GENERAL SURGICAL PROCEDURES COMPETENCY EVALUATION
THE ANATOMY:
1. Identify the 9 regions of the abdomen shown in Figure 14-1.
1. right hypochondriac
2. epigastric
3. left hypochondriac
4. right lumbar
5. umbilical
6. left lumbar
7. right iliac
8. hypogastric
9. left iliac
2. Which section contains the majority of the small intestine? __umbilical____.
3. Identify the 4 quadrants of the abdomen shown in Figure 14-1B.
1.right upper quadrant (RUQ)
2. left upper quadrant (LUQ
3. right lower quadrant (RLQ)
4. left lower quadrant (LLQ)
4. Please place the appropriate quadrant abbreviation next to the organs of the abdomen it contains.
NOTE: Use the quadrant illustrated abdomen (Figure 14-1) for reference.
Example: Liver RUQ
Liver RUQ Appendix = RLQ
Sigmoid Colon = LLQ Tail of Pancreas = LUQ
Head of Pancreas = RUQ Terminal Ileum = RLQ Descending Colon = LUQ/LLQ Splenic Flexure = LUQ
Hepatic Flexure = RUQ Rt inguinal hernia = RLQ Duodenum = RUQ ***Free Space***
Most of Stomach = LUQ
Spleen = LUQ
Gallbladder = RUQ
Cecum = RLQ
5. Please place the following structures/segments of the alimentary canal in correct numerical order.
A.
Upper Gastrointestinal Tract ( Use numbers 1 – 15) Example: Mouth 1
Uvula 2
Cardiac sphincter 6
Duodenum 12
Fundus of Stomach 8
Pylorus of Stomach 10
Body of stomach 9
Mouth 1
Epiglottis 4
Ileum 14
Jejunum 13
Cardia of Stomach 7
Pharynx 3
Esophagus 5
Pyloric sphincter 11
Ileocecal Valve 15
B.
Lower Gastrointestinal Tract (Begin at small intestine and Use numbers 1 – 10)
Hepatic flexure 4
Rectum 9
Transverse colon 5
Ileocecal valve 1
Anus 10
Sigmoid colon 8
Cecum 2
Ascending colon 3
Splenic flexure 6
Descending colon 7
6. What major nerve innervates the stomach? __Vagus (aka )Pneumogastric,(aka) Cranial Nerve X___
THE PROCEDURE:
7. What can be used to close a large hernia defect? ___Mesh____
8. What type of stitch is used prior to inverting the appendiceal stump? _Pursestring___

9. What device is used for a circular GI anastomosis? ____EEA – (End to End Anastomosis_)(“Time to check the donuts”)
10. What suture is commonly used to oversew an intestinal anastomosis? _3-0 Silk__
11. Please match the procedure with its corresponding description.
3 Gastroduodenostomy
7 Creation of permanent stoma for breathing
8 Repair of the diaphragm with fundus wrap
5 Excision of breast, lymph nodes, pectoralis
4 Gastrojejunostomy
2 Pancreaticojejunostomy, gastrojejunostomy, choledochojejunostomy
6 Lobectomy – recurrent laryngeal nerve
9 Reconstruction of gastric sphincter
1 Surgery for splenomegaly
12. Match the most likely position with the surgical procedure.
A.
Supine
B.
Trendelenburg
C.
Reverse Trendelenbury
D.
Kraske
E.
Lateral
__C__ Cholecystectomy
__E___ Esophagectomy
__D__ Pilonidal Cystectomy
__A__ Herniorrhaphy or Mastectomy
__B__ Endoscopic Hernia Repair
13. Match the incision with the surgical procedure.
__F__ Paramedial Incision – heals stronger
__C__ Right subcostal/Kocher
__D__ Thoracoabdominal
__E_ Inguinal oblique incision
__B__ Median incision – more likely to herniated
__A__ McBurney
14. Match the type of hernia with the definition.
__F__ Includes both direct and indirect
__I__ Occurs usually @ esophageal hiatus
__J__ Direct or indirect hernia usually in men
__B__ Acquired defect in Hesselbach’s triangle
__H__ Congenital/acquired - obesity/pregnancy
__G__ Entrapment of organs – no return to abd.
__A__ Common in females - may entrap nodes
__E__ Occurs on anterior abdominal wall
__C__ Usually congenital along spermatic cord
__D_ Entrapment that compromises blood supply
A.
B.
C.
D.
E.
F.
A.
Appendectomy
Trauma – quicker
Cholecystectomy
Esophagoduodenostomy
Herniorrhaphy
Sigmoid Surgery
B.
Direct
C.
Indirect
D.
Incarcerated
E.
Ventral
F.
Pantaloon
G.
Strangulated
H.
I.
J.
Femoral
Umbilical
Diaphragmatic
Inguinal
1 Splenectomy
2 Whipple
3 Bilroth I
4 Bilroth II
5 Radical mastectomy
6 Thyroidectomy
7 Tracheostomy
8 Nissen fundoplication
9 Pyloroplasty

15. Match the instrument /closure device with its usage.
A.
Randall forceps __G__ clamp, clamp, cut ______ to control bleeding
__I_ liver laceration/biopsy to control bleeding
__B_ maintains or enlarges size of esophagus
__J__ grasps bowel such as appendix
__D_ fistula incision guide
__C__ wet to manipulate spermatic cord/esophagus
__A__ removal of stones from duct
__E__ extends incision in vessel or duct
__H__ Decompress an engorged gallbladder
__F__ clamps for occlusion of intestines
16. Match scrub precaution to the surgical procedure.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Maloney dilator/bougie
Penrose drain
Probe/grooved director
Potts Smith scissor
Allen clamp
Tie
Ochsner GB trochar
Large chromic blunt needle
Babcock
__C__ Separation of clean/dirt y– clean closure
__A_ Extra laps & Cell saver for immediate use
__E__ Pass scissors with T-tube for alteration
__I__ Trach tray available for possible postop swell
__D__ Prepare for reuse when returned from MD
__H__ No air bubble in contrast media
__B__ Check balloon. Send obturator with pt postop
__F_ Lubrication required for anal orifice
__J__ Have culture tubes ready aerobic/anaerobic
__G__ Instrument /tissue care to prevent seeding
THE PATHOLOGY:
17. Match the condition with the description.
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Liver laceration
Tracheostomy
Bowel resection
Use of linear stapler
CBDE
Hemorrhoidectomy
Mastectomy
Cholecystectomy with IOC
Thyroidectomy
Appendectomy
__C__ Sac or pouch enlargement of intestinal wall
__H__ Mucosal growth precursor to dysplasia
__G__ Telescoping of intestine within itself
__F__ Twisting of bowel
__I__ Occurs in sacrococcygeal area – sinus formed
__A__ Difficulty swallowing
__B__ Hiatal hernia causing mucosal trauma
__J__ Perianal abscess
__D__ Congenital outpouching located in ileum
__E__ Chronic condition – wt ↓ /abscess/bleeding
A.
B.
F.
G.
H.
I.
J.
Dysphagia
Reflux Disease
C.
DIverticulum
D.
Meckel’s Diverticulum
E.
Crohn’s disease
Volvulus
Intussusception
Polyp
Pilonidal Disease
Fistula-in-ano
18. What is gynecomastia?Development of breast tissue on male; can be functional & develop Cancer.

19. Why is lymphatic drainage important in the mammary gland? Knowing how lymph drains can aid in breast cancer detection and/or a metastatic process.
20. What is meant by the phrase “mobilize the bowel”? Detach it from its support structures (vessels) in mesentery in preparation for resection or anastomosis.
21. What is the purpose of mesentery? Provides vascular supply to the intestines.
22. What happens if all the parathyroid glands are removed? Blood calcium level drops which, in turn, affects muscles and nerves with the potential for resulting tetany and, if untreated, death.
23. What nerve requires careful dissection during thyroid surgery? Recurrent Laryngeal Nerve.
24. Linea alba literally means white line and will be found in the anterior or ventral abdominal wall.
25. Identify where the abdominocrural creases are located between the thighs and abdomen.
26. List three basic configurations for intestinal anastomosis. a. end to end, b. end to side c. side to side.
27. What ligament is used as an anatomical landmark to identify the end of the duodenum and the beginning of the jejunum? Ligament of Treitz.
28. What technique is used to care for instrumentation and supplies that have been exposed to the inside of the intestinal tract? Bowel technique – all instruments exposed are contained within the immediate field and when removed placed in a separate, but visible basin for subsequent counting.
29. PERITONEUM
Primary function
Two layers
Three retroperitoneum regions
Organs of each region
Provide a slippery surface over which the viscera can freely glide.
1. Visceral - organ cover
2. Parietal – lines wall
1. anterior pararenal space
2. pararenal
3. posterior pararenal space
1. Pancreas, duodenum, colon
2. urological and vascular structures
3. No organs
30. Define varicose veins? Veins that have become abnormally elongated, dilated and torturous due to malfunctioning valves which all blood to pool in them causing swelling. (Varices)

31. Where do varicose veins occur? Lower extremities, lower esophagus, spermatic cord and anorectal region (hemorrhoids).
32. Match the closure device to its usage.
_F_33. Mucosal layer closure of intestines
_A_34. Used to reinforce defects (stapled/sutured)
_B__35. Vessel or duct closure using applier
_C_36. Serosal layer closure of intestines
_D__37. Liver laceration or biopsy to control bleed
_E__38. Single applicaton for bowel resection
A.
Mesh
B.
Hemoclip or ligating clip
C.
3-0 Silk interrupted suture
D.
Large chromic blunt needle
E.
GIA or linear stapler
F.
3-0 absorbable continuous suture
Figure 14-1

33. Identify the incisions in noted by the letters in the above diagrams.
A.
_Right Upper Paramedian incision
B.
Left Lower Paramedian incision
C.
Right Subcostal or Right Kocher Incision
D.
Right Transverse Incision
E.
Pfannenstiel (Bikini/Smiley) Incision
F.
Epigastric or Upper Midline Incision
G.
Hypogastric or Lower Midline Incision
H.
McBurney Incision
I.
Right Inguinal Incision; Lower Right Oblique