Module 13: Biliary Surgery Quiz

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Questions and Answers

What is the main purpose of a splenectomy?

To improve immune responses against infections

To treat chronic kidney disease

To enhance blood clotting capabilities

To remove old or damaged blood cells (correct)

Which pancreatic transplant procedure is most common?

Pancreatic Nectar Transplant

Pancreas Transplant Alone

Simultaneous Pancreas-Kidney Transplant (correct)

Pancreas After Kidney Transplant

Which anatomical structure is primarily responsible for filtering blood?

Liver

Kidney

Duodenum

Spleen (correct)

What must be ligated to perform a splenectomy?

Arterial and venous blood supply to the spleen Signup and view all the answers

Which of the following describes a pancreatic transplant that occurs after a kidney transplant?

Pancreatic After Kidney Transplant Signup and view all the answers

During which surgical procedure is the splenorenal ligament clamped and divided?

Splenectomy Signup and view all the answers

Which statement is true regarding lifelong medication after a pancreatic transplant?

Lifelong immunosuppressants are needed Signup and view all the answers

What anatomical feature ensures the blood supply to the spleen?

Celiac axis and splenic artery Signup and view all the answers

What are possible complications associated with CO2 insufflation during surgery?

Bile duct injuries and infection Signup and view all the answers

What is the purpose of the intraoperative cholangiogram?

To visualize blockages in the biliary tract Signup and view all the answers

What is used to secure the main camera port during laparoscopic surgery?

O-Polysorb or Vicryl Signup and view all the answers

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

Skin incision with a blade Signup and view all the answers

What needs to be done before conducting an intraoperative cholangiogram?

Clip the cystic duct Signup and view all the answers

Which tool is commonly used to remove stones during laparoscopic surgery under X-Ray guidance?

Flexible stone forceps Signup and view all the answers

What is the primary function of the 10-12 mm hassan trocar in the operative procedure?

To serve as a camera port Signup and view all the answers

What does the surgeon inject during the ERCP procedure to visualize the biliary structures?

Contrast dye Signup and view all the answers

What is the purpose of choledochoduodenostomy?

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

What anatomical position is the pancreas located in?

Retroperitoneal, behind the stomach Signup and view all the answers

Which branch of the celiac axis does NOT directly supply the pancreas?

Pancreatic artery Signup and view all the answers

Which type of surgery involves internal drainage of pancreatic cysts into the jejunum?

Cystojejunostomy Signup and view all the answers

What is typically the primary prognosis for patients with ductal adenocarcinoma of the pancreas?

Very poor prognosis Signup and view all the answers

In which condition is a Whipple procedure most often performed?

Localized pancreatic cancer Signup and view all the answers

What is the main function of the Islets of Langerhans in the pancreas?

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

Which surgical method is primarily used for cyst drainage into the stomach?

Cystogastrostomy Signup and view all the answers

What is the correct order of organ removal during an organ retrieval procedure?

Heart, lungs, liver, kidneys Signup and view all the answers

Which type of donor is characterized by a neurological determination of death?

Neurological Determination of Death (NDD) Signup and view all the answers

What is a critical perioperative nursing consideration during organ retrieval?

Maintenance of Aseptic Technique Signup and view all the answers

In the event of an intraoperative death, what is the appropriate role of the perioperative nurse?

Prepare the body for transport Signup and view all the answers

What is one of the necessary elements to be completed based on hospital policy during organ retrieval?

Surgical count Signup and view all the answers

What type of communication is essential following an intraoperative death?

Effective communication with the family Signup and view all the answers

Which professional may be contacted for support following an intraoperative death?

Spiritual care provider Signup and view all the answers

What should be done postmortem for patients who experience intraoperative death?

Provide dignified and respectful care Signup and view all the answers

What are the three branches of the Celiac Axis responsible for supplying blood to specific organs?

Left Gastric, Splenic, Common Hepatic Signup and view all the answers

Which structure is NOT part of the Triangle of Calot?

Spleen Signup and view all the answers

What is a critical consideration for patients undergoing biliary surgery regarding blood management?

Orders and availability of blood products must be confirmed at all stages Signup and view all the answers

Which of the following statements is true about the anatomy of the spleen?

The splenic artery is one of the branches of the Celiac Axis Signup and view all the answers

What type of anesthesia do patients typically receive during biliary surgeries?

General anesthesia (GA) Signup and view all the answers

Which of the following is a perioperative nursing consideration for biliary surgery?

Being prepared for potential blood replacement needs Signup and view all the answers

What is the purpose of the Celiac Axis in the context of biliary surgery?

Supplying blood to the liver, pancreas, and spleen Signup and view all the answers

What does the nursing assessment for a patient undergoing biliary surgery prioritize?

Ensuring proper anesthesia administration and intubation Signup and view all the answers

Study Notes

Biliary Anatomy

Celiac Axis Trunk: Originates from the aorta; supplies blood to several organs with three main branches: Left Gastric (stomach), Splenic (pancreas, short gastric), and Common Hepatic (gastroduodenal, hepatic arteries).
Triangle of Calot: Key landmark for gallbladder removal; contains the Cystic Duct, Common Hepatic Duct, and Cystic Artery.

Perioperative Nursing Considerations

Assessment: Patients undergo General Anesthesia (GA) and intubation; pain control is tailored to individual needs.
Blood Management: Extensive dissection may necessitate blood transfusions; pre-, intra-, and post-operative blood product availability must be ensured.
Surgical Preparation: Scrub role requires hemostatic agents to handle potential complications.
Complications: Risks include bile leak, bile duct injury, jaundice, infections, and bleeding.

Operative Procedure Steps

Incision and Access: Create pneumoperitoneum with an 11-blade, insert trocars; umbilical port is the main camera insertion site.
Gallbladder Manipulation: Use atraumatic grasper to expose the Triangle of Calot; hemoclips applied to cystic artery before division.
Cholangiogram: May be performed to assess biliary structures and confirm the presence of blockages using contrast dye.

Surgical Techniques for Biliary Issues

Endoscopic Retrograde Cholangiopancreatography (ERCP): Diagnostic and therapeutic procedure for biliary tract issues using an endoscope; involves injective contrast dye for visualization.
Common Biliary Anastomoses:
- Choledochoduodenostomy: Common bile duct anastomosed to the duodenum.
- Choledocojejunostomy: Common bile duct anastomosed to the jejunum.

Pancreas and Its Surgical Considerations

Anatomy: Located retroperitoneally; functions include exocrine (enzyme secretion) and endocrine (hormone release).
Pancreatic Cysts Treatment:
- Cystojejunostomy: Drainage to jejunum.
- Cystogastrostomy: Drainage into the stomach.
- Cystoduodenostomy: Drainage into the duodenum.

Whipple Resection

Laparoscopic Whipple: Pancreaticoduodenectomy; primarily for pancreatic cancer, especially in the head.
Three Essential Anastomoses:
- Hepaticojejunostomy
- Pancreaticojejunostomy
- Gastrojejunostomy

Pancreatic Transplant

Types:
- Pancreas Transplant Alone (PTA)
- Simultaneous Pancreas-Kidney Transplant (SPK)
- Pancreas After Kidney Transplant (PAK)
Post-Transplant Care: Patients require lifelong immunosuppressive therapy; blood glucose is closely monitored.

Spleen Anatomy and Function

Function: Filters blood, produces lymphocytes, and stores blood; located in the upper left quadrant.
Blood Supply: Receives arterial blood from the splenic artery, which branches from the celiac axis; venous drainage into the portal vein.

Surgical Intervention: Splenectomy

Indications: Trauma, tumors, infections, splenomegaly, hemolytic anemia.
Procedure: Can be performed open or laparoscopically; involves clamping and division of surrounding ligaments.

Organ Donation and Retrieval

Types of Donors: Neurological Determination of Death (NDD) and After Circulatory Death (DCD).
Perioperative Considerations: Maintaining aseptic technique is critical; responsibilities include surgical counts and assuring tissue/organ identification.

Death in the Operating Room

Causes of Intraoperative Death: Comorbidities, anesthesia reactions, trauma, unsuccessful CPR.
Post-Mortem Care: Importance of dignified care for the deceased; support for the family is crucial, along with effective communication and preparatory measures for transport.

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Description

Test your knowledge on the anatomy of the gall bladder, pancreas, spleen, and liver as covered in Module 13. This quiz will help you understand the purpose of biliary surgeries and their procedural considerations. Assess your comprehension of key concepts from the suggested readings.