Chapter 23 General surgery

Wire localization

A biopsy procedure in which a hook wire is inserted under fluoroscopy into tissue suspected of being cancerous. The tissue surrounding the hook wire is removed.

Morbid obesity

A condition in which the patient's body mass index (BMI) is 40 or higher, and the individual is at least 100 pounds (45 kg) over the ideal weight despite aggressive attempts to lose weight

Friable

A descriptive term for tissue that means fragile and easily torn, and may bleed profusely. Some disease states produce friable tissue. The liver and spleen normally are friable. (

Hook wire

A device used to pinpoint the exact location of a nonpalpable mass detected during a mammogram; also referred to as a hook needle. A fine wire is inserted into the mass during the examination, and the tissue around the needle is removed for pathological examination and definitive diagnosis.

Cirrhosis

A disease of the liver in which the tissue hardens and the venous drainage becomes blocked. It usually is caused by chronic alcoholism but may result from other disease conditions.

Skin Flap

A flap that is created by incising the skin and cutting it away from the underlying tissue to which it is attached. The flap can be increased in size or "raised" as it is enlarged by dissection.

Nasogastric (NG) tube

A flexible tube inserted through the nose and advanced into the stomach. The NG tube is used to decompress the stomach or to provide a means of feeding the patient liquid nutrients and medication.

Billroth I procedure

A gastroduodenostomy, or surgical anastomosis, of the stomach and the duodenum

Billroth II procedure

A gastrojejunostomy, or surgical anastomosis, of the stomach and the jejunum.

Strangulated hernia

A hernia in which abdominal tissue has become trapped between the layers of an abdominal wall defect.

Indirect inguinal hernia

A hernia that protrudes into the membranous sac of the spermatic cord. This condition usually is due to a congenital defect in the abdominal wall.

Direct inguinal hernia

A hernia that results from an acquired weakness in the inguinal floor.

Exploratory laparotomy

A laparotomy performed to examine the abdominal cavity when less invasive measures fail to confirm a diagnosis.

Bowel Technique

A method of preventing cross-contamination between the bowel contents and the abdominal cavity.

Midline (upper and lower)

A midline incision is made through the skin, subcutaneous fat, and the linea alba. This is the center of the fascial layer to which the rectus muscles attach; it is also an avascular area of the rectus sheath.

Mastectomy

A procedure in which breast tissue, including the skin, areola, and nipple, is removed, but the lymph nodes are not removed; also called a simple mastectomy.

Sentinel lymph node biopsy (SLNB)

A procedure in which one or more lymph nodes are removed to determine whether a tumor has metastasized

Laparotomy

A procedure in which the abdominal cavity is surgically opened. The techniques used for laparotomy are used for all open surgical procedures of the abdomen.

Subcutaneous mastectomy

A procedure in which the breast is removed, but the skin, nipple, and areola are left intact; also called a lumpectomy.

Modified radical mastectomy:

A procedure in which the entire breast, nipple, and areolar region are removed. The lymph nodes also are usually removed

Hernia

A protrusion of tissue under the skin through a weakened area of the body wall.

Technetium-99

A radioactive substance used to identify sentinel lymph nodes

Linea alba

A strip of avascular tissue that follows the midline and extends from the pubis to the xiphoid process.

-ostomy

A suffix that refers to an opening between two hollow organs; for example, gastroduodenostomy, a surgical procedure that joins the stomach and duodenum.

Gastrostomy

A surgical opening through the stomach wall connecting to the outside of the body or another hollow anatomical structure.

Anastomosis

A surgical procedure in which two hollow structures are joined.

Ostomy

A technique in which a new opening is made between a tubular structure such as the intestine or ureter and the outside of the body or another hollow structure or organ.

Stoma appliance

A two- or three-piece medical device used to collect drainage from a stoma. The appliance is attached to the patient's skin and completely covers the stoma. This allows free drainage into a collection device or bag.

Ventral hernia

A weakness in the abdominal wall, usually resulting in protrusion of abdominal viscera against the peritoneum and abdominal fascia.

Fistula

An abnormal tract or passage leading from one organ to another or from an organ to the skin; usually caused by infection.

McBurney Incision

An incision in which the oblique right muscle is manually split to allow removal of the appendix.

Stoma

An opening created in a hollow organ and sutured to the skin to drain the organ's contents (e.g., an intestinal or ureteral stoma). A stoma may be a temporary or permanent method of bypass.

Segmental resection

Anatomical resection of the liver in which segments divided by specific blood vessels and biliary ducts are removed.

Esophageal varices

Distended veins of the esophagus, caused by an advanced liver disease. The condition occurs as a result of portal vein obstruction arising from fibrosis of the liver. Esophageal varices may bleed profusely

Diagnostic & Operative Endoscopy

Endoscopy is an outpatient procedure, and the surgery is performed with the patient under sedation.

Incarcerated hernia

Herniated tissue that is trapped in an abdominal wall defect. Incarcerated tissue requires emergency surgery to prevent ischemia and tissue necrosis.

Body image

In psychology, the way a person sees himself or herself through the eyes of others. (Fuller 482)

Evisceration

Protrusion of the viscera outside the body as a result of trauma or wound disruption.

Lobectomy

Surgical removal of one or more anatomical sections of the liver.

Viscera

The organs or tissue of the abdominal cavity.

Incisional hernia

The postoperative herniation of tissue into the tissue layers around an abdominal incision. This may occur in the immediate postoperative period or later, after the incision has healed.

Abdominal peritoneum

The serous membrane lining the walls of the abdominal cavity. The retroperitoneum is the posterior aspect. In surgical discussions, abdominal usually refers to the anterior aspect.

Subcostal Incision

This incision follows the lower rib margin in a semi-curved shape; it is painful postoperatively.

Lower transverse abdominal (Pfannenstiel)

This incision follows the natural skin folds to achieve cosmetic closure; it is very strong and offers good exposure to the pelvic contents

Inguinal (oblique)

This incision is used to gain access to the inguinal region for hernia repair; it also may be used for internal access to the spermatic cord.

Paramedian (upper and lower)

This is a muscle-splitting incision. It is less painful than a subcostal muscle-cutting incision for access to the upper quadrants.

Reduce

To replace or push herniated tissue back into its normal anatomical position.

Functions of the large intestines

absorption of water & electrolytes and formations of fecal waste

Hesselbach triangle

area bounded by the rectus abdominis muscle, the inguinal ligament, and the inferior epigastric vessels.

teniae coli

contraction of logitudinal band of muscle

small intestine

duodenum, ileum, and jejunum. digestion and absorption of fats, proteins, carbs, and other soluble molecules such as vitamins

Colonoscopy or lower GI

endoscopy of the large intestine.

Excision of an Esophageal diverticulum (open procedure)

esophageal diverticulum is removed and the wall of the esophagus is stregthened to prevent recurrence

duodenum

is 8 to 10 inches (20-25cm) long. It receives chyme. The pancreatic duct and the common bile duct from liver drain digestive enzymes into this section of the intestines

jejunum

is 9 feet (2.7m) long. It connects to the ileum, which is 13.5 feet (4m) long.

Esophagoduodenoscopy

is a diagnostic endoscopy of the esophagus, stomach, and proximal duodenum.

Pharyngoesophageal diverticulum / Zenker diverticulum

is mucosa and submucosa that have herniated through the cricopharyngeal muscles. Occurs in patients over 60

Sigmoidoscopy

is performed to examine tissue and/or obtain a biopsy specimen of the sigmoid colon and rectum

hautra

long axis of the colon forms a series of puckers

large intestine

made up of 5 sections: ascending colon, the transverse colon, descending colon, sigmoid colon and the rectum. 5 feet (1.5m) long in adults

laparotomy

open surgery of the abdominal cavity for access to the abdominal surgery

Viscera

organs

mesentery

suspends the jejunum and the ileum from the abdominal wall