Chapter 23 - General Surgery

fascia

2-0 nonabsorbable or absorbable synthetic sutures

subcutaneous tissue

2-0 or 3-0 absorbable sutures

wire localization

a biopsy procedure in which a hook wire is inserted under fluroscopy 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 highter and weighs at least 100 pounds over the ideal weight despite aggressive attempts to lose weight

hook wire (or needle)

a device used to pinpoint the exact location of a nonpalpable mass detected during a mammogram; 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 the venous drainage becomes blocked; usually is caused by chronic alcoholism but may result from other disease conditions

nasogastric tube (NG)

a flexible tube inserted through the nose and advanced into the stomach; 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; the strangulated tissue usually becomes swollen as a result of venous congestion; lack of blood supply can lead to tissue necrosis

indirect inguinal hernia

a hernia that protrudes into the membraneous sac of the spermatic cord; usually is due to a congenital defect in the abdominal wall

direct inguinal hernia

a hernia that results from 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

mastectomy

a procedure in which breast tissue, including the skin, areola, and nipple is removed but the lymph nodes are not removed

sentinel lymph node biopsy (SLNB)

a procedure in which one or more lymph nodes are removed to determine whether a tumor has metastasized; other lymph nodes may be removed periodically to determine whether metastasis has occured

laparotomy

a procedure in which the abdominal cavity is surgically opened; all techniques used for open surgical procedures of the abdomen

subcutaneous masectomy

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 are usually removed too

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 vascular 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 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; attached to the patient's skin and covers the stoma; 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

mesentery

an extension of the peritoneum that attaches to the posterior abdominal wall and fans out to cover the small intestine

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; 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

Hesselbach triangle

area bounded by the rectus abdominis muscle, the inguinal ligament, and the inferior epigastric vessels; area associated with an inguinal hernia; larger in the mall than the female corresponding to the higher incidence in males

skin flap

created by incising the skin and cutting it away from the underlying tissue to which it is attached; can be increased in size or raised as it is enlarged by dissection

esophageal varices

distended veins of the esophagus, caused by advanced liver disease; occurs as a result of portal vein obstruction arising from fibrosis of the liver; may bleed profusely

greater omentum

extension of the serous membrane covering the stomach, duodenum, and part of the colon

friable

fragile and easily torn tissue that may bleed profusely; ex. liver & spleen

incarcerated hernia

herniated tissue that is trapped in an abdominal wall defect; requires emergency surgery to prevent ischemia and necrosis

evisceration

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

skin

staples or 3-0 or 4-0 nonabsorbable sutures

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; 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

body image

the way a person sees himself or herself through the eyes of others; a negative body image can severely affect a patient's sense of identity and social and personal interactions

reduce

to replace or push herniated tissue back into its normal anatomical positions

surgical mesh

used for most hernia repairs; biosynthetic is made of synthetic material similar to suture (prolene, dacron, mersilene); provides a bridge of strong material over the abdominal wall weakness and release tension on the tissue edges during repair & healing