CHAPTER 14

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 1©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied,

duplicated, or posted to a publicly accessible website, in whole or in part.

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 2©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part.

CHAPTER 14

General Surgery

©2014 Delmar, Cengage Learning. All Rights Reserved. May not be scanned, copied, duplicated, or posted to a publicly accessible website, in whole or in part. 3

Objectives• After studying this chapter, you will be able

to:– Indicate the pathology and related

terminology of each system or organ that prompts surgical intervention

– Indicate special preoperative preparation procedures related to general surgery procedures


Objectives (cont’d.)– Recall the names and uses of general surgery

instruments, supplies, and specialty equipment

– Propose the intraoperative preparations of the patient specific to the illustrative procedures

– Summarize the surgical steps of the illustrative general surgery procedures in this chapter


Objectives (cont’d.)– Identify the purpose and expected outcomes

of the illustrative procedures– Determine the immediate postoperative care

of the patient and possible complications of the illustrative procedures

– Determine any specific variations related to the preoperative, intraoperative, and postoperative care of the general surgery patient


Part I: General Information • Introduction

– General surgery involves many organ systems

• Most commonly involves the abdominal cavity and organs contained within the cavity

– General surgeon • Performs procedures on tissues and organs

• Specific procedures– Refer to text


Instrumentation, Routine Equipment, and Supplies

• Instrumentation – Many influential factors

• Major set: refer to Figure 14-1• Minor set: refer to Figure 14-2• Biliary instruments: refer to Figure 14-3• Intestinal instruments: refer to Figure 14-4• Other general surgery instruments and sets: vary

according to procedure– Routine equipment and supplies

• Refer to text


Incisions• A variety of incisions are used to gain

access to the abdominal contents– Refer to Table 14-3

• Incision type depends on:– Access desired– Procedure to be performed– Surgeon’s preference– Ability to lengthen the incision– Wound security and healing


Hernias• Protrusion of a viscus through an opening

in the wall of the cavity in which it is contained– May be internal, interparietal, or external– May be congenital, acquired, or a combination– Types: refer to Table 14-4

• Hernia repair– Refer to Procedure 14-3


Surgery of the Alimentary Canal• Surgery on the digestive system

– Constitutes the major portion of surgery performed by the general surgeon

• Procedures – Many are variations on a common theme

because of the tubular anatomical structure of the digestive tract


Esophageal Pathology• Pathological conditions of the esophagus

fall into four major categories– Hiatal hernia and reflux esophagitis– Esophageal motility disorders– Neoplasms– Trauma


Laparoscopic Nissen Fundoplication

• Surgical procedure performed to correct a hiatal hernia– Preferred operative procedure

• Pathological conditions of the stomach– Refer to Table 14-6


Gastrostomy• Surgical creation of an opening from the

gastric mucosa to the skin – Performed to provide nutrition “feeding” to the

patient or to decompress and drain the stomach

– May be performed in conjunction with a gastrectomy


Total Gastrectomy• Involves removal of the stomach and

reconstitution of the alimentary tract• Subtotal gastrectomy types

– Billroth I: removal of pylorus of the stomach and end-to-end anastomosis of remaining stomach and duodenum

– Billroth II: cut ends of duodenum are closed and jejunum is anastomosed to the stomach


Bowel Pathology• Pathological conditions that affect the

bowel– Refer to Table 14-8

• Principles of bowel resection and anastomosis– Numerous variations

• Bowel anastomosis options– Refer to Table 14-9


Bowel Pathology (cont’d.)• Appendectomy

– Performed for acute appendicitis or incidentally during other surgery as a prophylactic measure

• Pathological conditions of the colon– Refer to Table 14-10


Stomas• Communication of a section of bowel with

the outside of the abdominal cavity – Created to divert the fecal stream

• Done temporarily to protect a recent intestinal anastomosis, to avoid potential abdominal spillage postoperatively, or an end result of bowel resection

• Stoma types– Refer to Table 14-11


Anorectal Pathology• Pathological conditions of the anorectal

area – Refer to Table 14-12

• Anorectal pathology presents with a variety of signs and symptoms – Refer to Table 14-13


Select Pathology of the Liver and Biliary Tract

• Liver pathology and surgical conditions– Diagnosed via patient history, physical

examination, changes in laboratory data, sonography, liver scan, CT scan, and biopsy

• Biliary tract – Subject to the same diagnostic examinations

• Select pathology and treatment of liver– Refer to Table 14-14


Liver Resection• Most commonly performed to excise

hepatocellular tumor– Also performed as part of treatment for

carcinoma of the gallbladder, to resolve uncontrollable bleeding or parenchymal maceration following abdominal trauma, or for transplant

• Components of the liver– Refer to Figure 14-17


Liver Resection (cont’d.)• Surgical treatment of gallbladder disease

– Sequence: conservative, noninvasive treatment; open cholecystectomy with cholangiogram; laparoscopic cholecystectomy

• Conservative treatment for cholelithiasis– Includes medications or extracorporeal shock-

wave lithotripsy


Cholecystectomy and Cholangiography

• Cholecystectomy – Excision of the gallbladder– Primarily performed for acute cholecystitis– Performed through laparoscopic means in up

to 90% of all cases, and this route is successful 95% of the time


Surgery of the Pancreas and Spleen

• Spleen – Commonly traumatized and removed during

emergency surgery• Cancer of the pancreas

– Symptoms and diagnosis of pancreatic cancer: refer to Table 14-15


Pancreatectomy• Whipple procedure

– Performed for managing tumors of the head of the pancreas

– Requires both resection and reconstruction• Refer to Figure 14-21


Breast Surgery• Vast majority of breast cancer cases are

female– Beast cancer is not limited to the female

breast• Treatment of breast cancer

– Multidisciplinary – Has received emphasis in finding a cure


Breast Surgery (cont’d.)• Breast and axilla: pathology and diagnosis

– Breast cancer has been staged: refer to Table 14-16

– Tumor excision: refer to Figure 14-23– Breast biopsy: accomplished with a needle or

by surgical removal


Breast Surgery (cont’d.)• Modified radical mastectomy

– Removal of the entire breast including axillary lymph nodes

– Used in Stage I and II breast cancer or in conjunction with chemotherapy and radiation treatments for Stage III and IV breast cancer


Surgery of the Thyroid and Parathyroid

• Thyroid gland – May fall within the realm of other specialties in

some locales– General surgeon commonly operates on the

thyroid and parathyroid glands• Pathological conditions affecting the

thyroid and parathyroid – Refer to Tables 14-17 and 14-18


Surgery of the Thyroid and Parathyroid (cont’d.)

• Thyroidectomy – Surgical removal of the thyroid gland– Parathyroid glands must be spared– A life-threatening condition associated with

the parathyroid glands is tetany– If all four glands are removed, the patient will

experience hypoparathyroidism, which causes hypocalcemia that leads to the neuromuscular symptoms of tetany


Summary• This chapter reviewed:

– Preoperative preparation procedures related to general surgery procedures

– General surgery instruments, supplies, and specialty equipment

– Specific procedures performed – Immediate postoperative care of the patient

and possible complications

CHAPTER 14

Documents

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