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131 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Gallbladder inflammation
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Cholecystitis
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Pertaining to the liver
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Hepatic
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Pancreatoduodenectomy
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The removal of:
head of Pancreas Entire Duodenum Portion of jejunum Distal 3rd of stomach Lower 1/2 of common bile duct Reestablishment of: continuity of biliary, pancreatic and GI tract |
Whipple Procedure
May take 5-6 hours |
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Cholecystectomy
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Operation to remove the gallbladder
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The gllbladder is a small sac found just under the liver which stores bile and releases it into the intestines. Bile is important because it helps to digest fat. The gallbladder isn't an essentil organ and bile will continue to be released into the intestine after removal of the gallbladder.
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Choledochotomy
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Incision into the common bile duct
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Cholelithiasis
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Gallbladder stones
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Cholecystectomy is often performed for this problem
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Choledochostomy
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Opening from gallbladder with tube insertion for drainage
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Choledochscopy
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Scope used to look at the gallbladder
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Cholangiogram
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X-Ray of the bile ducts
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Hepatomegaly
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abnormal enlargement of the lver
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Anorexia
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Loss of appetite
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Can be purposeful or not
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Splenectomy
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Removal of the spleen
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The spleen helps fight infections, and destroys redundant red blood cells. A splenectomy is usually done for trauma to it and specific malignant conditions such as Hodgkin's disease, leukemias, hemolytic jaundice, etc.
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Cirrhosis
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Chronic disease of the liver
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Often found in alcoholics, characterized by many damaged cells with fibrosis and nodular degeneration which causes scar tissue, in turn causing a swollen liver. Note the striations and the blue lines on google images from the pressure it causes on the liver
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CBD stands for...
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Common Bile Duct
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The sheath of connective tissue enclosing the hepatic artery, hepatic duct, and portal vein
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Glisson's capsule
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Sheath which covers the liver
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Where is the liver located?
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The right upper quadrant under the diaphragm and above the stomach
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The arterial blood supply to the liver is from the
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Hepatic artery
And the venous return is through the...... |
Digestive tract which includes the pancreas, liver, spleen and portal vein.
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The nerve supply to the liver is from the .....
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Thoracic 7-11, sympathetic and parasympathetic, right and left vagus nerves which...
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Stimulates contraction
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The functions of the liver are...
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To produce and secrete bile
Aids in blood clotting Detoxification of drugs/alcohol Aids in metabolism of carbs and converts glycol to be secreted for protein Filter |
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The right and left ducts drain the bile from the liver into the...
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common bile duct
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Stores and concentrates bile and forces bile into the duodenum during the digestion of fats...
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Gallbladder
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The sphincter of oddi guards the entrance into the duodenum
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The cystic duct joins the hepatic duct to form the
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Common bile duct
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Where is the gallbladder located?
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Upper right quadrant
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Pear shape. Located under right lobe of liver
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The arterial blood supply to the gallbladder is from the...
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Cystic artery
and the venous return is through the |
Hepatic vein
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The______ nerve supplies the gallbladder
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Vagus
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This is the 10th cranial nerve involved in a vaso-vagal attack for ex: when you're in pain this nerve may kick in to cause you to faint and not feel the pain
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What are the functions of the gallbladder?
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Stores and concentrates bile to metabolize fat.
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The _____ duct drains bile from the gallbladder into the ________ duct
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Cystic
Common bile duct |
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The flow of bile.....
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Liver to the
Hepatic duct to the Gallbladder to the Cystic duct to the Duodenum |
Acronym:
Lets Hope Gardner Chad Does it |
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What is the function of bile?
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Breaks fat into smaller paricles to aid in digestion to small intestine. Orange or yellow but mostly water. Contains bile salts and cholesterol. Crystals can form if there isn't enough salts and can turn into stones otherwise known as...
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Cholelithiasis
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Where is the pancreas located?
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posterior to the stomach, transverse in upper abdomen behind stomach, attached to hyland of pleph
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Divided into four regions: the head, neck, body and tail
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The pancreas is a _____ gland
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mixed
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Called exocrine(out of) and endotocrine (into). Endocrine is ductless which secretes beta cells where as intocrine secretes alpha cells.
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What is the function of the pancreas as an exocrine gland?
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As an exocrine gland it secretes sodium bicarbonate to neutralize the acidity of the stomach contents that enter the duodenum. Pancreatic juices contain enzymes for digesting carbs, fats and proteins
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What is the function of the pancreas as an endocrine gland?
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The islets of langerhans secrete insulin which is important for carb metabolism. Secretes glucagon to raise blood glucose levels and somatostatin to exert a hypoglycemic effect.
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The Pancreatic Duct is also known as...
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Duct of Wirsung
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The line that goes down the middle of the pancreas
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The Pancreatic Duct (Duct of Wirsung) joins the _____ at the ________.
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Common Bile Duct
Ampulla of vader |
Fork like extension at the end of the pancreatic duct
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What is a major problem of the pancreas?
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Diabetes types 1&2
Hypoglycemia |
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Located in the upper left (but your right side when you're looking at it) quadrant protected by ribs 10,11 &12
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Spleen
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Sometimes when it is enlarged (splenomegaly) it could indicate Mono and that person would need to refrain from any contact sports such as footbal so it wouldn't burst.
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The spleen is attached to what peritoneal ligaments?
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Spleno
Reno Gastrosplenic and greater Omentum |
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What are the functions of the spleen?
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Phagocytizes damages red blood cells. It also acts to help keep the blood free of unwanted substances including wastes and infecting organisms.
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In the normal adult, in times of stress or in need of more RBCS, the spleen contracts rhythmically to produce more blood.
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What happens to these functions when the spleen is removed?
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Other tissues take over these functions.
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A person can live without the spleen , although they may get sick more often. Also, the spleen may be swollen when a person gets sick.
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Infectious hepatitis. Commonly seen in the fall and winter. Young children. Spread by the fecal to oral route. (Hep B is spread by blood). Person to person contact by contaminated fruits, vegetables and uncooked fish, milk and poorly washed utensils.
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Hepatitis A
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Vaccine is available
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Infectious hepatitis (liver)Transmitted by blood, saliva and semen(Drug addicts, health care personnel, hemodialysis pts.)
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Hepatitis B
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Vaccine available
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Infectious liver hepatitis. Transmittal the same as Hep B. Occurs frequently in those receiving frequent blood transfusions. Cirrhosis is a complication.
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Hepatitis C
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A chronic, progressive disease of the liver characterized by diffuse damage to cells with fibrosis and nodular regeneration which causes formation of scar tissue, in turn causing an enlarged liver (ascites). Frequent in alcoholics and can cause Hepatitis C. Causes decreased mental alertness.
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Cirrhosis
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Because of the increased scarring, blood may go back up into the portal veinand into the stomach causing esophageal varices and cause bleeding.
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Trauma to the liver would include...
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Paracentesis(needle placed in abdomen) to drain blood duild up
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Neoplasm
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New growth benign hyrid cyst
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May be benign or malignant
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Cysts
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Most are harmless, but should be removed because they may change into malignant growths become infected (such as in obstructing the liver) or a gland obstruction.
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There are four main types of cysts: retention cysts, exucdation cysts, embryonic cysts and paracytic cysts.
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Adenoma
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A benign epithelial tumor
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Carcinoma
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A new malignant growth giving rise to metastasis
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metastasis means it grows at a fast rate
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Cholecystitis
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Inflammation of the gallbladder. Blockage of cystic duct. Swells gallbladder
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Chronic cholecystitis causes liver damage with inadequate fat absorption and vitamin A deficiency
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Cholelithiasis
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Gallstones. Causes super saturation of body cholesterol with not enough bile to break down stones. Often occurs in a fasting diet. Small stones are o.k. but big stones have to be removed.
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Biliary atresia
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The failure of a fetus to form adequate bile drainage from the liver to the intestine. Usually because of stones or tumors.(common bile duct between intestines
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Cystic Fibrosis
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pancreatic duct fills with mucus. Causes thick sticky mucus and very salty sweat. All portals in the body such as the lungs, ducts, etc are filled with the thick sticky mucus.
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In the pancreas, it fills with the mucus and is unable to produce enough pancreatic juices to aid in digestion. Transplant.
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Pancreatitis
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Inflammation of the pancreas
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Fluid collects in pancreas causing it to eat itself. 40% caused by alcoholism
20% from trauma 40% by gallstones (because it obstructs the pancreatic duct) |
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Pancreatic cysts (pseudocysts)
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A laparoscopic procedure with a T-tube is done. The procedure is called the Roux-en-Y is done to drain the cyst
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Done for pancreatitis
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Cholangiogram done to...
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Visualize open and closed areaof the bile duct
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What is needed to do a cholangiogram?
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Clango Catheter Xray
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Contrast medium is used
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The cholangiocatheter is inserted into the _____and _____
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cystic and common bile duct
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The common bile duct is filled with saline which dilates the duct. Contrast medium is used to view the ducts
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Cholecystostomy
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Opening in the gallbladder that permits drainage and removes stones, grasp with gallbladder then purse string.
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Choledochoscopy
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Visualization of lumen and mucus membranes of the bile duct
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Gallbladder and pancreas
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Choledochostomy or choledochotomy
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The common bile duct is opened longitudinally between two traction sutures.
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Any stones can then be removed with stone forceps or removed by irrigation of the duct with saline solution. See pg 377 of Alexander's book
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Cholelithotripsy
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Ultrasonic gallstone crusher
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Non surgical
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Cholecystoduodenostomy or cholecystojejunostomy
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Surgical anastomosis of the gallbladder and duodenum or of the gallbladder and the jejunum
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Choledochoduodenostomy or choledochojejunostomy (Roux-en-Y)
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Between common bile duct and duodenum.
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Mini Gastric Bypass procedure used for obesity. Used to bypass the stomach.
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The position for a choleystectomy is...
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Supine
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What type of incision is used for a cholecystectomy?
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Right subcostal or upper midline
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****Cases on the biliary system are considered
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Clean contaminated
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Liver abscess drainage
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Occurs primarily by spread of bacteria or other organisms throught the portal system, a direct route after trauma, the biliary tract or the hepatic artery in generalized septicemia (blood poisoning)
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Sometimes, although rare can be caused by a hydatid which contains larvae of the tapeworm whose eggs are carried from the intestinal tract to the liver by way of the portal system.
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Describe the draping procedure for each hepatic Resection
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left: regular lap drape
right: cut is bigger, put steri drape on top |
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The incision for a left hepatic resection is....
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midline paramedine subcostal
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The incision for a right hepatic resection is...
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Right subcostal
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The incision used for an enlarged liver is...
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Thoracic abominal incision
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An enlarged liver would be noted in Cirrhosis/ascites
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What type of needle is used to sew the liver?
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Blunt needle
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A manometer is used to measure the.....
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portal pressure
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Chest tubes would be used for what procedure
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In right liver resection if the surgery enters the thoracic cavity
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Wedge resection
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Used to excise metastatic cancerous tumors
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The ultrasound matcos lazer electrical serig 1 unit may be used for the above procedure.
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Radioimmunoguided Surgery preparation
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2-3 weeks before surgery, the pt receives an IV injection of a radiolabeled antibody which binds active antigen near or on the tumor.
b. This keeps minute particles of radioactivity localized in the tissue. c. Intraoperatively a gamma held probe is used to scan the liver and areas emitting strong pitched are marked with a marking pen. d. This is used with CT and ultrasound to confirm lesions. |
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What does hemostatic mean?
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To stop blood flow
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What are some types of hemostatic materials?
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gelfoam
surgicel thrombin avitene electrsurgery liga clips |
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Gelfoam
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Absorbable powder or compressed forms
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Surgicel
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Absorbable oxidation product of cellulose. On contact with blood, clot forms. Increases in size and forms a gel. Absorbs 10 x its own weight.
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Thrombin
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Enzyme extracted from bovine (pig) blood. Accelerates coagulation of blood. Unites apidly with fibrin to form a clot
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May be used topically as a dry powder or as a solution that sponges are dipped in. May also be sprayed on. Loses potency after 3 hours
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Avitene
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Hydrochloric acid salt of purified bovine corium collagen. Makes adhesions (sticks together) of platelets and prompt fibrin deposits.
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Applied dry. Firm pressure against bleeding surface.
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Electrosurgery
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Used to cut and coagulate tissue but has a bad reputation for injuries
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Box 7-62 on pg. 218 of Alexanders
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Liga Clips
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Disposable relocid
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List tissue and sutures used to close an abdominal case.....
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partium 0-20 running sutures. Absorbable on taper needle. Usually circle or chromic mesuel. 2-0 intrepered absorbable on taper needle cornic viers. Subcuso 3-0 running on taper absorbable. Skin staples 40 vicrol monecry absorbable running stitches cutting neals
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I have no idea what you wrote!
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Staples
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Used for anastomosis and skin closure
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Laparotomy sponges are used with_____ to wall of organs
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Moist saline
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List two wound drains
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Hemovac suction or jackson pratt or penrose drain
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Good pics on Google Images
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A ____ tube would be used to drain the Common Bile Duct
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T-Tube
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Chest tubes would be needed for a ______ procedure
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Right liver
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What are the supplies needed for an intraoperative radiography(cholangiogram)??
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Contrast media (hypague conray
Cholangiocatheter (Drain) 20 cc leur lock syringe |
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Culture tubes
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Swab used to culture or rule out possible bacterial infections, usually has a blue cap and looks like a strep swab. Usually used on the skin
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The position used for a splenectomy is
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Supine
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The incision used for splenectomy is...
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Left subcostal or upper midline
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The three ligaments clamped and ligated to free the spleen are....
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splenorenal
slenocdic(gallladder) gastrophenal |
Clips and staples are used to divide them
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Which is divided and ligated first, the splenic artery or vein and why?
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First the splenic artery because it allows blood to flow back into the system and then the vein.
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Why are long instruments used for a splenectomy?
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It is located deep into the body. Two long right angle clamps are needed
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Describe a complication of splenectomy or damage to the spleen...
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Hemmorrhage which could cause the pt to bleed to death
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Golden Hour
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Saving a person's life in the first hour status post trauma
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EMS
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Rapidtransfer to a hospital
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Trauma Center level 1
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open 24/7 has the appropriate equipment and medical staff
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Trauma Center level 2
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provides surgical intervention not all of resources.
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Trauma Center level 3
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Community Hospital
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Trauma Center Level 4
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Doctor's office
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MAST suit
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M medical
A anti S shock T trousers |
Slows or arrests vascular bleeding, rescues potental spaces where hematomas may form and support central circulation. Supports vital organs. The suit must only be removed by a physician. Go to Google Images to see.
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Auto transfusion
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Receiving your own blood. Used for tauma cases, no time for cross match. Decreases reactions.
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Indications for auto transfusions:
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Increase circulating blood volume
increase number of RBCs Provide plasma clotting factors To filter blood |
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Preservation of evidence such as in a gun shot wound...
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Remove clothing at seams
Cut around wound Bag hand gun Document who handled it |
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Cell Saver
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Machine used for Saving one's own blood for transfusion. Plasma and RBcs are saved and filtered and frozen for future
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Pancreatoduodenectomy
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Whipple procedure
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What organs are removed in a Whipple Procedure?
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Distal 3rd of the stomach
Part of Pancreas Duodenum Part of jejunum Lower 1/2 of common bile duct |
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The incision for the Whipple Procedure is_____, _____ or _____.
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Upper
Transverse Bilateral subcostal or long perimedium. |
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List three anastomosis used to restore GI continuity...
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Pancreatic Jejunostomy
choledonjejunostomy Gastrojejunostomy |
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Pancreatectomy
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Removal of the pancreas
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Schnertrocar
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Used to drain the gallbladder if it is greatly distended
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List two structures that are clamped, ligated and divided in a cholecystectomy...
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Cystic Artery
Cystic Vein |
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Describe the suture needle used to sew the liver or galllbladder bed (raw surface of the liver)
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30 or 40 fine taper needle
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A ______- is used to drain the common bile duct
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Tube
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Explain other methods of removing the gallbladder
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Lap Chole
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What is a non-surgical treatment for gallstones?
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Cholelithotripsy
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What is a Laparoscopic Cholecystectomy? (Lap Chole)
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Scope into the abdomen in the peri-umbilical core
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The postion for a lap chole is...
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supine
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The number of incisions made in a lap chole is...
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4
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The two structures identified, ligated and divided in a lap chole are...
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Cystic Duct
Common Bile Duct |
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Laparoscopic Cholecystectomy
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A patient having this procedure usually stays in the hospital overnight and may return to work within a week versus an open cholecystectomy for which a patient stays in the hospital for about 5 days and off of work for about 6 weeks.
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What instrument is used to grasp the gallbladder?
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Judd Demartel
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What are some symptoms of pts with Liver conditions?
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Nodular liver (enlargement)
hepatomegaly weight loss anemia nausea ascites edema fever jaundice RUQ pain |
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What are some symptoms of a pt with Gallbladder conditions?
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Indigestion
Fever and malaise jaundice gallstone colic |
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What are some symptoms of pts with a condition of the pancreas?
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Pain
elevated enzymes weight loss jaundice anorexia |
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What are some symptoms of a pt with a spleen condition?
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jaundice
anemia splenomegaly (large spleen) rupture |
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