Module 13: Biliary Surgery

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Questions and Answers

What is the main anatomical landmark involved in the surgical removal of the gallbladder?

Hepatic Tree

Pancreatic Duct

Triangle of Calot (correct)

Celiac Axis

Which of the following arteries is NOT a branch of the Celiac Axis?

Splenic

Common Hepatic

Left Gastric

Aortic (correct)

What type of anesthesia is typically used for patients undergoing biliary specific surgeries?

Local anesthesia

Regional anesthesia

Sedation only

General anesthesia (correct)

During biliary surgeries, why might patients require blood transfusions?

Extensive tissue dissection in vascular areas Signup and view all the answers

Which of the following components is NOT part of the Triangle of Calot?

Splenic Artery Signup and view all the answers

What is the primary focus of perioperative nursing assessment for biliary surgeries?

Confirming blood product availability Signup and view all the answers

Which organ does not contribute to the blood supply via the Celiac Axis?

Gallbladder Signup and view all the answers

What surgical technique might require the use of hemostatic agents during biliary surgery?

Open surgery with extensive dissection Signup and view all the answers

What is the correct patient position for a biliary surgery?

Supine position Signup and view all the answers

Which of the following is NOT a part of the surgical count process?

Postoperative count Signup and view all the answers

What type of trocars are typically used for a laparoscopy in biliary surgery?

2x 5mm and 2x 10-12mm Hassan trocars Signup and view all the answers

Which of the following is considered a procedural consideration during laparoscopic surgery?

Visceral or vascular injury Signup and view all the answers

What is the purpose of the safety strap for a patient in the operating room?

To prevent movement during the procedure Signup and view all the answers

What is the main indication for performing a cholecystectomy?

Chronic inflammation or gallstones Signup and view all the answers

During laparoscopic surgery, where should the 5mm trocars be placed?

Right lateral side of the abdomen Signup and view all the answers

What additional equipment is required for an intraoperative cholangiogram during open cholecystectomy?

X-ray equipment Signup and view all the answers

What complication may arise due to CO2 insufflation during surgery?

Respiratory acidosis Signup and view all the answers

What is the purpose of the hemoclips during the operative procedure?

To clip the cystic artery Signup and view all the answers

During an intraoperative cholangiogram, what is injected to highlight biliary structures?

Contrast dye medium Signup and view all the answers

What is the first step in the operative procedure for gallbladder removal?

Skin incision with a blade (#11) Signup and view all the answers

What is the role of the flexible stone forceps in the laparoscopic procedure?

To retrieve stones under X-Ray guidance Signup and view all the answers

Which of the following statements is true regarding the placement of trocars?

Trocars are inserted through the subxiphoid and two right side locations Signup and view all the answers

What is the main purpose of performing an Endoscopic Retrograde Cholangiopancreatography (ERCP)?

To diagnose and treat problems in the biliary tract Signup and view all the answers

Which procedure is conducted immediately after clipping the cystic duct during an intraoperative cholangiogram?

Catheter insertion into the cystic duct Signup and view all the answers

What is the primary purpose of a choledochoduodenostomy?

To reestablish bile flow into the intestinal system Signup and view all the answers

Which organ is located retroperitoneally behind the stomach?

Pancreas Signup and view all the answers

What is the role of the Islets of Langerhans in the pancreas?

Excreting hormones directly into the bloodstream Signup and view all the answers

Which surgical procedure involves the drainage of pancreatic cysts into the stomach?

Cystogastrostomy Signup and view all the answers

What is the most common type of pancreatic cancer?

Ductal adenocarcinoma Signup and view all the answers

What is typically preserved during a Whipple procedure to improve quality of life?

The pylorus of the stomach Signup and view all the answers

Which artery is NOT directly supplying the pancreas?

Pancreatic artery Signup and view all the answers

What is the main focus after a tumor is removed during a Whipple procedure?

To reestablish continuity of biliary, pancreatic, and GI tract systems Signup and view all the answers

What is the surgical procedure that involves removing the head of the pancreas while preserving the pylorus?

Pylorus Preserving Whipple Signup and view all the answers

Which pancreas transplant procedure is performed when a patient has uncontrolled diabetes leading to chronic kidney failure?

Simultaneous Pancreas-Kidney Transplant (SPK) Signup and view all the answers

What is the primary function of the spleen?

Filtration and destruction of old blood cells Signup and view all the answers

Which surgical intervention requires ligation of both arterial and venous blood supplies?

Splenectomy Signup and view all the answers

After a successful pancreatic transplant, what is a possible outcome concerning the patient's diabetes management?

Elimination of hypoglycemic events Signup and view all the answers

What anatomical location does the spleen occupy within the human body?

Upper left quadrant Signup and view all the answers

Which procedure involves careful monitoring of blood glucose levels post-surgery?

Pancreatic transplant Signup and view all the answers

What should be done first in the procedure of a splenectomy?

Clamping and dividing the ligaments Signup and view all the answers

Study Notes

Biliary Anatomy

The Celiac Axis branches from the aorta, supplying critical organs:
- Left Gastric: supplies esophageal and stomach curvature
- Splenic: supplies pancreatic and short gastric branches
- Common Hepatic: supplies gastroduodenal and hepatic arteries
Triangle of Calot is essential in gallbladder surgery, comprised of:
- Cystic Duct
- Common Hepatic Duct
- Cystic Artery

Perioperative Nursing Considerations

General Anesthesia (GA) is standard for biliary surgeries, necessitating intubation.
Patient-specific pain control strategies are required.
Extensive tissue dissection often leads to significant blood loss; preoperative confirmation of blood products is crucial.
Patient positioning should follow the surgical procedure directive; typically supine.
Surgical instrument counting includes Major Initial Count, Major Closing Count, and Minor Final Count.

Surgical Interventions

Cholecystectomy (Open or Laparoscopic):
- Removes gallbladder due to cholecystitis or cholelithiasis; laparoscopic is preferred.
- Intraoperative cholangiogram may be performed to visualize biliary anatomy.
- Complications may include bile leak, bile duct injury, jaundice, infection, or bleeding.
Instrumentation Required:
- MIS Tower, sterile laparoscope, and specific trocars for port placement.
- Two types of trocars: 5 mm for lateral access and 10-12 mm for abdominal landmarks.
Operative Procedure Steps:
- Incision, pneumoperitoneum creation, trocar insertion, and gallbladder retrieval through umbilical port.

Intraoperative Cholangiogram

Differentiates itself from ERCP by being performed during surgery to visualize biliary tract blockages.
Involves injecting contrast dye after clipping the cystic duct to ensure no bile loss during evaluation.

Common Biliary Anastomoses

Choledochoduodenostomy: Joins common bile duct to duodenum.
Choledocojejunostomy: Joins common bile duct to jejunum, preferred due to jejunum's length and mobility.

Pancreas Surgery

Pancreatic Anatomy: Located retroperitoneally, serves both exocrine (enzyme secretion) and endocrine (hormone release) functions.
Drainage of Pancreatic Cysts involves:
- Cystojejunostomy, Cystogastrostomy, Cystoduodenostomy depending on cyst location.
Laparoscopic Whipple Resection:
- Surgical removal of tumors in the head of the pancreas; involves three critical anastomoses to reconnect biliary and gastrointestinal systems.
Pancreatic Transplant Types:
- PTA, SPK (simultaneous pancreas-kidney), and PAK (after kidney transplant); lifelong immunosuppressants are mandatory post-transplant.

Spleen Anatomy

Functions include filtering blood, producing lymphocytes, and blood storage.
Supplied by the splenic artery from the aorta; drains via the splenic vein to the portal system.

Splenectomy

Surgical removal performed due to trauma, tumors, or infections; conducted using either open or laparoscopic techniques.
Ligaments associated with the spleen must be clamped and divided during the procedure.

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Description

This quiz covers the anatomy and surgical considerations related to the gall bladder, pancreas, spleen, and liver as outlined in Alexander’s Care of the Patient in Surgery, Chapter 12. It also discusses the purpose of biliary surgeries and differentiates between various procedures. Dive deeper into the learning outcomes and enhance your understanding of biliary surgery.