General Review 2

1. General Review 2

2. Ventral Hernias- • Can occur _________ or after previous operations

3. spontaneously • Spontaneous include _____________ and _________hernias

4. epigastric and umbilical • What can be the cause of ventral hernias?

5. Incisional- occur more frequently when incision was T-shaped or vertical midlineMore common with operations with potential contamination ((perforated ulcers, etc.)Poor nutrition with hypoproteinemia predisposes some peopleFaulty surgical technique or choice of inappropriate suture materials • What is the difference between a ventral hernia and an incisional hernia?

6. Ventral hernia- any hernia in the abdominal wall, excluding the groin or inguinal area, often result of previous abdominal surgery. Sometimes referred to as an INCISIONAL Hernia. • This is a tract or tunnel through the tissue that develops a lining of epithelium. The constant drainage of pus prevents it from healing, whereas newly injured tissue heals because the fibrin and collagen cells join and weld the tissue together.

7. Fistula • If the abdominal wall ruptures or is torn through trauma, the viscera can protrude outside the body, which is called________________.

8. Evisceration • What is it? • Extraperitoneal, small fascial defects under the umbilicus • Common in children, usually disappear spontaneously by age 2 • Persistent defects require simple approximation of overlying fascia

9. Umbilical hernias • In adults represent a defect in the________, just above the umbilicus • Occur more frequently in obese people • Potentially dangerous, as they have small necks and frequently become incarcerated • Repair surgically, even if asymptomatic

10. linea alba • Largest endocrine gland in the body, weighing approx 20 grams in the adult

11. Thyroid • Right and left lobes united by an ___________ • Lobes lie below larynx and beside the trachea

12. isthmus • long, thin upward projection on isthmus • Found in 80% of patients surgically • Is the vestige of the embryonic thyroglossal duct

13. Pyramidal lobe • In the breast, small, painless, well delineated, relatively mobile mass • Primarily in women under 30 • Usually a solitary nodule • Grow very slowly

14. Fibroadenoma • _________________ __________________in the breast is an all encompassing term used to describe many different breast changes • Multiple lesions of fibrous disease, intraductal papilloma, cysts and solid masses • Pain frequently calls attention to the problem

15. Fibrocystic change • Nipple discharge is more commonly associated with benign lesions than with cancer • Significant if it is _____________ and ________ • Chronic unilateral nipple discharge, especially if bloody, should prompt and investigation for cancer

16. spontaneous and persistent • For small nonpalpable lesions a _____________may be done immediately prior to surgery • Localized by the insertion of a needle or needles or a wire within a needle • Needles are either left in place or are removed after insertion of the wire Needle or wire is then taped in place and the patient is transferred to the OR for biopsy • The excised specimen may be returned to the radiology department for mammography validation of correct surgical excision prior to pathologic examination

17. mammogram • What are the benefits of using an ultrasound?

18. Ultrasound differentiates between solid and cystic lesions.Not as sensitive or definitive as mammographyUseful in women pregnant or lactating women, and women with dense breasts • Fine needle aspiration- can _______________

19. determine if a mass is solid or cystic • ____ is showing promise as an adjunct to mammography

20. MRI • What is the treatment?

21. Surgical excision of the tumor • Radiation therapy, either alone or combined with excision • Chemotherapy • Recommended for premenopausal women with axillary metastasis

22. Surgical interventions • Choice of operation depends on :

23. Size and site of the massStage of the diseasePatients choice • What is the positioning?

24. Supine, with operative side near edge of OR tableArm on operative side on an armboard • Prep-Breast biopsy?

25. Prep-Breast biopsy • Depends on location of lesion and type of procedure • Avoid vigorous scrubbing, which could possibly seed cancer cells from the main mass to surrounding tissues • Care must be taken not to move or dislodge the wire if placed

26. Prep for Mastectomy?

27. Prep-Mastectomy • Prep must extend into the axilla • Arm must be prepped circumferentially so that it may be draped free • “Hang” the arm to facilitate circumferential prep

28. How about Draping? • __________________square with towels and a pediatric laparotomy sheet • ______________- the arm must be draped free to allow access to the axilla

29. Biopsies and Lumpectomies-Mastectomy • If a breast biopsy will be immediately followed by a modified radical mastectomy, ______________may be done between procedures

30. a new skin prep and drape • Breast biopsy- a portion of the mass is surgically excised

31. Incisional- • Entire tumor mass is excised

32. Excisional- • Segmental resection or ____________- removal of the tumor mass with at least a 1-inch margin of surrounding tissue

33. lumpectomy • The first lymph nodes along the lymphatic channel from the primary tumor site • Inject either isosulfan blue dye or metastable technetium 99 (a radioactive material) • Blue dye is injected directly into the tumor mass, and sentinel nodes stained with blue dye are identified, excised and sent to pathology

34. Sentinel node biopsy • What must be done if technetium is used?

35. Procedure is coordinated with the staff of the nuclear medicine department and requires the use of a hand-held detector like a Geiger counter if technetium is used • Patient is injected with the technetium in the nuclear medicine department the morning of surgery

36. Sentinel node biopsy, cont. • Patients with histologically negative nodes have a greater likelihood of survival than patients with metastatic lymph nodes • Evidence of a positive node results in an axillary node dissection • Anesthesia used?

37. Local Anesthesia • What are the considerations when freezing a section?

38. Sentinel node biopsy, cont. • Specimen should not be placed in formalin if a frozen section is to be performed • If frozen section is definitive and consent has been obtained, a more extensive procedure may be done immediately • A 48-hour permanent section may be required to obtain a definitive diagnosis

39. What is it? • Also called adenomammectomy • Removal of all breast tissue with the overlying skin and nipple left intact

40. Subcutaneous mastectomy • Also called a total mastectomy • Removal of entire involved breast without lymph node dissection • For extensive benign disease or malignancy confined to the breast tissue

41. Simple mastectomy • Removal of the breast and all the axillary contents • The underlying pectoral muscles are not removed • Performed after tissue biopsy with a positive diagnosis of malignancy • Done to remove the involved area with the hope of decreasing the spread of malignancy

42. Modified radical mastectomy • Modified radical mastectomy- Uses _________incision around the nipple • Contains ducts – ductal Ca is most common

43. eliptical • Skin is undermined off of ___________tissue

44. subcutaneous • Breast tissue (subcutaneous, lactiferous glands and ducts) _________off of the chest muscles (pectoralis muscle)

45. dissected • Continue to _________for nodes

46. axilla • Removed “EN BLOC” – which is __________

47. one piece