERIC arteries

Question 5

large intestine:

• ileocecal valve
• veriform appendix

Answer 5

• junction of the ileum and the cecum (small bowel meets large)
• extends from lower portion of cecum

Question 6

appendectomy is done for?

Answer 6

uncomplicated acute appendicitis

Question 7

appendicitis often mimics (3)

Answer 7

• ectopic pregnancy
• ovarian cyst
• ureteral stone

Question 8

methods of transecting the appendix

Answer 8

• endoscopic linear stapler
• ligating loop instrument (endoloop)
• suture instrument

Question 9

colon resection: mocker’s diverticulum are located?

Answer 9

in the Ileum

Question 10

colon resection: what can neoplasms form as a result of?

Answer 10

Polyps: pedunculated tumors

Question 11

colon resection: endoscopic anesthesia options (3)

Answer 11

• local anesthesia
• IV conscious sedation
• general anesthesia

Question 12

what is given to patient prior to colonoscopy to cleanse bowel?

Answer 12

-citrate of magnesia

Question 13

position of patient for colonoscopy

Answer 13

PT placed on left side to allow for visualization

Question 14

what is PT observed for following colonoscopy? (3)

Answer 14

• post procedural bleeding
• pain
• signs of perforations

Question 15

sigmoidoscopy is performed for?

Answer 15

visualization of the sigmoid up to splenic flexure

Question 16

intestinal clamps

Answer 16

• allen clamp
• dennis clamp
• doyen clamp

Question 17

when is bowel technique used? (2)

Answer 17

• when GI tract is clamped and resected

- used to isolate any instruments that come in contact with the mucosa or bowel contents

Question 18

suture method: serosal layer of posterior wall

Answer 18

• interrupted mattress stitch

- non absorbable

Question 19

how is colostomy secured to skin?

Answer 19

• closed bowel loop

- bridge is used/plastic rode

Question 20

when is second stage colostomy formed?

Answer 20

performed in PTs room or treatment room 24hr after surgery

Question 21

laparoscopic nissen fundoplication

Answer 21

• upper curves of stomach (fundus) wrapped around esophagus and sewn in place to strengthen valve between esophagus/stomach
• stops acid from backing up so easily

Question 22

diagnostic interventions: fundoplication (5)

Answer 22

• history/physical
• barium swallow
• endoscopy (esophagus, stomach, duodenum identified)
• manometry
• CT scan

Question 23

laparoscopic nissen fundoplication: which dilators are used/why?

Answer 23

• hurst / maloney*

- esophageal dilators prevents stricture/maintains patency during wrap procedure

Question 24

difference between Billroth 1 / Billroth 2

Answer 24

Bilroth 1: re-anastomosis stomach to duodenum
Bilroth 2: re-anastomosis stomach to jejunum
used to treat neoplasms/ulcerative disease

Question 25

what is bile manufactured by? | what collects and transports bile to ducts?

Answer 25

- hepatocytes | - bile canuliculi

Question 26

what stores and concentrates rates of bile?

Answer 26

gallbladder

Question 27

what is common bile duct? | where does it transport bile?

Answer 27

- joining of common hepatic/cystic duct | - brings bile to duodenum

Question 28

what does ERCP stand for?

Answer 28

endoscopic retrograde cholangiopancreatography

Question 29

anesthesia for cholecystectomy

Answer 29

- prophylaxis used to prevent post op infection | - nasogastric tube placed for medicine delivery or attached to suction to keep stomach empty

Question 30

what incision is made for open approach cholecystectomy?

Answer 30

- right subcostal aka Kocher (preferred method) - right paramedian - midline

Question 31

what is used to harvest core structure for liver biopsy?

Answer 31

Vim-Silverman core biopsy needle

Question 32

suture considerations for liver resection?

Answer 32

- absorbable suture | - blunt needles (tapered)

Question 33

incision for splenectomy?

Answer 33

* left subcostal* | - upper midline

Question 34

pancreaticoduodenectomy (whipple procedure)

Answer 34

*used to treat pancreatic cancer* | head of pancreas, duodenum, portion of stomach are removed, adjacent tissues are removed

Question 35

incision for whipple procedure

Answer 35

- upper transverse - paramedian - bilateral subcostal (chevron)

Question 36

suspensory ligaments of the breast?

Answer 36

coopers ligaments

Question 37

tail of spence

Answer 37

extension of breast tissue that extends into the axilla

Question 38

what is a fibroadenoma?

Answer 38

benign lesion of the breast

Question 39

early menarche is?

Answer 39

* increased risk factor for breast cancer* | - early menstruation

Question 40

diagnostic intervention of breast cancer? (4)

Answer 40

- breast examination - mammography - core biopsy (vim silverman needle) - stereotactic biopsy (computer guided system used to digitally locate/pinpoint non palpable lesions)

Question 41

sentinel node biopsy:

Answer 41

- first lymph node along lymphatic channel from primary tumor site - surgeon injects ISOSULFAN to locate position of sentinel nerve

Question 42

skin prep considerations for breast biopsy

Answer 42

-vigorous scrubbing is avoided to prevent spread of cancerous cells

Question 43

modified radical mastectomy

Answer 43

removal of: - entire breast - pectoralis major fascia - axillary nodes (axillary, pectoral, superior apical)

Question 44

breast mastectomy incision

Answer 44

elliptical transverse | *allow 4cm margin from lesion*

Question 45

considerations when handling specimen during mastectomy?

Answer 45

- always ask surgeon before passing off | - be ready with marking stitch

Question 46

mastectomy tagging stitches (3)

Answer 46

- long lateral - short superior - 3-0 silk on SH needle

Question 47

incarcerated hernias

Answer 47

- trapped by defect | - not reducible

Question 48

strangulated hernias

Answer 48

- incarcerated hernia that has vascular compromise | - emergency situation

Question 49

inguinal herniorrhaphy

Answer 49

direct: - results from heavy lifting or straining - protrudes through hesselbachs triangle