Question 1

The liver,pancreas,and spleen share many similarities.Select the statement about these organs that is true.

Accepted Answer

A pathologic condition in the liver,biliary tract,pancreas,or spleen often requires surgical intervention.These organs are highly vascular and control many of the body's metabolic and immune functions.Solid organ transplantation,such as for the liver and pancreas,is a common means to treat primary hepatic tumors,end-stage liver disease,and insulin-deficient diabetes.

Question 2

Open common bile duct (CBD)exploration may be indicated in some cases where:

Accepted Answer

With the advent of endoscopic,percutaneous,and laparoscopic techniques,open exploration of the CBD is rare.The few contraindications to the laparoscopic approach to cholecystectomy include patients with suspected or diagnosed cancer of the gallbladder,third trimester of pregnancy,cirrhosis with portal hypertension,generalized peritonitis,septic shock,previous surgery that prevents access,and poor pulmonary or cardiac reserve.Such patients may not be able to tolerate the pneumoperitoneum required in laparoscopy.Further,if the surgeon is unable to identify all anatomic structures during a laparoscopic approach,conversion to an open procedure becomes necessary.

Question 3

The Whipple procedure is the removal of the head of the pancreas,the entire duodenum,a portion of the jejunum,the distal third of the stomach,and the ____________ as a surgical treatment for____________.

Accepted Answer

Pancreaticoduodenectomy (Whipple procedure)is the most common procedure for those with pancreatic cancer.In the Whipple procedure,the head of the pancreas,the entire duodenum,a portion of the jejunum,the distal third of the stomach,and the lower half of the common bile duct are removed,with reestablishment of continuity of the biliary,pancreatic,and GI tract systems.

Question 4

A 29-year-old man with paraplegia caused by a spinal cord injury from a diving accident 4 years ago is scheduled for an open cholecystectomy.The perioperative nurse conducts a preoperative assessment to prepare for his procedure.The patient tells the nurse that he is latex-sensitive because he was told that as a spinal cord injured person he should always be considered latex-allergic.An appropriate risk reduction strategy for the patient's latex sensitivity/allergy would be to:

Accepted Answer

Notify healthcare providers in other perioperative areas of the patient's latex sensitivity status.Plan for a latex-safe environment of care: remove all latex products from the room unless no alternative exists.

Question 5

A 42-year-old woman from India is visiting her daughter and new grandson.She is a devout follower of Hindu religious practices and has been diagnosed with splenomegaly,possibly from idiopathic thrombocytopenia.The patient is scheduled for a total splenectomy.During the preoperative assessment,the perioperative nurse,an observant practitioner of Hinduism,is concerned about the possibility of significant bleeding because of the patient's coagulopathy and the need for hemostatic agents that are typically used to stop bleeding.Many of these products are manufactured from bovine source products,and it would be in conflict with the patient's religion to use products from a cow.An appropriate risk-reduction strategy for selection of hemostatic agents that would not be in conflict with the patient's belief system would be:

Accepted Answer

These hemostatic products do not contain bovine products: absorbable gelatin,powder,or compressed forms (Gelfoam); purified porcine gelatin,beaten,dried,and heat-sterilized; and oxidized cellulose (Surgicel,Surgicel Nu-Knit); absorbable oxidation product of cellulose.These products are manufactured from bovine products: absorbable collagen (Collastat,Superstat,Helistat); bovine collagen origin.Collagen activates the coagulation mechanism,aggregation of platelets; microfibrillar collagen (Avitene,Instat),hydrochloric acid salt of purified bovine corium collagen; thrombin enzyme extracted from bovine blood.

Question 6

A 9-year-old boy is admitted to the emergency department (ED)after a sledding accident in which he lost control of his sled and crashed into a tree.He is pale and in pain; his abdomen is tender and firm to palpation.The computed tomography (CT)scan suggests rupture of the spleen with internal bleeding.The scheduled surgery will most probably be a(n):

Accepted Answer

Splenectomy is removal of the spleen.It is performed for multiple reasons,including trauma to the spleen.For these patients,an open approach is indicated.If splenectomy is required due to trauma and there is massive hemorrhage,a surgical-crisis checklist may be implemented; Arriaga (2013)found checklist use was associated with significant improvement in managing OR emergencies.

Question 7

The functional units of the liver are the lobules.The functional cells of the liver are the ______________,and they manufacture _______________.

Accepted Answer

Lobules are the functional units of the liver.Each lobule contains a portal triad that consists of a hepatic duct,a hepatic portal vein branch,and a branch of the hepatic artery,nerves,and lymphatics.The hepatic cords consist of numerous columns of hepatocytes-the functional cells of the liver.The hepatic sinusoids are the blood channels that communicate among the columns of hepatocytes.The sinusoids have a thin epithelial lining composed primarily of Kupffer cells-phagocytic cells that engulf bacteria and toxins.Bile is manufactured by the hepatocytes.

Question 8

The head of the pancreas is fixed to the:

Accepted Answer

The pancreas is a fixed structure lying transversely behind the stomach in the upper abdomen.The head of the pancreas is fixed to the curve of the duodenum.

Question 9

A 39-year-old,248-lb mother of four children is assisted with transfer from a transport vehicle to the OR bed for laparoscopic cholecystectomy,operative cholangiogram,and possible CBD exploration.The perioperative nurse identifies that the patient is at risk for positional injury related to her size and the positional requirements and OR bed manipulations required for this procedure.An appropriate nursing implementation for positioning this patient would be to:

Accepted Answer

For biliary surgery,the patient is placed in a supine position.Arms are placed on padded arm boards with the palms up and fingers extended.A small positioning aid may be placed under the lower right side of the thorax to elevate the lower rib cage,providing better exposure and access to the viscera in the right upper quadrant of the abdomen.When anticipating an operative cholangiogram,the perioperative nurse must ensure that the OR bed has been equipped and positioned so that C-arm image intensification can be accomplished efficiently.

Question 10

The biliary system (also called the biliary tree)drains bile from the gallbladder to the ampulla of Vater.The primary function of the gallbladder is to:

Accepted Answer

The gallbladder,which lies in a sulcus on the undersurface of the right lobe of the liver,terminates in the cystic duct.This ductal system provides a channel for the flow of bile to the gallbladder,where it becomes highly concentrated during storage.The liver produces about 600 to 1000 mL of bile each day.The gallbladder's average storage capacity is 40 to 70 mL.As the musculature of the gallbladder contracts,bile is forced into the cystic duct and through the common duct.As the sphincter of Oddi in the ampulla of Vater relaxes,bile is released,flowing into the duodenum to aid in digestion by emulsification of fats.

Question 11

What technologic characteristic of robotic surgery provides a superior indication for robotic-assisted laparoscopic cholecystectomy?

Accepted Answer

Robotic surgery offers multiple benefits: less blood loss,faster recovery,less scarring,and reduced postoperative pain.The robot extends the surgeon's skills by providing a 360-degree range of motion that is not possible with traditional laparoscopic instruments.It also allows access to all the fine structures of the liver and better visualization of delicate blood vessels.

Question 12

The donor liver OR is prepared for an open laparotomy procedure with basic laparotomy and vascular instruments and accessories.A second sterile,draped medium-sized instrument table is set up to receive and prepare the procured liver away from the main sterile field.Select the additional instruments and accessories needed on the donor organ preparation table.

Accepted Answer

The donor OR is set up for a major laparotomy procedure.Basic instrumentation and equipment include a basic laparotomy set,cardiovascular instruments,power sternal saw,and nephrectomy instruments.A sterile,draped,medium-size instrument table is needed for preparation of the liver away from the main sterile field and instrument tables.The procurement team provides special Collins solution for flushing the organs,sterile plastic containers and ice chests for organs,and in situ flush tubing.The liver is generally placed in two Lahey bags immediately after procurement.

Question 13

The liver is essential in the metabolism of carbohydrates,proteins,and fats,generating nutrient stores of which substance that supplies energy sources to the brain and body?

Accepted Answer

The liver is essential in the metabolism of carbohydrates,proteins,and fats.It metabolizes nutrients into stores of glycogen,used for regulation of blood glucose levels and as energy sources for the brain and body functions.

Question 14

An example of an indication for liver transplantation would be:

Accepted Answer

Liver transplant procedures include entire organ transplants as well as living-related organ donations.Liver transplantation is indicated for patients with chronic hepatocellular disease,chronic cholestatic disease,metabolic liver disease,primary hepatic cancer,acute fulminant liver disease,and inborn errors of metabolism.

Question 15

The circulating nurse approaches the preoperative holding lounge to see her next patient,a 57-year-old nurse,newly diagnosed with pancreatic cancer.He had an endoscopic retrograde cholangiopancreatography (ERCP)1 week ago and,based on the findings,was scheduled for surgery at the comprehensive cancer center,where he works in the interventional endoscopy unit.He is aware of the poor prognosis for this disease,and the nurse has recorded his nursing diagnosis as anxiety related to impending surgical procedure,perioperative events,and surgical outcome.An appropriate nursing action for the patient would be to:

Accepted Answer

When patients are anxious,the perioperative nurse should speak slowly and clearly,using terminology the patient can understand.Offer emotional reassurance by using touch,assisting the patient to a position of comfort on the OR bed,and offering warm blankets (thermal comfort).

Question 16

While the pancreas' function is carbohydrate metabolism with the production of insulin and digestive enzymes,the spleen's function is primarily ___________ with the production of _______________.

Accepted Answer

The spleen has many functions.Among them are defense of the body by phagocytosis of microorganisms,formation of nongranular leukocytes and plasma cells,and phagocytosis of damaged red blood cells.It also acts as a blood reservoir.

Question 17

A perioperative nurse was the scrub person during a robotic-assisted laparoscopic cholecystectomy.She locked the robotic endoscissor into the adaptor on the robotic arm and positioned the tip end into the trocar port in order for the surgeon to dissect the cystic duct and artery,while the surgical assistant placed the clips on the cystic duct and artery.As she reached across the sterile field to insert the cholangiocatheter through the port,the anesthesia provider accidentally made contact with the distal end of the catheter as he stood up to reach the monitor controls.The contaminated end of the catheter touched the endoscopic clip applier,the endoscissor connector that the surgeon was using,the glove of the assistant,and the perioperative nurse's gown sleeve.The surgeon ordered everyone to change their gown and gloves and covered the port area with a sterile towel.What was the rationale for the surgeon to continue to dissect and not change his attire?

Accepted Answer

The surgeon manages the robotic system from a console away from the operative field.With current robotic systems,the surgeon sits at an operative console with three-dimensional imaging and handheld controls.Movement of the controls follows the movement of the instrument's tip.Robotic arms function just like a surgeon's hands.

Question 18

A 51-year-old male with hepatobiliary disease is scheduled for surgery.The perioperative nurse,during the preoperative assessment,questions and examines the patient for signs and symptoms of jaundice,petechiae,and lethargy and:

Accepted Answer

The patient with hepatobiliary disease may have extreme jaundice,urticaria,petechiae,lethargy,and irritability.Depending on the extent of the disease,bleeding and coagulation times may increase and the platelet count may decrease,contributing to intraoperative concerns with achieving hemostasis.A thorough nursing history is necessary for proper assessment of the health status of patients with dysfunctions of the hepatobiliary system,pancreas,or spleen.

Question 19

A 52-year-old man,9 days post liver transplant,presents to the ER with tachycardia,fever,right upper quadrant pain and jaundice.These symptoms are reflective of what postoperative complication?

Accepted Answer

Acute graft rejection occurs from the fourth to the tenth postoperative day.It is manifested by tachycardia,fever,right upper quadrant (RUQ)or flank pain,diminished bile drainage or change in bile color,or increased jaundice.Laboratory changes include increased levels of serum bilirubin,transaminases,and alkaline phosphatase and prolonged prothrombin time.

Question 20

An example of a potential risk associated with pneumoperitoneum would be:

Accepted Answer

The gas of choice for pneumoperitoneum is CO₂.Elevated CO₂ levels and respiratory acidosis may occur because CO₂ diffuses into the patient's bloodstream during laparoscopy.Intra-abdominal pressure is normally between 8 and 10 mm Hg,and the surgeon commonly uses that range as an indicator for proper Veress needle placement.The perioperative nurse should set the insufflation unit to a maximum pressure of 15 mm Hg.When intra-abdominal pressure reaches 15 mm Hg,flow will stop.Pressure higher than 15 mm Hg may result in bradycardia or a change in blood pressure,or it may force a gas embolus into an exposed blood vessel during the operative procedure.

Quiz 12: Surgery of the Biliary Tract, pancreas, liver, and Spleen

The liver,pancreas,and spleen share many similarities.Select the statement about these organs that is true.

Open common bile duct (CBD) exploration may be indicated in some cases where:

The Whipple procedure is the removal of the head of the pancreas,the entire duodenum,a portion of the jejunum,the distal third of the stomach,and the as a surgical treatment for.

The functional units of the liver are the lobules.The functional cells of the liver are the ,and they manufacture _.