Question 1

A patient whose neck has been slashed and has a severed lower trachea may also have injury to the:

Accepted Answer

The esophagus begins at C6 and passes through the neck posterior to the trachea.

Question 2

Review the list below and select the answer that reflects the correct match between the procedure and the disease.

Accepted Answer

Common GI endoscopy procedures used to establish a diagnosis or monitor gastric disease include esophagogastroduodenoscopy (EGD) (also referred to as gastroscopy or upper endoscopy).

Question 3

Carly Shelmire is a 5-year-old girl with a history of weight loss and stomach upset and pain after eating; she is also small for her age. Her pediatrician suspects celiac disease. Carly has arrived at the pediatric endoscopy unit for a procedure that is less invasive and will also have the benefit of spending the next few hours in the mall across from the hospital with her mom until the procedure is over. What is Carly's scheduled procedure?

Accepted Answer

Capsule endoscopy is an emerging technology and noninvasive diagnostic test that uses a small wireless camera in the shape of a capsule about the size of a large vitamin. This device is suitable for imaging the mucosal surface of the esophagus, stomach, and small intestine.

Question 4

Edward Lewis is scheduled for a transthoracic esophagectomy with lymph node dissection for cancer of the esophagus. Which incisional approach is indicated for this procedure?

Accepted Answer

Transthoracic esophagectomy is indicated for disease of the middle third of the esophagus and high-grade dysplasia in Barrett's esophagus, permitting complete lymph node dissection under direct vision and combines a left-sided thoracoabdominal incision or separate right posterior lateral thoracotomy and midline abdominal incision. The latter describes the traditional Ivor Lewis approach. Another variation, sometimes called the "three-hole esophagectomy," combines an approach for proximal tumors. The single-incision thoracoabdominal incision provides the best exposure for low gastroesophageal junction tumors and is indicated for patients with cardiac and pulmonary disease.

Question 5

Which statement about the McBurney incision is most correct?

Accepted Answer

The McBurney incision is an open appendectomy approach and the appendix is typically in the right lower quadrant of the abdomen.

Question 6

Exposure of intra-abdominal anatomy is crucial to safe surgery and employs varied instruments, applications of highly technical energy sources, patient manipulations, light, and imaging. What is unique to the laparoscopic approach that promotes exposure?

Accepted Answer

Abdominal insufflation with carbon dioxide expands the abdominal compartment, permitting better visualization and room to manipulate instruments.

Question 7

As the surgeon prepared to clamp and transect the bowel during a small bowel resection for tumor, the scrub person transferred instruments from the Mayo stand to the back table and prepared the sterile field for bowel isolation technique. The rationale for this application involves

Accepted Answer

Bowel technique, also referred to as contamination or isolation technique, prevents cross-contamination of the wound or abdomen with bowel organisms. Initiate practices required for creating and maintaining a sterile field. Protect the patient from cross-contamination-employ bowel/GI technique as appropriate.

Question 8

Two patients are scheduled to have a gastrojejunostomy for obstruction. How will perioperative planning differ for a patient weighing 280 lb as compared to that for a 150-lb patient?

Accepted Answer

The larger patient will require longer instruments and deeper retractors.

Question 9

Select the statement that most correctly matches a risk factor for adhesions with an appropriate preventive strategy.

Accepted Answer

Adhesions may also develop as a result of radiation-induced endarteritis, endometriosis, pelvic inflammatory disease (PID), or Crohn's disease. Preventive measures include the following: minimizing tissue trauma and inflammation with meticulous surgical technique and using the laparoscopic approach when indicated.

Question 10

Ramona Guerne has been admitted through the emergency department for severe abdominal pain, distended abdomen, and fever. The surgery service has been consulted and has scheduled her for exploratory surgery. Ramona has undergone two abdominal surgeries in the past for "female problems" and states that she has a tendency to form keloids. A small bowel obstruction is suspected. Postoperative ileus is a common complication of open abdominal surgery. Select the procedure that is least likely to promote postoperative ileus formation in this patient.

Accepted Answer

A laparoscopic approach combined with sharp-dissection lysis of adhesions and release of bowel torsion (twisting) does not include a bowel resection and will not cause excessive manipulation of the bowel. This patient may possess risk factors for development of postoperative (paralytic) ileus attributable to two past surgeries, keloid history, and possible bowel obstruction.

Question 11

An abdominal perineal resection, or APR, for a patient at high risk for colon cancer without anal/rectal involvement (e.g., familial adenopolyposis [FAP]) can be accomplished through an open laparotomy or laparoscopic-assisted ileoanal pull-through approach, per surgeon preference and appropriate patient selection. Which of these statements about approaches for APR is correct?

Accepted Answer

The laparoscopic-assisted ileoanal pull-through procedure for total colectomy creates a rectal anastomosis in which the distal ileal segment is anastomosed to the rectal segment. Intraluminal staples are inserted through the rectum to connect the rectum to the created J pouch. The only skin incisions are the trocar port sites.

Question 12

Specific positioning considerations for bariatric patients require particular attention to protecting these patients from inherent risks related to their size and weight. Of considerable concern is the risk of injury to staff. Protective measures to protect both patient and staff include those below. Which measure reflects the most safety protection for both patient and staff?

Accepted Answer

A special OR bed is required that can accommodate patients who weigh more than 350 lb (159 kg).

Question 13

Select the statement that best reflects the functional components of the gastrointestinal (GI) tract.

Accepted Answer

The GI tract, or alimentary canal, is a continuous tubelike structure that extends the entire length of the trunk. The tract includes the mouth; pharynx; esophagus; stomach; small intestine, consisting of the duodenum, jejunum, and ileum; and large intestine, which consists of the cecum, ascending colon, transverse colon, descending colon, sigmoid colon, rectum, and anus.

Question 14

During a laparoscopic colectomy, the scrub person carefully placed the endoscopic electrosurgery instruments on the Mayo stand after inspecting the integrity of the insulation along the shaft. This practice is designed to meet the expectation for the following outcome: The patient will be free from:

Accepted Answer

The patient is at risk for impaired tissue integrity from thermal burns that may be caused by defects in the surface of the insulation coating on laparoscopic electrosurgery instruments.

Question 15

Select the option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the abdomen.

Accepted Answer

Cancer of the peritoneum can be treated with topical application of selected chemotherapeutic agents instilled into the abdomen after induction of anesthesia. Lysis of adhesions is a surgical procedure that employs sharp tissue dissection to cut and release adhesions.

Question 16

Select the diagnosis/procedure option that pairs the correct surgical diagnosis with the surgical/endoscopic procedure for diseases of the esophagus:

Accepted Answer

Endoscopic mucosal resection (EMR) is an interventional technique to remove submucosal flat or depressed lesions of Barrett's esophageal dysplasia.

Question 17

Triangulation is a term used to describe the method used to provide instrument access to the anatomy during abdominal surgery. It is uniquely associated with which surgical incision?

Accepted Answer

Traditional laparoscopic port placement, via triangulation, is the fundamental concept of laparoscopic surgery. It places the instruments on planes where they meet to effectively support dissection with adequate visualization and identification of anatomy and pathology. Incorrectly placed ports can cause "sword-fighting" instruments and indirect access to the operative anatomy.

Question 18

When setting up for a gastrectomy, the scrub person will ensure that appropriate instruments are available to clamp and ligate the:

Accepted Answer

Gastrectomy requires clamping and ligating the splenic vessels.

Question 19

The general risks associated with gastrointestinal surgery parallel those risks associated with most abdominal procedures. Select a complication that is the most typical risk associated with surgery of the large bowel.

Accepted Answer

The risks for injury or failure to achieve the intended outcome are equally present in GI surgery as in any surgical or invasive procedure. The surgical and anesthesia experience challenges the immune system and poses many risks of introducing endogenous and exogenous microorganisms.

Question 20

Sharon Close has been diagnosed with severe gastroesophageal reflux disease (GERD) without the dysplastic changes of Barrett's esophagus. Her GERD is unresponsive to proton pump inhibitors and histamine blockers. She also has a history of endometriosis with multiple surgeries for ablation of endometrial implants on her small bowel and adhesiolysis. Her surgeon is hesitant to pursue an open or a laparoscopic Nissen surgical approach. What procedure might her surgeon consider in lieu of a Nissen?

Accepted Answer

Endoluminal plication is an antireflux procedure that can be performed endoscopically in an endoscopy procedure room using moderate sedation or a general anesthetic. One example is the EndoCinch (Bard Medical) technique that dilates the lumen of the esophagus before passing the EndoCinch device through an EGD scope. The device is a sewing capsule that pinches or pleats mucosal folds and anchors them in place with suture. Several plications are placed in a circumferential or staggered vertical pattern. Another device is the Wilson-Cook sewing system (Wilson-Cook Medical). It is a submucosal plication device that suctions a small fold of tissue into the lumen of the scope accessory, and then plicates, sutures, and knots the tissue pleat.

Quiz 2: Gastrointestinal Surgery