Surgical Anatomy and Techniques Quiz

Questions and Answers

What is the primary purpose of a temporary colostomy?

To allow bowel rest and healing from inflammatory disease (correct)

To provide a long-term solution for bowel obstruction

To remove the entire colon due to a perforation

To permanently divert fecal flow due to cancer

In a Hartmann's Procedure, which part of the bowel is brought out to the skin?

Proximal part for normal fecal drainage (correct)

Closed mucous fistula

Entire bowel segment

Distal stump for fecal drainage

Which surgical position is typically used during an abdominoperineal resection?

Lateral position for better access

Supine position with leg elevation

Lithotomy position for abdominal access (correct)

Prone position for rectal access

What characterizes a permanent colostomy like the Rosebud colostomy?

It is established after removal of the rectum due to cancer Signup and view all the answers

What is a key requirement for the surgical team during an abdominoperineal resection?

Two teams, each with two scrub nurses, are necessary Signup and view all the answers

What is the primary purpose of Bowel Isolation Techniques during surgery?

To prevent cross-contamination and mechanical metastasis of malignant cells Signup and view all the answers

Which statement accurately describes the function of the GIA stapler?

Cuts, staples, and divides simultaneously for side to side anastomosis Signup and view all the answers

What is a critical consideration when performing a Nissen Fundoplication regarding suturing tension?

Tight suturing may result in GERD symptoms returning Signup and view all the answers

What does the process of mesenteric defect repair aim to achieve post-bowel removal?

Minimize the risk of bowel obstruction and entrapment Signup and view all the answers

In Roux-En-Y Gastric Bypass, what occurs to nutrient absorption?

It is decreased due to bypassing the duodenum Signup and view all the answers

Which arteriopathy is responsible for supplying the small intestine and parts of the colon?

Superior Mesenteric Artery Signup and view all the answers

What differentiates the EEA stapler from other staplers used in surgery?

It is designed for end to end or end to side anastomosis cutting in a circular fashion Signup and view all the answers

What is a key characteristic of the Gastric Lap Band procedure?

It allows for adjustment to manage food ingestion Signup and view all the answers

Study Notes

Ligament of Treitz and Blood Supply

The Ligament of Treitz connects the duodenum to the jejunum.
Blood supply from the celiac trunk includes:
- Splenic artery
- Common hepatic artery
- Left gastric artery
Superior mesenteric artery supplies the small intestine, ascending colon, and two-thirds of the transverse colon.
Inferior mesenteric artery supplies the transverse colon to the rectum.

Surgical Techniques and Instrumentation

Abdomen sequence for surgical procedure: clamp, clamp, cut, tie.
Bowel isolation techniques prevent cross-contamination and mechanical metastasis of malignant cells.
Isolation begins once the gastrointestinal (GI) tract is clamped and opened, including irrigation before wound closure.
Bowel instruments are kept separate from clean instruments, stored in a K-basin on the table.
Extra draping may be applied around the incision for closure.
Surgical team must change gloves and gowns post-anastomosis and before closing the wound.

Staplers Used in Surgery

GIA (Gastrointestinal Anastomosis): cuts, staples, and divides simultaneously; suitable for side-to-side anastomosis; available in endoscopic form; accommodates different sized lumens.
TA (Thoracoabdominal Stapler): staples tissues together but requires manual cutting.
EEA (End to End Anastomosis) or ILS (Intraluminal Stapler): performs end-to-end or end-to-side anastomosis with a circular cutting method; primarily used for lower bowel.

Mesenteric Repair

Removal of bowel necessitates dissection of corresponding mesenteries, requiring repair of mesenteric defects.
Repair is essential to prevent post-operative bowel entrapment and obstruction.

Nissen Fundoplication

Consists of two components:
- Plication: folding stomach tissue around the esophagus to shorten it.
- Crurrorhaphy: permanent suture repair utilizing non-absorbable material.
Challenge lies in achieving optimal suturing tension; too loose can cause GERD, too tight can obstruct food passage.

Bariatric Surgery Procedures

Roux-En-Y Gastric Bypass: reduces stomach size and connects it to jejunum; bypasses duodenum; results in fewer calories absorbed and increased satiety.
Gastric Lap Band: adjustable band around the stomach to restrict ingested food volume.
Sleeve Gastrectomy: removes up to 85% of the stomach to limit food intake.

Colostomy/Ileostomy

Temporary colostomy may be performed to allow bowel rest during inflammatory disease or to heal anastomosis, serving to decompress a perforating bowel.
Hartmann’s Procedure: emergency colostomy to prevent bowel perforation or contamination; proximal end is brought out for normal fecal drainage, distal stump is closed as a mucous fistula.
In about three months, the bowel may be reconnected by anastomosing the distal stump with the proximal colostomy.
Permanent colostomy, referred to as "Rosebud colostomy," occurs after bowel resection for cancer.

Abdominoperineal Resection

Indicated when a rectal tumor is too large or close to the anus for traditional surgery.
Involves resection of the lower sigmoid colon, rectum, and anus, performed through both abdominal and perineal incisions.
Requires a two-team approach with two scrub nurses, separate count sheets, and dual surgical setups.

Description

Test your knowledge on the anatomy of the Ligament of Treitz and the blood supply involved in gastrointestinal surgery. This quiz includes surgical techniques and instrumentation practices essential for procedures involving the GI tract. Review important aspects of bowel isolation and proper handling of surgical instruments.