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26 Cards in this Set
- Front
- Back
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What is the definition of laparotomy?
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Incision through the abdominal wall
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What are 2 incisions that can be used to allow access to the peritoneal cavity (laparotomy)?
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ventral midline
flank/paracostal |
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What are the 3 incisions you make when performing a ventral midline laparotomy?
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Skin incision
Subcutaneous incision Abdominal wall incision -deal w/ falciform ligament cranially |
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What do you have to do after making your subcutaneous incision when performing a ventral midline laparotomy?
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Clean the linea alba
-important for closure not to have fat where linea alba will be closed |
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What are 2 reasons its important not to dissect excessively when cleaning the linea alba during a ventral midline laparotomy?
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Creates dead space
seroma, hematoma |
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Where do you want to incise into the abdominal wall when performing a ventral midline laparotomy? Why?
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Right on the linea alba
-if go lateral to linea alba you'll cut into the rectus abdominis muscle |
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What is the linea alba?
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Where aponeurosis of the transverse and internal and external oblique muscles attach to midline
-wider and thinner cranially, narrows and thickens caudally |
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Why is the linea alba thicker caudally?
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More aponeuroses come together caudally
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What is the proper way to penetrate the abdominal wall?
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pick up the abdominal wall with forceps as far as you can so pulling abdominal wall away from organs then turn blade other way around so cutting edge is facing upwards and go in at about 45 degree angle and make a key hole incision then can pass forceps in and use blade w/ cutting edge down or mayo scissors
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What should you do as incising the linea alba?
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Make sure to check for incisions then continue opening linea alba
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When do you have to deal with the falciform ligament when performing a laparotomy? How do you remove it?
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Cranial abdomen
Can be removed w/ forceps and pulling or electrocautery -don't always have to remove |
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**What MUST always be included when closing up a laparotomy?
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MUST include external sheath of the rectus muscle=holding layer
-no need to include the peritoneal layer in sutures but not harmful |
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Where do you want to place sutures when closing up the linea alba?
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Want suture placed lateral to transition between linea alba and rectus sheath
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Do you want to use a continuous or interrupted pattern to close up the abdominal wall?
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Continuous pattern is adequate
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How many throws do you want to use when performing a continuous pattern while closing up the abdominal wall?
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-Need 1 extra at start knot
-Need 2 to 3 extra throws at end -for PDS this means 5 throws at the start and 6-7 throws for end knot |
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How many throws is a square knot?
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2 throws
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What type of suture material do you wan to use to close up the abdominal wall?
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Monofilament synthetic
-PDS -Maxon -Polypropylene -Nylon |
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What suture material is NOT recommended for closing the abdominal wall?
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Gut and poliglecaprone
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The closure of the linea alba is always ______ of closure of other layers and no _____ from SQ shouldn't be included in sutures.
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Independent
No fat-sutures will loosen |
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How do you perform a paracostal laparotomy?
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Cut into peritoneum then in belly
Close up each muscle layer individually |
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What is the definition of an exploratory laparotomy?
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Systematic examination of the organs accessible through a laparotomy to find and potentially correct the cause of disease
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**What is the omental bursa?
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A virtual space that exists b/w dorsal leaf and ventral leaf of omentum
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Are structures located cranially or caudally in the omental bursa?
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Cranially NOT caudally
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Why do you have to open up the omental bursa on exploratories?
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Can see left limb of pancreas, colon
*where PSS hide is in the omental bursa |
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How do you exploring the right gutter?
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Use the mesoduodenum to retract the intestine to the left and examine the right "gutter". palpate the kidneys and examine the adrenal gland, ureter and ovary
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How do you explore the left gutter?
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Use the descending colon to retract the abdominal organs to the right and examine the left kidney, adrenal gland, ureter and ovary
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