Case Studies

describe how a mcburneys incision is made for an open procedure. a laparoscopic appendectomy will require an infraumbilical incision for the hasson trocar; where is this incision made?

Obliquely downward and inward over McBurney's point, the junction of the middle and the outer third of the line that joins the umbilicus and the anterior superior iliac spine incision on right side at an oblique angle, below umbilicus

describe the signs and symptoms of appendicits. describe the significance of perforation

RLQ pain, nausea, vomiting, constipation, diarrhea, increase white blood cell count, fever. Periforation is significant because gangrene can result in pylephlebitis, septic thrombosis, and peritonitis

If linda has a femoral hernia, the hernia exists below what anatomical marker? what defect is repaired?

The hernia exists below the abdominocrual crease. the lymph nodes may form a mass and needs to be corrected

Describe how the appendix/mesoappendix is ligated and how the appendiceal stump is inverted.

The mesoappendix is transected free with either a clamp, clamp tie technique, or a stapler. The appendiceal stump is then inverted within the lumen of the cecum (the stump is gently pushed in with a hemostat as the purse-string stitch is tightened).

jons hernia was described in the postoperative report as an indirect hernia. what is the usual type or cause of an indirect hernia? describe how the hernia sac is removed

congenital defects. the sac is confined to spermatic cord. purse string is used

describe the anatomy of hesselbachs triangle. analyze the types of hernia. which inguinal hernia occurs in hesselbachs triangle? describe the chances that Jon's hernia is this type of hernia?

inguinal ligament, lateral border of rectus abdominus, inferior epigastric vessels. the hernia that occurs is direct. most of these hernias occur in males

evaluate the chances that jons hernia is a femoral hernia and compare that to lindas chance

linda will have a higher chance of a femoral hernia because it is more common in females. 97% femoral are in females

During the procedure, the surgeon is afraid that she has accidently injured the ureter. what diagnostic dye can be given intravenously to go check for leakage intraoperatively?

methylene blue/ indigo . site is observed for die.

describe the setup for this procedure. why are two setups necessary? how do you set up ray-tec for use during this procedure?

must be a clean and dirty set up so that dirty items will not go back with sterile items. need extra down and gloves. raytecs on sponge stick; should not be free-for lower rectal segment

describe the causes of appendicitis. is the appendix ever removed when appendicitis is not involved?

obstruction of appendiceal lumen. Yes may be removed as a prophylactic precaution or because injury as an incidental appenedectomy when a surgeon may be doing other surgery

the appendix was perforated; the surgeon intends to use the principles of third intention healing. he asks for a penrose drain. from information in previous chapters regarding wound healing, describe what this means to the patient

patient will have delayed wound healing, will intend by third intention. packed open for 2-3 days and drain will be inserted after 2-3 days patient will return for closure

the surgery is over and you are placing the dressing; the patient begins to wake up and does not like the endotracheal tube. you notice his stomach is contracting and he is coughing hard. the surgeon instructs you to place some pressure on the suture line. what do you think will happen if a stitch breaks

possible wound dehiscence of hernia.

the surgeon is worried about the length of the surgery and asks for sequential compression devices to be placed on her legs. describe why

prevents venous pooling with resultant venous stasis and thrombus formation, can lead to pulmonary embolism

Jons hernia is said to be incarcerated. what does this mean? why will his case go first?

surgeon is unable to use manual manipulation to return hernia to abdominal cavity. considered emergency

describe the position that the patient will be placed in. what type of stirrups will be used- c shaped high lithotomy stirrups or allen stirrups

the patient will be in supine position with arms at sides. it will be legs in lithotomy. allen stirrups will be used.

describe what precautions you take with the instrument, lap sponges, and supplies that come in contact with the appendix

they are dirty/contaminated when coming in contact with appendiceal stump. do not put back on sterile table/mayo stand. pass off in basin