Anatomy and Surgery of the GI Tract

Questions and Answers

What is the purpose of a temporary colostomy?

To allow the bowel to rest and heal (correct)

To remove the entire colon

To perform an initial surgical procedure for cancer

To permanently divert fecal flow

What is the primary blood supply to the small intestine and parts of the colon?

Gastric arteries

Inferior mesenteric artery

Superior mesenteric artery (correct)

Celiac trunk

What procedure involves the removal of the uterus, cervix, and surrounding structures, commonly due to cancer?

Vaginal Hysterectomy

Partial Hysterectomy

Bilateral Salpingo-Oophorectomy

Radical Hysterectomy (correct)

Which ligaments are associated with the support of the uterus?

Cardinal, uterosacral, round, and broad Signup and view all the answers

Which step is not part of the abdominal sequence when performing a procedure?

Irrigate Signup and view all the answers

What is the primary concern if the intraperitoneal pressure exceeds 16 mmHg during pneumoperitoneum?

Risk for gas embolism Signup and view all the answers

What is the purpose of separating bowel instruments from clean instruments during surgery?

To prevent cross-contamination Signup and view all the answers

What surgical procedure is indicated for heavy bleeding, miscarriage, or abortion?

Dilation and Curretage (D & C) Signup and view all the answers

In the context of gastric sleeve procedures, what percentage of the stomach is typically removed?

85% or more Signup and view all the answers

What is primarily addressed during a Nissen fundoplication to prevent gastric reflux?

Reconstruction of the lower esophageal sphincter Signup and view all the answers

In the Hartmanns Procedure, what happens to the distal part of the bowel?

It is closed and forms a mucous fistula Signup and view all the answers

Which type of stapler is used for cutting and stapling tissue simultaneously in gastrointestinal surgeries?

GIA (Gastrointestinal Anastomosis) Signup and view all the answers

What condition is commonly referred to as the 'silent killer' due to vague early symptoms?

Ovarian cancer Signup and view all the answers

What is the initial action during a Dilation and Curettage (D & C) procedure?

Dilation of the cervix Signup and view all the answers

What might happen if the suturing tension is too tight during cruroplasty in fundoplication?

Obstruction of food passage Signup and view all the answers

Which method can be used for endometrial ablation?

Laser with blanching and dragging technique Signup and view all the answers

What is a common method to ensure bowel isolation during surgical procedures?

Placement of extra draping around the wound Signup and view all the answers

During a Roux-en-Y gastric bypass, which part of the digestive tract is bypassed?

Duodenum Signup and view all the answers

What is required for procedural considerations during endometrial ablation?

Non-electrolytic ionic medium Signup and view all the answers

Why is mesenteric repair necessary after bowel removal?

To prevent bowel entrapment and obstruction Signup and view all the answers

What is the primary goal of Coronary Artery Bypass Grafts (CABG)?

To revascularize the ischemic myocardium Signup and view all the answers

Which medication is indicated for vasodilation and relaxing blood vessels during surgery?

Papavarine Signup and view all the answers

What is the primary function of an Implantable Cardioverter Defibrillator (ICD)?

To defibrillate and pace the heart during arrhythmias Signup and view all the answers

Which vascular graft has proven to have excellent long-term patency due to its anatomical attachment?

Left Internal Mammary Artery (LIMA) Signup and view all the answers

In the context of single-lung ventilation, which component of the Double Lumen Endotracheal Tube (ETT) is responsible for ventilating the non-operative lung?

Bronchial lumen (blue) Signup and view all the answers

What surgical process is indicated for patients suffering from chronic obstructive pulmonary disease (COPD)?

Lung Volume Reduction Surgery Signup and view all the answers

Which type of incision is used in the Transhiatal Esophagectomy approach?

Laparotomy Signup and view all the answers

During a Femoral Popliteal Bypass, which vein is primarily used due to its good patency and longevity?

Saphenous Vein Signup and view all the answers

What role do the Mediastinal Lymph Nodes play in lung surgeries?

Aid in the diagnosis of lung cancer Signup and view all the answers

Which structure is responsible for the negative intrapleural pressure that assists pulmonary ventilation?

Parietal Pleura Signup and view all the answers

What is the primary purpose of the TURP procedure?

To relieve symptoms of benign prostatic hyperplasia Signup and view all the answers

Which irrigation fluid should be used with monopolar cautery during TURP?

Nonelectrolytic solution Signup and view all the answers

What type of donor kidney is typically preferred for transplantation?

Kidneys from normotensive young individuals Signup and view all the answers

During a simple retropubic prostatectomy, what major concern might a surgeon need to address?

Bleeding complications Signup and view all the answers

What is a significant risk associated with irrigation fluid overload during surgical procedures?

Hypervolemia and varying blood pressure Signup and view all the answers

Which type of prostatectomy involves the removal of pelvic lymph nodes?

Nerve Sparing Radical Retropubic Prostatectomy Signup and view all the answers

What is the purpose of a Kock Pouch in urinary diversion procedures?

To act as a bladder replacement with a one-way valve Signup and view all the answers

What anatomical structure carries deoxygenated blood to the right atrium?

Superior and inferior vena cava Signup and view all the answers

What is the primary role of the perfusionist during cardiac surgery?

To operate the cardiopulmonary bypass machine Signup and view all the answers

What type of suture material is typically used for valve repair or replacement in cardiac surgeries?

Braided polyester sutures Signup and view all the answers

Which medication is used as an anticoagulant to decrease the clotting ability of blood during surgical procedures?

Heparinized Solution Signup and view all the answers

What is the primary goal of performing a CABG procedure?

To revascularize the ischemic myocardium Signup and view all the answers

What is the main purpose of an Implantable Cardioverter Defibrillator (ICD)?

To deliver defibrillator shocks as needed Signup and view all the answers

Which vascular graft is known for its durability and is already attached to the aorta?

LIMA Signup and view all the answers

What is a potential complication if pneumoperitoneum pressure exceeds 16 mmHg during surgery?

Gas embolism Signup and view all the answers

What is the primary purpose of the Hartmann's Procedure?

To address bowel perforation risks Signup and view all the answers

What specific procedure involves the removal of a wedge-shaped section of the lung?

Wedge Resection of Lung Signup and view all the answers

Which ligaments provide structural support to the uterus?

Cardinal and broad ligaments Signup and view all the answers

In the context of single-lung ventilation, what is the function of the bronchial lumen of the Double Lumen ETT?

To ventilate the non-operative lung Signup and view all the answers

What technique utilizes a transhiatal approach for esophagectomy during surgery?

Laparotomy and neck incision Signup and view all the answers

In a partial hysterectomy, which of the following is retained?

Uterus only Signup and view all the answers

What is the main component removed during pelvic exenteration?

Rectum and urinary bladder Signup and view all the answers

What anatomical structure is crucial for negative intrapleural pressure that facilitates pulmonary ventilation?

Parietal Pleura Signup and view all the answers

Which surgery is indicated specifically for patients with COPD, particularly due to chronic pulmonary emphysema?

Lung Volume Reduction Surgery Signup and view all the answers

Which medical condition is most frequently associated with a total abdominal hysterectomy?

Cervical cancer Signup and view all the answers

During a Femoral Popliteal Bypass, which vein is primarily chosen for its excellent patency?

Saphenous Vein Signup and view all the answers

What is the purpose of a Dilation and Curettage (D & C) procedure?

To scrape the uterine lining Signup and view all the answers

What is the role of non-electrolytic ionic mediums during endometrial ablation?

To enhance the cauterization effect Signup and view all the answers

Which step is performed last in the closing sequence of a surgical procedure involving the cervix?

Final (minor) closing Signup and view all the answers

After what duration do patients typically return to have their bowel reconnected following a Hartmann's Procedure?

3 months Signup and view all the answers

Which type of irrigation fluid is indicated for TURP when high absorption into the bloodstream is anticipated?

Nonelectrolytic Solution Signup and view all the answers

What is a major concern during a suprapubic prostatectomy due to its surgical approach?

Significant bleeding Signup and view all the answers

In the context of kidney transplants, why is the left kidney often preferred for removal?

The left renal vein is typically longer Signup and view all the answers

What is the surgical intervention indicated for treating an undescended testicle?

Orchidopexy Signup and view all the answers

Which surgical approach allows excellent exposure of the prostate bed during radical prostatectomy?

Simple retropubic approach Signup and view all the answers

Which suture material is typically used for anastomosis or repair of vessels in cardiac procedures?

Surgipro/Prolene Signup and view all the answers

What type of monitoring is critical during general anesthesia induction for patients with ventricular ischemia?

Comprehensive monitoring Signup and view all the answers

What does the Kock Pouch allow a patient to do?

Self-catheterize to remove urine Signup and view all the answers

During cardiac surgery using the CPB machine, what is the purpose of the cardioplegia catheter?

To administer cardioplegia solution Signup and view all the answers

In the context of irrigation fluid overload, what abdominal complication may occur?

Bladder perforation Signup and view all the answers

What is the main function of the Ligament of Treitz in the digestive system?

It connects the duodenum to the jejunum. Signup and view all the answers

What are the potential consequences of improper tension during the cruroplasty of a Nissen fundoplication?

It can cause persistent gastroesophageal reflux disease (GERD). Signup and view all the answers

Which surgical technique is used to cut and staple tissues simultaneously for gastrointestinal procedures?

GIA (Gastrointestinal Anastomosis) Signup and view all the answers

What is the primary reason for performing mesenteric defect repair after bowel removal?

To prevent post-operative bowel entrapment and obstruction. Signup and view all the answers

Which bariatric surgery procedure causes the stomach to bypass the duodenum?

Roux-en-Y gastric bypass Signup and view all the answers

During surgery, what is the purpose of bowel isolation techniques?

To prevent contamination and spread of malignant cells. Signup and view all the answers

What are the steps involved in the typical abdominal sequence during surgical procedures?

Clamp - clamp - cut - tie Signup and view all the answers

What is the primary function of the GIA stapler in gastrointestinal surgeries?

To staple two different sized lumens together. Signup and view all the answers

What defines the surgical intervention of sleeve gastrectomy?

Reducing the stomach by removing a significant portion. Signup and view all the answers

Which component of the Nissen fundoplication procedure involves wrapping a fold of stomach tissue around the esophagus?

Plication Signup and view all the answers

Study Notes

Surgical Anatomy and Techniques

Ligament of Treitz: connects the duodenum to the jejunum; significant landmark in gastrointestinal anatomy.
Blood supply to the stomach and intestines comes from:
- Celiac trunk: branches include splenic, common hepatic, and left gastric arteries.
- Superior mesenteric artery: supplies small intestine, ascending colon, and ⅔ of the transverse colon.
- Inferior mesenteric artery: supplies transverse colon down to rectum.

Bowel Isolation Techniques

Initiated upon clamping and opening of the gastrointestinal tract to prevent cross-contamination and metastasis of malignant cells.
Bowel instruments kept separate from clean instruments in a K-basin.
Extra draping may be added around the incisional area for enhanced isolation.
Surgical team must change gloves and gowns post-anastomosis and before closure.

Stapling Devices in Surgery

GIA (Gastrointestinal Anastomosis): facilitates side-to-side anastomosis, able to handle different lumen sizes, available in endoscopic form.
TA (Thoracoabdominal Stapler): staples tissue together; requires manual cutting.
EEA (End to End Anastomosis) or ILS (Intraluminal Stapler): performs circular cuts for end-to-end or end-to-side anastomosis, primarily used in the lower bowel.

Mesenteric Repair

Dissection of mesenteries during bowel removal necessitates repair to prevent post-operative bowel entrapment and obstruction.

Bariatric Surgery

Roux-En-Y Gastric Bypass: reduces stomach size, connects to the jejunum, leading to reduced calorie absorption and increased satiety.
Gastric Lap Band: adjustable band around the stomach restricts food intake.
Sleeve Gastrectomy: removes 85% or more of the stomach to limit food intake.

Colostomy/Ileostomy

Temporary procedures allow bowel rest due to disease or facilitate anastomosis healing.
Hartmann's Procedure entails a colostomy with a closure of the distal stump, allowing return surgeries after a healing period.
Permanent colostomies may occur after cancer surgery.

Uterine Procedures

CRUB ligaments (Cardinal, Uterosacral, Round, Broad) play a crucial role in uterine stabilization.
D & C (Dilation and Curettage): uterine lining scraping performed for heavy bleeding or post-miscarriage.
Vault Count: surgical count method when entering or removing the cervix.

Hysterectomy Types

Total Abdominal Hysterectomy: removes uterus and cervix.
Partial/Subtotal: removes only the uterus.
Radical Hysterectomy: encompasses removal of uterus, cervix, fallopian tubes, ovaries, and surrounding lymph nodes.

Kidney Transplant

Typically performed laparoscopically for enhanced recovery; donor kidneys from younger, healthy individuals with intact blood flow are preferred.
Anastomosis involves connecting the donor's renal artery and vein to recipient's iliac artery and vein.

Prostate Surgery

Various techniques such as Suprapubic and Simple Retropubic Prostatectomy focus on removing the prostate to alleviate urinary obstruction.
Nerve Sparing Radical Retropubic Prostatectomy protects erectile function while excising cancerous prostate tissue.

Lung Surgery

VATS (Video-Assisted Thoracoscopic Surgery) allows for lobectomy and wedge resection of lung lesions with minimized recovery time.
Double lumen ETT facilitates single-lung ventilation during procedures.
Esophagectomy techniques vary, including transhiatal and transthoracic methods for esophageal cancer treatment.

Interventions for Cardiac Procedures

Cardiac catheterization reveals coronary arteries' health for planning bypass grafts, using synthetic sutures for vascular repair.
Cardiopulmonary Bypass Machine (CPBM) diverts blood flow during heart surgery, allowing surgeons to operate on a still heart.

Medications and Solutions in Surgery

Heparinized solutions prevent clotting during procedures; Papavarine serves as a vasodilator.
CABG focuses on revascularization in patients with severe coronary artery disease using mammary artery grafts for effective long-term results.

Additional Surgical Terms

Ureteroscopy and urethroscopy are procedures for stone removal from the urinary tract.
Pyelithotomy involves the extraction of stones from the renal pelvis.
Orchidopexy fixes undescended testicles back into the scrotum.