General surgery 12 - Grade: 5 PDF

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General surgery final essays ...

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12). Basic surgical procedures – tomy and stomy. • -tomy o From the greek word tomos, meaning cutting, sharp or separate. o Surgical incision into the body or structure o Muscles should be split and not cut (where possible) o Usually using a scalpel o On cutting bleeding can be seen, this can be prevented by: ▪ For very fine surgery of the extremities, the blood may be drained and a tourniquet applied ▪ The skin and subcutaneous tissues can be infiltrated with a weak (e.g. 1 in 250 000) solution of adrenaline, which produces vascular constriction ▪ Simple pressure on the cut edges for a few minutes usually controls small vessel bleeding. Neurosurgeons traditionally apply the tips of fine haemostatic forceps to the dermis and evert the edges to slightly compress them and control bleeding. Haemostatic forceps can be applied to individual vessels which may be sealed by compression, by twisting or by ligature o Examples: ▪ Medial sternotomy- for cardiac procedure, incision made from sternal notch to the xiphoid process ▪ Thoracotomy -division of the chest at the side from the ribs ▪ Laparotomy • Midline incision along linea alba (most common) • Pfannenstiel incision- transverse incision below the umbilicus and above the pubic symphysis. Used for caesarean section and hysterectomy • McBurney incisions-oblique incision made in the right lower quadrant, classically used for appendectomy (rapid healing and god cosmetic results • A Kocher incision- a subcostal incision used to gain access for gall bladder and/or biliary tree pathology ▪ Laparoscopic port sites (keyhole surgery) • Small incision made in the skin which allows instruments to be passed into the abdo cavity • Includes the use of a camera, cutting and dissecting scissors and gripppers o Closure ▪ Healing will be best if the wound edge retains a good blood supply, absent from infection and are opposed accurately without tension or trauma ▪ Ischemic edges must be cut back until bleeding is seen ▪ Materials used: Stitches, staples, adhesive strips ▪ A dressing is placed to protect the area of damage or put pressure on the wound to prevent bleeding ▪ Non-absorbable suture or staples need to removed post-op • stomy o From the greek word stomia, meaning mouth o Surgical incision that remains open o For most -ostomy surgeries, a stoma is formed on the abdomen o Tracheostomy – opening the ant. Neck and opening a direct airway through an incision in the trachea or a site for a tracheal tube o Gastrostomy- opening made in the stomach to insert a feeding tube o Gastroduodenostomy: ▪ Forming a new opening between the stomach and duodenum ▪

Surgical procedure where natural connection between the duodenum and stomach is removed and new connection is formed o Colostomy – opening in a healthy part of the large intestine and suturing it to the abdominal wall and attaching a stoma appliance to provide an alternate route for faeces to leave the body. Can be reversible or irreversible o Nephrostomy – artificial opening created in the skin and kidney which allows urine diversion from the renal pelvis in case of a distal blockage and so urine is collected externally in a bag...