Deck 11: Gastrointestinal Surgery

Question 1

Select the statement/s that best describe the properties of the gastrointestinal (GI)tract.

A) The omentum is a double layer of fatty peritoneum attached along the concave margin of the stomach.
B) The GI tract creates a complex microbiologic ecosystem to support and maintain essential life-sustaining digestive and protective functions.
C) The nerve supply of the esophagus is from branches of the vagus nerve and the sympathetic nervous system.
D) The function of the esophagus is dependent on gravity.
E) The longest part of the GI tract is the small intestine which begins at the pylorus and ends at the ileocecal valve.

Answer 1

B,C,E
The GI tract,or alimentary canal,is a continuous,tube-like structure that spans the human torso.It includes the mouth; pharynx; esophagus; stomach; small intestine,consisting of the duodenum,jejunum,and ileum; and large intestine.The large intestine consists of the cecum,ascending colon,transverse colon,descending colon,sigmoid colon,rectum,and anus.The omentum is a double layer of fatty peritoneum attached along the greater curve of the stomach.It drapes down loosely over the intestines and then folds posteriorly on itself before sweeping upward to attach along the transverse colon.The GI tract creates a complex microbiologic ecosystem to support and maintain essential life-sustaining digestive and protective functions.Substantial populations of microorganisms exist in the intestinal lumen.The esophagus is a collapsible musculomembranous tube through which ingested material moves,by peristalsis,from the pharynx to the stomach.Its nerve supply is from branches of the vagus nerve and the sympathetic nervous system.Functionality of the esophagus is not dependent on gravity.Food can be moved from the mouth to the stomach,even if a person is standing on her head.The longest part of the GI tract is the small intestine which begins at the pylorus and ends at the ileocecal valve.There is variation in length of the adult small intestine but typically it is about 3 m long with a diameter of approximately 2.5 cm.The small intestine consists of three parts: the duodenum (20 cm),the jejunum (110 cm),and the ileum (155 cm).

Question 2

A 19-year-old male has suffered from subsacral pain and swelling for 2 weeks and finally was referred to a colorectal surgeon for care.He is currently in the ambulatory surgical center operating room (OR)bed positioned in the jackknife position.The perioperative nurse has gently but firmly taped his buttocks laterally to the rails of the OR bed to promote exposure to the surgical site.Which procedure is the patient prepared to undergo based on his symptoms and the surgical preparation?

A) Internal hemorrhoidectomy
B) External hemorrhoidectomy
C) Removal of rectal foreign body
D) Pilonidal cystectomy

Answer 2

D
Excision of a pilonidal cyst and sinus is removal of the cyst with sinus tracts from the intergluteal fold on the posterior surface of the lower sacrum.A pilonidal cyst and sinus,which may be congenital in origin,rarely become symptomatic until the individual reaches adulthood,most commonly in young men.The patient is placed in the jackknife position with the buttocks taped open laterally and secured to the sides of the OR bed.

Question 3

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

A) Barrett's dysplasia of the distal esophagus/endoscopic mucosal resection (EMR)
B) GERD/photodynamic therapy (PDT)
C) Zenker's diverticulum/Ivor Lewis esophagectomy
D) Esophageal varices/Heller myotomy

Answer 3

A
EMR is the excision of dysplastic lesions related to Barrett's esophagus (BE).

Question 4

A 12-year-old girl with a history of weight loss and stomach upset and pain after eating is also small for her age.Her pediatrician suspects celiac disease.The patient 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 her scheduled procedure?

A) GI manometry
B) Small bowel enteroscopy
C) Capsule endoscopy
D) Stretta procedure

Question 5

A 38-year-old female has been admitted through the emergency department (ED)for severe abdominal pain,distended abdomen,and fever.The surgery service has been consulted and has scheduled her for exploratory surgery.The patient has undergone two open abdominal surgeries in the past for "female problems" and states that she has a tendency to form keloids.Review the list below and select the most likely preoperative diagnosis for the patient based on her surgical history and symptoms.

A) Keloidal mass of the mesentery
B) Endometriosis plaques on the small bowel
C) Small bowel obstruction with torsion
D) Ruptured appendix

Question 6

A patient consulted a noted colorectal surgeon after experiencing episodes of rectal bleeding over the last 2 weeks.The patient had a screening colonoscopy 5 years ago with several adenomatous polyps and mild diverticular disease.She presents to the endoscopy suite after a successful bowel prep and NPO since midnight.The GI endoscopist is confident that he will find tumor growth in the rectum and decides to employ further diagnostic applications to determine potential for metastasis.Which of the following endoscopic procedures best describes the patient's procedure?

A) Endoscopic mucosal resection (EMR) with photodynamic therapy (PTD)
B) Rectal manometry with dilatation
C) Flexible sigmoidoscopy with endoscopic mucosal dissection (ESD)
D) Colonoscopy with endoscopic ultrasound (EUS)

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.Review the list below and select the nursing diagnosis that is most closely related to bowel isolation technique.

A) Risk for surgical site infection
B) Risk for metastasis
C) Risk for tissue injury
D) Risk for ineffective gastrointestinal perfusion

Question 8

Triangular orientation 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?

A) Mid-epigastric transverse incision
B) Left paramedian incision
C) Thoracoabdominal incision
D) Laparoscopic port incisions

Question 9

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

A) epiploic branches of the peritoneal artery.
B) gastric branches of the gastroepiploic vessels.
C) gastric branch of the peritoneal artery.
D) Treitz arterial stump.

Question 10

Which statement about the McBurney incision is most correct?

A) It is an oblique inguinal incision in the left lower quadrant.
B) It is the incision of choice to repair a direct inguinal hernia.
C) It is an oblique inguinal incision in the right lower quadrant.
D) The direction is more transverse than oblique.

Question 11

A 72-year-old male is scheduled for a total colectomy with ileostomy in the morning.The wound ostomy care nurse (WOCN)has consulted the patient to initiate his ostomy teaching,answer his questions,and mark the site on his abdomen that would be the ideal placement for the ileostomy.An appropriate nursing diagnosis for the patient at this time would be:

A) ineffective self-health management.
B) deficient diversional activity.
C) disturbed body image related to intestinal diversion.
D) impaired social interaction.

Question 12

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 nursing outcome: the patient will be free from injury due to:

A) impaired thermoregulation.
B) thermal burns and adhesions.
C) impaired tissue integrity.
D) thermal burns and adhesions and impaired tissue integrity.

Question 13

Pure natural orifice transluminal endoscopic surgery (NOTES)procedures are procedures performed using flexible endoscopes and instruments passed through the scopes' working channels.Many surgeons use a hybrid NOTES technique.What is the difference between the pure NOTES and hybrid technique?

A) Pure NOTES does not use the rectal approach.
B) Hybrid NOTES is laparoscopic assisted.
C) Pure NOTES does not use the vaginal approach.
D) Hybrid NOTES considers the umbilicus a natural orifice.

Question 14

A 42-year-old woman 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 fundoplication surgical approach.Which procedure might her surgeon consider in lieu of a Nissen?

A) Thoracoabdominal partial esophagectomy
B) Endoscopic mucosal resection
C) Intraluminal plication of the lower esophageal segment
D) Heller's myotomy

Question 15

Exposure of intra-abdominal anatomy in laparoscopy is crucial to safe surgery and employs varied instruments,applications of highly technical energy sources,patient manipulations,light,and imaging.Review the list below and select the technique that is initiated to promote exposure.

A) Insertion of self-retaining retractors
B) Employing the Hasson technique
C) Establishing pneumoperitoneum
D) Insertion of fan retractor

Question 16

When compared with open and laparoscopic techniques,the potential benefits of natural orifice transluminal endoscopic surgery (NOTES)include no visible scars,possibly less pain,and potentially shorter hospital stays.Select a complication that is the most typical risk associated with NOTES.

A) Colitis
B) Peritonitis
C) Paralytic ileus
D) Intestinal obstruction

Question 17

A 55-year-old woman has arrived for an outpatient esophagogastroduodenoscopy.She is assessed by the perioperative nurse to be in good health and is listed as American Society of Anesthesiologists (ASA)class I.The patient changes into her gown and awaits transfer to the procedure room when she is informed that she will not be transferred to the procedure room until __________ and must wait for ________.

A) she is typed and screened; type and crossmatch
B) her ride home arrives; a responsible adult
C) she is NPO for 2 more hours; a bowel prep
D) her esophagus is cleansed; return of gag reflex

Question 18

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

A) Colon cancer/laparoscopic Roux-en-Y (RNY)
B) Ascites/hyperthermic intraperitoneal antibiotic therapy (HIAT)
C) Obesity/laparoscopic adjustable gastric banding (LAGB)
D) Esophageal varices/photo dynamic therapy (PDT)

Question 19

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 120-lb patient?

A) The ligament of Treitz will not need to be identified in a lighter person.
B) Intraoperative warming devices are more important for a lighter patient.
C) The anastomosis will require sutures rather than staples for the heavier patient.
D) Deaver retractors will replace Richardson retractors with the heavier patient.

Question 20

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

A) Duodenoscopy for gastric reflux disease and hiatal hernia
B) Roux-en-Y for gastritis
C) Esophagogastroduodenoscopy (EGD) for gastric ulcer disease
D) Small bowel enteroscopy for ulcerative colitis

Question 21

The stomach receives ingested food from the esophagus to begin the digestive process.In anticipation of receiving ingested material,the stomach prepares for its role in digestion by:

A) decreasing motility.
B) releasing pepsinogen.
C) releasing mucus.
D) increasing motility.
E) secrete digestive enzymes.