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Coleman College for Health Sciences

Surgical Technology Program

SRGT 1441: Surgical Procedures I Lab

CRN#’S 75428 & 75623 – Spring 2014

Coleman Campus – Room 264 | Thursday 1pm-4pm, Friday 9a-12p

4 hour Lab course / 64 hours per semester / 16 weeks

Instructor: Jerilyn L. Garcia, CST/CSFA, AAS

713-718-7291 Office

[email protected]

1900 Pressler Suite 424

Office Hours 10a-12p Thursday; Friday by appointment only

Jessie A. Hernandez, CST, OTC

713-718-7362 Office

1900 Pressler Suite 425

COURSE SYLLABUS

CATALOG DESCRIPTION

Introduction to surgical pathology and its relationships to surgical procedures. The perioperative

theory associated with the following surgical specialties is presented: general, gynecology &

obstetrical, genitourinary, orthopedic, neurologic, and ophthalmic. The perioperative physical and

psychological care associated with each specific surgical procedure is presented. Intraoperative

care of the surgical patient is described. Specific surgical procedures in each of the surgical

specialties and techniques along with instrumentation, equipment and supplies required for safe

patient care are presented. Laboratory experience for each technique presented is required.

PURPOSE AND RATIONALE

Surgical Technologists are expected to function in a scrub role in all surgical procedures. This

course provides didactic studies or surgical specialty procedures so as to prepare the learner to

become a skilled technical health provider in the operating room in conjunction with the

professional staff.

COURSE GOALS

Goals of this course are to provide the learner with knowledge of following:

1. the different surgical specialties

2. indications for surgical interventions

3. different types of surgical complications and their role in alleviating them

4. basic instruments, supplies and suture for surgical specialty procedures

5. the steps involved in specialty procedures

6. how to apply learned theory to the scrub role

7. how to apply learned theory in assisting the circulator

At the completion of this course the learner should be able to incorporate the theory learned to

clinical practice in a competent and efficient manner.

Prerequisites: SRGT 1201, SRGT 1405, SRGT1409, SRGT 1361, SRGT 1471

Credit: 4 credit hours (3 lecture, 3 lab)

Required Textbook:

Surgical Technology Principles and Practice, Latest Edition, Joanna Kotcher Fuller, Elsevier

Differentiating Surgical Instruments, Latest edition, Colleen J. Rutherford, F.A. Davis

Surgical Mayo Setups, Latest Edition, Tammy Allhoff & Debbie Hinton

Alexander's Surgical Procedures, Latest Edition, Jane C. Rothrock, Sherri M. Alexander. Elsevier

METHOD FOR DETERMINING COURSE GRADE

Attendance 5 % 90-100 = A

Weekly Questions 5 % 80- 89 = B

Lab Exams 10 % 70- 79 = C

Theory Exams 15 % 60- 69 = D

Theory Final 25 % 00- 59 = F

Video Final 40 %

Total 100%

Guidelines for Attendance Grade 0 Day - 100%

1 Day - 90%

2 Days - 80%

3 Days - 70%

4 Days - Administrative Withdrawal

A grade of C is required to pass the course or to remain in the program and proceed into the next

semester Theory and Lab Finals: Final theory and lab exams will be taken only one time. There are

no retakes. The video lab final will be administered first. A passing grade of 70 or higher in the circulating

and scrubbing role is required to take the theory final. It is mandatory that the student passes both the

theory and the video lab final for this course with a minimum grade of 70. The theory and video lab finals

are exit exams for this class. Students must have a paid, current, AST membership by the end of the

spring semester to be allowed to continue to the summer semester. Only proof from AST website or

AST card is acceptable. This will qualify each student to sit for the National Certification exam at the end

of the summer semester. No student will be allowed to register for summer semester without their

membership.

COURSE REQUIREMENTS

The major requirements are:

1. Reading the assigned readings prior to class

2. Completion of all exams within one week of the time given

3. Class and lab attendance according to catalog requirements

4. Mandatory practice of all techniques presented in lab

5. Completion of all assignments

CONFERENCE TIME

Conference time is to be scheduled with the instructor

POLICIES AND PROCEDURES:

The student may find the following information in the student handbook and college catalogue:

Withdrawal Policy

Refund Policy

Plagiarism Policy

ADA CONSIDERATIONS:

The Houston Community College System does not discriminate on the basis of disability in the

recruitment and admission of students or the operation of any of its programs and activities. The

designated office for compliance with the Americans with Disabilities Act (ADA) and Section 504 of

the Rehabilitation Act of 1973 is the HCCS Access and Equity office at 713-718-8606. In order to serve

you better, Disability Support Services Counselors (DSSC) recommend that you meet with them at least

60 days prior to the beginning of the term. Qualifying individuals under the Americans with Disabilities

Act (ADA) guidelines who require reasonable accommodations should report to the ADA counselor at

the campus within the first week of the start of the semester. If the course instructor believes you can

benefit from ADA counseling, after informing you, he/she may refer you to the ADA office or inform

the ADA office. Students must have had recent contact. with the ADA office and documented ADA

support for reasonable accommodations to occur in the course.

Early Alert Syllabus Statement

The Houston Community College Early Alert program has been established to assist in the overall

effort to retain students who are at risk of failing, withdrawing, or dropping a course. This process

requires instructional faculty and student support staff to identify students who are performing

poorly as early as possible and provide relevant support services to help students overcome their

deficiencies. A student is identified when an instructor notices academic or personal difficulties that

affect student’s academic performance. The possible problem (s) could be tardiness, missed/failed

test scores, excessive absences, or a number of other circumstances. Once a referral is made

counselors will then contact students to discuss the issues and possible solutions to their academic

difficulties.

SCAN SKILLS- SECRETARY'S COMMISSION ON ACHIEVING NECESSARY SKILLS

SCAN SKILLS

In 1988, the American society for Training and Development conducted a study with the U.S

Department of Labor to identify skills that employers want to see in entry level employees. This course

incorporates the following SCAN competencies: Information, Systems, Basic Skills, Thinking Skills,

and Personal Qualities.

I. Resources: the student will:

Time:

Review the class agenda and test schedule and prepare a study schedule that allows them to

study consistently in preparation for each test.

II. Interpersonal: the student will:

Participates as Member of a Team:

Form study groups and show up at appointed times to study with the group.

Works With Diversity:

Study with fellow students regardless of sexual orientation, race, religion, or gender.

III. Information: the student will:

Use Computers to Process Information:

Take lecture notes from computer generated Class presentations. Use computers to process

information: download class syllabus, course supplements and other information from the

program web page and Internet.

VI. Basic Skills: the student will:

Listening:

Receive the lecture, presentation material and record this information in proper note-taking

format.

Speaking:

Properly phrase questions and responses during class

Reading:

Complete reading assignments according to the syllabus.

Writing:

Complete written assignments.

VII. Thinking Skills: the student will:

Creative Skills:

Adapt basic positions to non-routine positions when called for during practical exams.

Decision Making:

Determine the appropriate sequencing of multiple procedures.

Seeing Thing in the Mind's Eye:

Be able to conceptualize how the internal body part will look when the body is manipulated

(turned/rotated)

VIII. Personal Qualities: the student will:

Responsibility:

Follow the Program Student Handbook code of ethics and the AST scope of practice.

Sociability:

Work as a part of the class in study and practical situations.

Self Management:

Determine how long the semester is, how many tests and practical exam they have

and how to quantify their time to be prepared for all of it.

Integrity/honesty:

Sign-in/sign out only for self, not cheats on practical or written exams, bring personal

mistakes to the attention the instructor.

OUTLINE

I. General Surgery

A. Anatomy Involved

B. General Consideration, Pharmacology, Psychological Aspects

C. Surgical Procedures

II. General Abdominal Procedures

A. Anatomy Involved



III. Gynecology & Obstetric Surgery

A. Anatomy Involved



IV. Genitourinary Surgery

A. Anatomy Involved



V. Ophthalmology Surgery

A. Anatomy Involved



VII. Orthopedic Surgery

A. Anatomy Involved



SRGT 1441

General Surgery

After completion of this unit, the student should be able to identify common abdominal incisions and list in order

the layers of abdominal tissues. The student should also be able to define an exploratory laparotomy and list step

involved in that procedure.

1. Match suffixes relating to surgical procedures with the correct definitions.

2. State the primary goal of surgical intervention.

3. Match reasons for surgical intervention with the correct descriptions.

4. Match common methods of diagnosis with the correct definitions. ~:"

5. List types of surgical complications.

6. Identify common abdominal incisions.

7. List common uses for abdominal incisions.

8. List in order the layers of abdominal tissues.

9. Define a laparotomy and an exploratory laparotomy.

10. List basic instruments needed for an exploratory laparotomy.

11. List steps involved in the procedure for an exploratory laparotomy

GENERAL SURGERY

I. Suffixes relating to surgical procedures and their definitions.

a. -centesis - To puncture in order to aspirate

b. -desis - Binding or fixation

c. -ectomy - Excision; surgical removal

d. -lithotomy - Incision for removal of stones

e. -oscopy - Inspection/examination through a lighted scope

f. -ostomy - Creation of a new opening for drainage

g. -otomy - Incision into

h. -pexy - Suspension or fixation

i. -plasty - Repair or surgical reconstruction of

j. -rrhaphy - Suture or repair

II. Primary goal of surgical intervention

To allow the patient to be able to return to his/her best possible state of physical and mental

health

III. Reasons for surgical intervention A. Prophylactic (preventive) - To prevent the occurrence of a disease or illness

B. Restorative (curative) - To regain the patient's health and strength

C. Palliative - To relieve or alleviate symptoms, without curing

the underlying cause or disease

D. Diagnostic - To investigate and identify the cause or nature of a

condition, illness, or disease

IV Types of surgical complications

A. Infection -

B. Respiratory distress -

C. Cardiac arrest -

D. Hemorrhage -

E. Procedure or equipment mishaps -

V. Common abdominal incisions -

A. Vertical

1. Median or midline -

a. Upper

b. Lower

2. Paramedian rectus -

a. Right or left upper

b. Right or left lower

B. Oblique

1. McBurney, muscle splitting (right) -

2. Subcostal (Kocher) -

a. Right

b. Left

3. Lower oblique inguinal -

a. Right

b. Left

4. Thoraco-abdominal -

a. Right

b. Left

C. Transverse

1. Midabdominal -

a. Right

b. Left

2. Pfannenstiel (lower) -

VI. Abdominal incisions and their common uses A. Upper median -

B. Lower median -

C. Right upper paramedian -

D. Left upper paramedian -

E. Right Lower paramedian -

F. Left lower paramedian -

G. McBurney-

H. Right subcostal -

I. Left subcostal -

J. Lower oblique inguinal -

K. Thoraco-abdominal-

L. Midabdominal transverse -

M. Pfannenstiel-

VII. Layers of abdominal tissues (listed from outside surface inward) A. Skin-

B. Subcutaneous-

C. Fascia-

D. Muscle-

E. Peritoneum-

VIII. Definitions of laparotomy and exploratory laparotomy

A. Laparotomy - An incision made through the abdominal wall into the peritoneal cavity

B. Exploratory laparotomy - An Incision made through the abdominal wall into the

peritoneal cavity as a diagnostic procedure, without knowing the exact nature of

the patient's condition or disease

IX. Basic instruments needed for an exploratory laparotomy A. Cutting instruments -

B. Grasping/holding instruments -

C. Clamping instruments -

D. Exposing instruments -

E. Accessory items -

X. Duties of the Surgical Technologist in an exploratory laparotomy

A. Preoperative

1. Pull

2. Scrub, gown, & glove

X. Duties of the Surgical Technologist in an exploratory laparotomy

A. Preoperative

3. Set-up back table and mayo

4. First count

5. Drape

6. Move mayo up

7. Clamp ESU & suction tubing

8. Place laps next to incision site

B. Intraoperative

1. Skin & subcutaneous - Pass scalpel. Be prepared to pass hemostats, free ties,

2. ESU pencil, or forceps

3. Fascia - Pass scalpel. Be prepared to pass retractors and replace laps

4. Muscle - Pass scalpel and prepare for entrance into peritoneum -

a. Dip laps in warm saline and wring out

b. Have self retaining abdominal retractor ready

c. Remove all raytex from field

5. Peritoneum

a. Pass hemostats, knife and/or Metz

b. Pass self-retaining retractor and saline moistened sponges

6. Perform as needed:

a. Keep field clear

b. Keep ESU pencil free of debris

c. Exchange soiled sponges for clean ones

d. Keep loose items off mayo

e. Protect field from contamination & notify surgeon if break occurs

f. Anticipate needs of surgeon

g. Care of specimen if needed

h. Assist with suction & irrigation & cutting suture as needed

i. Count

C. Postoperative

1. Assist in removing blood around incision site & place dressing

2. Remove drapes & light handle covers

3. Assist in moving patient to PACU bed

4. Clean room. Properly discard share

DIAGNOSTIC PROCEDURES

XI. Terms and Definitions

A. Artificial cardiac pacemaker - Electrical device that can control the beating of

the heart by a series of rhythmic electrical discharges.

Note: Artificial pacemakers can substitute for defective natural pacemakers (sinoatrial

node in the heart). They may be external or internal (implanted) depending on where the

electrodes are placed. A pacemaker may initiate atrial or ventricular contractions or both.

B. Cardiac catheterization - Passage of a tiny sterile plastic tube (catheter) into the

heart or a coronary artery to diagnose coronary disorders and anomalies.

C. Clinical pathology - Use of laboratory methods to establish a clinical diagnosis of the

nature of disease.

D. Computer - Programmable electronic device that can store, retrieves, and processes data.

Note: The computer has vastly expanded the capabilities of diagnostic medicine.

E. Contrast medium - Radiopaque substance used to provide a contrast in density between

the tissue or organ being filmed (x-rayed) and the medium.

Examples: Barium sulfate, Cystografin@

, Cardiografin@

F. Intraoperative - Procedures performed in the operating room as part of the, operation.

G. Invasive - Techniques using equipment placed into a body cavity or vessel and/or

substances injected into body structures.

H. Noninvasive - Techniques using equipment placed on or near the patient's skin but

outside body tissues.

I. Percutaneous puncture - Directions and depth of needle punctures through the skin to

locate lesions in various organs or structures, or injection of a substance into or out of an

organ or structure.

J. Preoperative - Procedures performed before the patient comes to the operating room suite

or performed in the operating room before the incision is made.

K. Radiopaque - Impenetrable to x-ray or other forms of radiation V Note: Radiopaque

substances appear white on x-ray.

L. Sensory evoked potentials - Method of testing the function of certain sense organs, even

if the subject is unconscious or uncooperative.

M. Surgical pathology - Study of alterations in body tissues removed by surgical

intervention.

N. Ultrasound - Sound at frequencies above the range of human hearing.

O. X-rays - High-energy electromagnetic radiation waves that penetrate most solid matter

to some extent and that act on photographic film; used both in diagnosis and treatment.

XII. Common methods of diagnosis

A. Radiology - Branch of medicine that uses x-rays, radioactive substances, and ionizing

radiations for diagnosis and treatment

B. Pathology - Branch of biological science that studies nature and cause of diseases

through changes in structure and function

C. Endoscopy -

D. Thermography - Detecting and measuring variations of the heat emitted by various

regions of the body and transforming them into visible signals that can be recorded

photographically

E. Ultrasonography

1. Uses high frequency sound waves to produce an image or photograph of an

organ or tissue

2. Ultrasonic echoes are recorded as they strike tissues of different densities

and elasticities

3. The basic component is a specialized transducer that converts ultrasonic

waves to electric impulses that can be digitized to produce images

4. A water-soluble gel is applied to the skin to maintain airtight contact

between the transducer and the skin

F. Magnetic resonance Imaging (MRI)

1. Uses electromagnetic energy and radio waves to form an image

2. Does not use radiation

3. Defines soft tissues in relationship to boney and neurovascular structures

4. Distinguishes between fat, muscle, compact bone, bone marow, brain, spinal

cord, fluid-filled cavities, ligaments, tendons, and blood vessels

5. Detects tumors, inflammatory diseases, infections/abscesses, and evaluates

the functions of cardiovascular and central nervous systems

6. Contraindicated for patients with pacemakers or ferromagnetic implants

Procedure

A. Patient lies flat inside a large electromagnet. Immobile for a long time

B. Bursts of alternating radio-frequency energy waves are emitted

C. The body cells are stimulated from their state of equilibrium to excitement and back again

emitting radio frequency signals

D. The signals are converted by digital computer into two-dimensional color images

displayed on a monitor and recorded on film

XIII. Radiology equipment used in diagnostic procedures

A. Portable x-ray machine -

B. Cassette -

C. Image intensifier (C-arm) -

D. Lead aprons/shields -

E. Radiographic table top -

F. Fluoroscope

XIV. Characteristics of computed (or computerized) tomography (CT) scans

A. uses an x-ray beam in conjunction with computer graphics technology

B. produces a sequential series of positive images of transverse (cross) sections of organs

and anatomical structures

C. x-ray tube & photomultiplier detectors rotate around the patient 1800

D. differences in tissue density are shown in different shades of gray or colors

E. CT scans are very useful in identifying deviations from the norm

F. CT scans present a hazard to the patient from ionizing radiation

G. Allergic reactions to IV contrast media may result

H. The procedure is performed under the supervision of the radiologist

XV. Basic pathology diagnostic procedures

A. Biopsy -

B. Culture -

C. Frozen section -

D. Surgical specimen -

XVI. Types of endoscopes and their uses

A. Arthroscope - Used for visualization of intra-articular surfaces; generally the knee (requires

small incision).

B. Bronchoscope - Used for direct visualization of the bronchus, its branches, and the mucosa of

the trachea

C. Choledochoscope - Used for visualization of the common bile duct

Note: This is used intra- operatively during an open procedure.

D. Colonoscope - Used for direct visualization of the entire large intestine.

E. Culdoscope - Used for visualization of pelvic structures; scope is introduced through small

incision in posterior vaginal cul-de-sac

F. Cystoscope - Used for visualization of the urinary bladder

G. Esophagogastroduodenoscope - Used for direct visualization of the esophagus, stomach, and

duodenum

H. Esophagoscope - Used for direct visualization of esophagus and cardia of the stomach

I. Gastroscope - Used for direct visualization of the stomach.

J. Laparoscope - Used for visualization of the peritoneal cavity through the anterior abdominal

wall (requires small incision).

K. Laryngoscope - Used for direct visualization of the interior of the larynx.

L. Mediastinoscope - Used for visualization of lymph nodes or tumors in the superior

mediastinum (requires a small incision).

M. Nephroscope - Used for visualization of renal pelvis, calyces, and upper ureter.

N. Proctoscope - Used for direct visualization of the rectum.

O. Sigmoidoscope - Used for direct visualization of the sigmoid colon

XVII. Diagnostic procedures performed in surgical specialties

A. General surgery diagnostic procedures

1. Biopsies

2. Endoscopic evaluations

3. Needle aspiration

4. Ultrasound

5. Cholangiograms

6. CT scans

7. MRI scans

B. Gastrointestinal diagnostic procedures

1. Endoscopic evaluations

2. Biopsies

3. Gastrointestinal x-ray studies

4. CT scans

5. MRI scans

C. Obstetrics and gynecological diagnostic procedures

1. Ultrasound

2. Amniocentesis

3. Endoscopy evaluations

4. Pelvic examinations

5. Papanicolaou smear

6. Schiller's test

7. Hysterosalpingography

8. Biopsies

D. Genitourinary diagnostic procedures

1. Intravenous pyelogram

2. Retrograde pyelogram

3. Cystogram

4. Urethrogram

5. Endoscopic examination

6. Cystometrogram

E. Head and neck diagnostic procedures

1. Endoscopy evaluations

2. Audiometry

3. Biopsies

4. CT scans

5. X-rays

6. MRI scans

7. Cultures

Course objectives

Task #2

After completion of this unit, the student should be able to identify types of hernias, list the main disorders

of the thyroid, and match types of operations on the breast with the correct

description. The student should also be able to arrange in order the procedures for inguinal herniorrhaphy,

breast biopsy, modified radical mastectomy, and a subtotal thyroidectomy.

This knowledge will be evidenced by scoring 85 percent on the unit test. .

Specific objectives

After completion of this unit, the student should be able to:

1. Match terms related to general surgery with the correct definitions.

2. Define a hernia.

3. State the purpose of a herniorrhaphy.

4. Distinguish between reducible, incarcerated, and strangulated hernias.

5. Identify regions of the abdomen when hernias may occur.

6. Match types of hernias with the correct descriptions.

7. Identify the parts of Hesselbach’s triangle.

8. Differentiate between direct and indirect hernias.

9. Select true statements concerning considerations for the surgical technologist

during an inguinal herniorrhaphy.

10. Complete statements concerning the procedure for an inguinal herniorrhaphy.

11. Complete statements concerning the anatomy of the thyroid gland.

12. State the primary function of the thyroid gland.

13. List the main disorders of the thyroid.

14. State the purpose of a thyroid biopsy.

15. Arrange in order the procedure for a subtotal thyroidectomy.

16. Match other operations on the thyroid with the correct descriptions.

17. Complete statements concerning the parathyroid glands and related procedures.

18. Complete statements concerning the anatomy of the breast.

19. Identify types of breast incisions

20. Match types of operations on the breast with the correct descriptions.

21. Select true statements concerning male breast biopsy

22. Arrange in order the procedure for an excisional breast biopsy.

23. Select true statement concerning the procedure for a modified radical

mastectomy.

HERNIA / THYROID / BREAST

I. Terms and definitions

A. Benign - Favorable; noncancerous

B. Biopsy - Removal of tissue, cells, or fluid from the body and examination to determine

its exact nature

C. Congenital defect - An imperfection existing since birth

D. En bloc - In a mass as a whole

E. Gynecomastia - Abnormal enlargement of the male breast(s)

F. Hesselbach I s triangle - Area of the lower abdomen where direct inguinal hernias occur

G. In situ - In position; localized and noninvasive

H. Ischemia - Localized tissue anemia due to obstruction of the inflow of arterial blood

I. Malignant - Tending to infiltrate, metastasize, and produce death; cancerous

J. Mammoplasty - Reconstructive surgery of the breast

K. Mastectomy - Excision of the breast

L. Metastasis - Transfer of disease from one site to another

M. Necrosis - Localized death of tissue

N. Tetany - Condition of physiologic calcium imbalance marked by muscle

spasms

O. Transversalis fascia - Major supporting structure of the posterior inguinal

floor

II. Definition of a hernia -

III. Purpose of herniorrhaphy -

IV. Reducible, Incarcerated, and strangulated hernias

A. Reducible hernia -

B. Incarcerated hernia-

C. Strangulated hernia -

V. Regions of the abdomen where hernias may occur

A. Inguinal

B. Femoral

C. Umbilical

D. Epigastric

E. Hiatal (diaphragmatic)

VI. Types of hernias A. Inguinal-

B. Femoral -

C. Hiatal-

D. Ventral-

1. Umbilical -

2. Epigastric -

3. Incisional -

VII. Parts of Hesselbach' s triangle

A. Deep epigastric vessels laterally

B. Inguinal ligament inferiorly

C. Rectus abdominis muscle medially

VIII. Direct and indirect inguinal hernias

A. Direct-

B. Indirect -

IX. Considerations for the surgical technologist during an inguinal herniorrhaphy.

X. Procedure for an inguinal herniorrhaphy A. if hernia is direct,

B. if hernia is indirect,

XI. Anatomy of the thyroid gland

XII. Primary function of the thyroid gland -

XIII. Main disorders of the thyroid

A. Hyperthyroidism (Grave's disease)

B. Hypothyroidism (Myxedema and cretinism)

C. Enlarged gland (Goiter)

D. Cancer

(Review Anatomy and Physiology, "Endocrine System," for a description of these disorders)

XIV. Purpose of a thyroid biopsy -

XV. Procedure for a subtotal thyroidectomy -

XVI. Other operations on the thyroid A. Thyroid lobectomy -

B. Substernal or intrathoracic thyroidectomy -

C. Thyroglossal duct cystectomy -

D. Total thyroidectomy -

XVII. Parathyroid glands and related procedures

A. Diseases of the parathyroid gland are:

1. Hyperparathyroidism -

2. Hypoparathyroidism -

3. Parathyroidadenoma -

XVIII. Anatomy of the breast

XIX. Types of breast incisions

XX. Types of operations on the breast and descriptions

A. Incision and drainage (I & D) -

B. Biopsies -

C. Mastectomies-

D. Mammoplasty-

1. Reduction-

2. Augmentation -

XXI. Male breast reduction -

XXII. Procedure for an excisional breast biopsy

XXIII. Procedure for a modified radical mastectomy.

A. Supine. Armboard & prep arm on affected side. Tuck other.

B. Elliptical skin incision around breast. Deepened with bovie.

C. Allis or kochers on skin edges to elevate flaps.

D. Skin dissected with #10 (change blades often) or bovie. Metz to isolate large vessels

when in extending into axilla

E. Breast and axillary fascia dissected from latissimus dorsi and suspensory ligaments. ~

Specimen passed to scrub.

F. Irrigation

G. Hemovac

Course objectives

Task #3

After completion of this unit, the student should be able to complete statements concerning

biliary, gastric intestinal, and rectal surgery. This knowledge will be evidenced by scoring 85 percent on

the unit test.

Specific objectives

After completion of the unit, the student should be able to:

1. Match terms related to gastrointestinal surgery.

2. Identify the three types of anastomoses.

3. Complete statements concerning the procedure for a cholecystectomy with operative

cholangiogram.

4. Match operations on the liver, spleen, and pancreas with the correct descriptions.

5. Complete statements concerning operations on the biliary tract.

6. Match operations on the liver, spleen, and pancreas with the correct descriptions.

7. List considerations for gastrointestinal surgery.

8. Match gastric procedures with the correct descriptions.

9. State in order the procedure for a Billroth II.

10. List in order the procedure for a gastrostomy.

11. Arrange in order the procedure for a pyloromyotomy.

12. List in order the procedure for a vagotomy.

13. Match operations on the intestine with the correct descriptions.

GASTROINTESTINAL / BILIARY

I. Terms and definitions A. Adhesion - A holding together by new tissue, produced by inflammation or injury, of two

structures which are normally separate.

B. Anastomosis - The union of parts or branches so as to intercommunicate.

C. Atresia - Imperforation or closure of a normal tubular opening of the body.

D. Bile - A yellow or greenish viscid alkaline fluid secreted by the liver which

aids in the digestion and absorption of fats.

E. Biliary tract - System of body parts conveying bile.

F. Cholangiogram - Injection of radiopaque (contrast media) solution into the cystic duct or

into a tube placed in the common bile duct to permit x-ray identification of the biliary

ductal system.

G. Cholecystitis - Inflammation of the gallbladder.

H. Cholelithiasis - Presence of stones in the gallbladder.

I. Diverticula - Small, blind pouches that form in the lining and wall of a canal or organ,

especially the colon.

J. Dysphagia - Difficulty in swallowing.

K. Endoscope - Rigid or flexible instrument designed for direct visual inspection.

L. Endoscopy - Direct, visual examination of the interior of a body cavity or organ with an

endoscope.

M. Fiberoptic lighting - System of high intensity, cool illumination conducted through a

bundle of coated glass fibers.

N. Fissure - A narrow opening or crack of considerable length and depth.

O. Fistula - An abnormal passage leading from an abscess or hollow organ to the body

surface or from one hollow organ to another.

P. Intussusception - Invagination of proximal intestine into the lumen of the distal intestine

causing intestinal obstruction.

Q. Lumen - Cavity or channel within a tube or tubular organ

R. Meckel's diverticulum - Pouch caused by continued existence of the omphalomesenteric

duct located on the ileum close to the ileocecal valve.

S. Mucosa - A mucous membrane.

T. Peptic Ulcer - An ulcer consisting of localized destruction of tissue on the mucous

membrane in the duodenum or stomach.

U. Peritonitis - Inflammation of the peritoneal cavity.

V. Polyp - An outward growth from a mucous membrane.

W. Pyloric stenosis - Congenital abnormality or narrowing of the opening between the

stomach and the duodenum.

X. Resection - Partial excision of a structure. Y. Sphincter-

Y. Sphincter-

Z. Volvulus-

II. Types of anastomoses

A. Side-to-side

B. End-to-end

C. End-to-side

III. Operations on the biliary tract . A. Cholecystectomy-

B. Cholecystotomy-

C. Choledochotomy-

D. Cholecystoduodenostomy-

E. Cholecystojejunostomy -

F. Choledochoduodenostomy-

G. Choledochojejunostomy (Roux- Y) -

H. Transduodenal sphincterotomy -

IV. Indications for biliary tract surgery. A. Acute or chronic cholecystitis -

B. Cholelithiasis-

C. Carcinoma-

D. Biliary atresia -

E. Obstruction in the common bile duct -

V. Procedure for a cholecystectomy with operative cholangiogram.

VI. Operations on the liver, spleen and pancreas and descriptions. A. Drainage of intrahepatic, subhepatic, or subphrenic abscess - Drainage of abscesses

of the liver

B. Hepatic resection -

C. Splenectomy --

D. Pancreaticojejunostomy-

E. Pancreaticoduodenectomy (Whipple operation) VII. Considerations for

gastrointestinal surgery

VIII. Gastric procedures and their descriptions A. Gastrotomy-

B. Total gastrectomy -

C. Subtotal or partial gastrectomy -

D. Gastrostomy-

E. Pyloromyotomy-

F. Pyloroplasty-

G. Gastric bypass -

H. Vagotomy-

IX. Procedure for a Billroth II (subtotal gastrectomy with gastrojejunostomy)

X. Procedure for a gastrostomy

XI. Procedure for a pyloromyotomy XII. Procedure for a vagotomy

XII. Procedure of a vagotomy

XIII. Operations on the intestine and descriptions A. Small intestine resection -

B. Colon resection -

C. Jejunoileal bypass -

D. Colectomy -

E. Hemicolectomy-

F. Ileostomy-

G. Colostomy-

H. Appendectomy-

I. Meckel's diverticulectomy -

XIV. Indications for resections of the small and large intestines A. Carcinoma-

B. Diverticulosis and Meckel's diverticula -

C. Ulceration-

D. Intussusception-

E. Volvulus-

F. Polyps -

G. Strangulated hernia -

H. Obstructions

1. Tumors

2. Adhesions

XV. Procedure for resection of a small intestine

XVI. Procedure for a loop colostomy (opening and closing)

XVII. Procedure for an appendectomy

XVIII. Characteristics of abdominoperineal resection

XIX. Operations on the anorectal region and descriptions.

XX. Procedure for a hemorrhoidectomy.

XXI. Endoscopic procedures commonly used in gastrointestinal surgery.

Course Objectives

Task #4

After completion of this unit, the student should be able to match abdominal and vaginal

procedures with the correct descriptions and complete statements concerning procedures for abdominal

hysterectomy, Cesarean section, laparoscopy, dilation and curettage, repair of cystocele and rectocele,

and vaginal hysterectomy. This knowledge will be evidenced by correctly performing the procedure

outlined in the assignment sheet and by scoring 85 percent on the unit test. .

Special Objectives


1. Match terms related to obstetrics and gynecology with the correct definitions.

2. Match obstetrical complications with the correct descriptions.

3. Complete statements concerning types of abortions.

4. Match gynecological complications with the correct definitions.

5. Match diagnostic techniques employed by gynecologists with the correct

descriptions.

6. Match abdominal procedures with the correct descriptions.

7. Complete statements concerning vaginal procedures and their descriptions.

8. Complete statements concerning the procedure for an abdominal hysterectomy.

9. List indications for a Cesarean section.

10. List in order the steps for performing a Cesarean section.

11. State in order the procedure for a dilation and curettage.

12. State in order the procedure for a vaginal hysterectomy.

13. Complete statements concerning the procedure for the repair of a cystocele and

rectocele.

OBSTETRICS/GYNECOLOGY


A. Carcinoma in situ - Noninvasive cancer located in a small area of the epithelial layer.

B. Conization - Excision of a cone of tissue.

C. Curette - An open spoon shaped instrument used to scrape tissue from a surface.

D. Cystocele - Herniation of the bladder into the vaginal canal.

E. Dilation (dilatation) - Act of stretching or enlarging an organ or part of the body.

F. Dysplasis - Abnormal growth or development.

G. Ectopic pregnancy - A pregnancy that occurs when the fetus lodges in a location other

than the uterus.

H. Endometriosis - The presence of functioning endometrial tissue in places

where it is not normally found.

I. Enterocele - Herniation of the cul-de-sac of Douglas which usually contains

loops of small intestine.

J. Episiotomy - Incision into the perineum during normal labor to prevent lacerations and to

facilitate delivery with less trauma.

K. Gynecology - Branch of medicine which deals with the pelvic diseases and hygiene of

women.

L. Insufflation - The act of blowing a gas or powder into a cavity.

M. Invasive cancer - Cancer which invades healthy tissue.

N. Leiomyomas - Benign fibromas

O. Marsupialization - Suturing of cyst walls to edges of wound, after evacuation, to permit

the cavity to close by granulation.

P. Obstetrics - Branch of medicine, which deals with prenatal, care childbirth, and

postpartum care.

Q. Oxytocin - A pituitary hormone that stimulates the uterus to contract, and thus expel its

contents.

R. Presentation - The manner in which the fetus is positioned in relation to the cervix.

S. Rectocele - Herniation of the rectum into the vagina.

T. Stress incontinence - Inability of the body to control the evacuative function because of

physical stress on body parts involved.

U. Vaginal vault - The dome or upper part of the vagina.

II. Obstetrical complications

A. Dystocia-

B. Placenta previs -

C. Abruptio placenta - -.

D. Cephalopelvic disproportion (CPD) -

E. Abnormal presentations

1. Breech presentation -

2. Transverse presentation -

3. Footling presentation -

4. Vertex presentation -

III. Types of abortions

A. Missed abortion -

B. Incomplete abortion -

C. Imminent abortion -

D. Spontaneous abortion -

E. Voluntary interrupted abortion -

IV. Gynecological complications

A. Amenorrhea-

B. Dysmenorrhea -

C. Menorrhagia -

D. Metorrhagia-

V. Diagnostic techniques employed by gynecologists A. Pelvic examination -

B. Papanicolaou (Pap) smear -

C. Schiller's test -

D. Punch biopsy -

E. Colposcopy-

F. Conization of the cervix -

G. Culdoscopy-

H. Laparoscopy

I. Culdocentesis -

J. Colpotomy -

K. Rubin's test (uterotubal insufflation) -

L. Hysterosalpingography-

VI. Abdominal procedures and descriptions

A. Laparoscopy-

B. Abdominal hysterectomy -

1. Subtotal hysterectomy (supracervical) -

2. Total hysterectomy (TAH) -

3. Wide cuff hysterectomy -

4. Radical hysterectomy (Wertheim) -

C. Myomectomy-

D. Salpingectomy-

E. Salpingostomy-

F. Oophorectomy-

G. Oophorocystectomy-

H. Salpingo-oophorectomy-

I. Tubal ligation -

J. Cesarean section -

K. Pelvic exenteration -

1. Anterior exenteration -

2. Posterior exenteration -

L. Marshall-Marchetti-suspension -

VII. Vaginal procedures and descriptions

A. Dilation and curettage (D & C) -

B. Suction curettage -

C. Conization of the cervix -

D. Marsupialization of Bartholin I s duct cyst or abscess -

E. Anterior and posterior repair -

F. Repair of fistula -

G. Trachelorrhaphy-

H. Shirodkar or MacDonald operation -

I. Vaginal hysterectomy -

J. Simple vulvectomy -

K. Le Fort operation (colpocleisis) -

VIII. Types of genital fistulae

A. Vesicovaginal fistula -

B. Ureterovaginal fistula -

C. Urethrovaginal fistula -

D. Rectovaginal fistula -

IX. Special features of obstetrics and gynecologic operations.

X. Procedure for an abdominal hysterectomy.

XI. Indications for a Cesarean section

XII. Procedure for a Cesarean section

XIII. Procedure for a laparoscopy.

XIV. Procedure for a dilation and curettage.

XV. Procedure for a vaginal hysterectomy.

XVI. Procedure for the repair of a cystocele and rectocele.

XVII. Characteristics of abdominal and vaginal hysterectomies.

TASK #5

After the completion of this unit, the students will be able to identify procedures, instruments, and

sutures used m cystoscopy and genitourinary procedures.

OBJECTIVES - Given a written exam and no references, the learner should be able to with 80%

accuracy:

1. Identify terms related to genitourinary surgery.

2. Match items relating to diseases and anomalies of the urinary tract.

3. Identify diagnostic procedures relating to the genitourinary system.

4. Distinguish between open and closed genitourinary procedures.

5. Identify duties of the surgical technologist.

6. Identify the cystoscopy instruments and proper care and handling of them.

7. Complete statements concerning special considerations during cystoscopy.

8. Match terms relating to open genitourinary surgeries.

9. Distinguish between the types of prostateectomies.

10. Complete statements concerning kidney transplants.

11. Complete statements concerning the circumcision procedure.

12. Arrange in order the procedure for an orchiectomy.

13. Complete statements concerning TURP.

14. Select true statements concerning a nephrectomy procedure.

GENITOURINARY SURGERY


A. Albumin - Any of numerous simple heat-coagulable, water-soluble plasma proteins.

B. Albuminuria - The presence of albumin in the urine, often symptomatic of

kidney disease. .

C. Calculus (plural: Ii) - An abnormal concentration of mineral salts found in hollow organs

or ducts; also called stones.

D. Calyx (plural:yces) - Cuplike cavity which is an extension of the renal pelvis.

E. Dialysis - Process of removing waste products from the blood of a patient in renal

failure.

F. Electrolytic solution - Solution which is a conductor of electricity.

G. Enucleate - To remove without cutting into.

Examples: Enucleate a tumor, enucleate the prostate gland.

H. Fulguration - Destruction of tissue by means of long, high-frequency electric

sparks.

I. Gerota's capsule - The perirenal fascia which helps to hold the kidney in place.

J. Glomerulus (plural:-li) - Tuft of capillaries at the point of origin of the nephron.

K. Hematuria - The presence of blood in the urine.

L. Lithotrite - Cystoscopic accessory used to crush bladder calculi.

M. Normotensive - Normal blood pressure.

N. Ptosis - Dropping or drooping of an organ or part.

O. Renal disease - Acute failure of the kidney to perform its essential functions.

P. Trigone - The triangular space at the base of the bladder.

II. Diseases and anomalies of the urinary tract and their definitions

A. Benign prostatic hypertrophy (BPH) -

B. Chordee -

C. Cryptorchism -

D. Cystitis -

E. Epispadias -

F. Glomerulonephritis -

G. Hydrocele -

H. Hypernephroma -

I. Hypospadias -

J. Nephritis -

K. Nephrolithiasis -

L. NephroptosIS -

M. Nephrosclerosis -

N. Nephrosis -

O. Paraphimosis -

P. Phimosis -

Q. Pyelitis -

R. Pyelonephritis -

S. Pyelophlebitis -

T. Polycystic kidneys -

U. Spermatocele -

V. Testicular torsion -

W. Uremia-

X. Urinary incontinence -

Y. Urinary (vesicoureteral) reflux -

Z. Varicocele -

AA. Wilm's tumor

III. Diagnostic procedures and their descriptions

A. Intravenous pyelogram (IVP)

B. Retrograde pyelogram

C. Cystogram -

D. Urethrogram-

E. KUB -

F. Cystoscopy -

G. Cystometrogram -

IV. Open and closed genitourinary procedures A. Open procedure-

B. Closed procedure -

V. Duties of the technologist during and after a cystoscopy

VI. Cystoscope components

A. Telescope –

B. Sheath -

C. Obturator -

D. Fiberoptic light cable -

VII. Care of the cystoscope

VIII. Special considerations during cystoscopy

IX. Procedure for a cystoscopy

X. Characteristics of a resectoscope A. Used for resections of -

B. Consists of the following components:

1. Telescope

2. Cutting electrode ("loop")

4. Working element

5. Sheath

6. Obturator

XI. Operations on the penis and urethra and their definition

A. Hypospadias repair –

B. Epispadias repair –

C. Circumcision -

D. Urethral meatotomy -

E. Urethral dilation and internal urethrotomy -

F. Urethroplasty -

G. Penile implant -

XII. Operations on the scrotum and their definitions

A. Hydrocelectomy -

B. Vasectomy -

C. Vasovasostomy -

D. Epididymectomy -

E. Spermatocelectomy -

F. Varicocelectomy -

G. Orchiopexy -

H. Orchiectomy

I. Radical lymphadenectomy -

XIII. Types of prostatectomies and their characteristics

A. Transurethral resection of the prostate gland (TURP)

B. Suprapubic prostatectomy

C. Retropubic prostatectomy

D. Perineal prostatectomy

XIV. Open operations on the bladder A. Cystotomy -

B. Cystolithotomy -

C. Cystostomy -

D. Partial cystectomy -

E. Total cystectomy -

F. Bladder neck operation (Y - V -plasty)

XV. Operations on the kidney and ureter and their descriptions A. Cutaneous ureterostomy -

B. Foley- Y pyeloureteroplasty -

C. Heminephrectomy -

D. Litholapaxy (lithotripsy)-

E. Nephrectomy -

F. Nephrolithotomy-

G. Nephroscopy-

H. Nephrostomy -

I. Nephrotomy -

J. Nephroureterectomy –

K. Pyelolithotomy -

L. Pyeloplasty -

M. Pyelostomy -

N. Pyelotomy -

O. Radical nephrectomy –

P. Ureterectomy -

Q. Ureteroileostomy (ileal conduit) -

R. Ureterolithotomy -

S. Ureteroneocystostomy -

T. Ureteroplasty -

U. Ureterosigmoidostomy -

V. Ureterostomy -

W. Ureteroureterostomy -

XVI. Incisional approaches to the kidney A. Lumbar or simple flank incision -

B. Nagamatsu incision-

C. Thoracoabdominal incision -

XVII. Characteristics of an adrenalectomy

XVIII. Kidney transplanting

XIX. Procedure for a circumcision

XX. Procedure for an orchiectomy

XXI. Procedure for a transurethral resection of the prostate gland (TURP)

XXII. Procedure for a nephrectomy

XXIII Procedure for a ureterolithotomy

TASK #6

After completion of this unit, the student should be able to complete statements concerning extraocular and

intraocular procedures, drugs used for ophthalmic surgery, and special considerations for ophthalmic surgery.

This knowledge will be evidenced by scoring 85 percent on the unit test.

Specific Objectives


1. Define terminology related to ophthalmic surgery

2 Identify diseases and anomalies of the eye

3. Complete statements concerning procedures to correct extraocular conditions.

4. Complete statements concerning procedures to' correct intraocular conditions.

5. Match procedures for removal of the eye with the correct descriptions.

6. Identify drugs used for ophthalmic surgery.

7. State the correct meanings for common eye abbreviations.

8. Identify special considerations used for ophthalmic surgery.

9. Complete statements concerning the use of lasers.

OPHTHALMIC SURGERY


A. Abrasion - A scraping injury in which skin or membrane is denuded.

B. Amblyopia - Reduced or dimness of vision, not dependent upon visible changes in the

eye and not a refractive error.

C. Anterior chamber - Frontal space in the eyeball; bounded by cornea, iris, and

lens.

D. Aqueous humor - Watery, transparent liquid that circulates through the anterior cavity

(anterior and posterior chambers) of the eye.

E. Bony orbit - Rounded socket in the cranium in which the eyeball is partially sunk

F. Conjunctive - Mucous membrane which lines the eyelids and covers the anterior surface

of the globe

G. Canthus - Inner or outer corner or angle where the eyelids meet

H. Cornea - Transparent portion of the outer layer (sclera) of the eyeball.

I. Crystalline lens - That part of the eye which in addition to the cornea refracts ~ light rays

and focuses them on the retina.

J. Extraocular - Outside the globe of the eye

K. Extrinsic eye muscles - Muscles connecting the eyeball to the orbital cavity

L. Globe - Eyeball

M. Hyperopia - Light rays come to a focus behind the retina; farsightedness

N. Intraocular - Inside the globe of the eye

O. Intrinsic eye muscles - Muscles located inside the eyeball itself; includes the iris and

ciliary body

P. Iris - Colored membrane of the eye which separates the anterior and posterior chambers;

contracts and dilates to regulate entrance of light rays

Q. Lacrimal glands and ducts - System which secretes and conducts tears

R. Limbus - The edge of the cornea where it unites with the sclera

S. Myopia - Light rays come to a focus in front of the retina; nearsightedness

T. Optic nerve - Second cranial nerve with special sense of sight which transmits

impulses to the occipital region of the brain concerned with vision

U. Posterior chamber - Space between iris and lens which is filled with aqueous humor

V. Pupil - Opening at the center of the iris

W. Retina - Innermost, incomplete coat of the eyeball

X. Sclera - The outer coat of the eye made up of transparent portion and a white portion

Y. Sensory receptors - Rods and cones in the retinal layer which are stimulated by light rays

to conduct nerve impulses to the brain via the optic nerve

Z. Tarsal plate -

AA. Vitreous humor -

BB. Zonules -

II. Diseases and anomalies of the eye

A. Ametropia -

B. Ankyloblepharon -

C. Astigmatism -

D. Blepharitis -

E. Blepharophimosis -

F. Blepharochalasis -

G. Cataract -

H. Chalazion -

I. Dacryocystitis -

J. Diplopia -

K. Distichiasis -

L. Ecchymosis (Black-eye) -

M. Ectropion -

N. Emmetropia -

O. Entropion -

P. Epicanthus -

Q. Esotropia -

R. Exotropia -

S. Glaucoma -

T. Hordeolum -

U. Hyperopia (hypermetropia) -

V. Myopia -

W. Pterygium -

X. Ptosis -

Y. trabismus -

Z. ymblepharon -

AA. Trichiasis -

III. Procedures to correct extraocular conditions

A. Eyelid -

1. Blepharoplasty -

2. Removal of chalazion -

B. Eye Muscles -

1. Advancement -

2. Recession -

3. Resection -

4. Tucking -

C. Lacrimal apparatus

1. Dacryocystectomy -

2. Dacryocystostomy -

3. Dacryocystorhinostomy -

IV. Procedures to correct intraocular conditions A. Procedures on the cornea

1. Corneal transplant (also known as keratoplasty)

2. Radial keratotomy -

3. Correction of pterygium -

B. Procedures for glaucoma

1. Iridectomy -

2. Iridencleisis -

3. Trephination / sclerectomy -

4. Cyclodialysis -

5. Goniotomy -

C. Procedures for a cataract

1. Removal of extraction of a cataract -

2. Implantation of intraocular lens (IOL) -

D. Procedures involving the retina

1. Repair of a detached retina -

2. Photocoagulation -

3. Laser surgery -

4. Vitrectomy -

V. Procedures for removal of the eye

A. Enucleation of the eye -

B. Exenteration of the eye -

C. Evisceration of the eye -

VI. Drugs for ophthalmic surgery and their uses

A. Anesthetics -

B. Antibiotics -

C. Anti-inflammatory agents -

D. Miotics -

E. Mydriatics/cycloplegics -

F. Irrigants -

G. Vasoconstrictors -

H. Miscellaneous -

VII. Eye abbreviations

A. O.D.

B. O.S.

C. O.U

VIII. Special considerations for ophthalmic surgery

IX. The use of lasers

COURSE OBJECTIVES

TASK #7

After completing the orthopedic unit, the student should be able to with an 80% accuracy;

1. Match terms related to orthopedic surgery with their correct definitions.

2. State purpose of orthopedic surgery.

3. Complete statements concerning special features of orthopedic surgery.

4. Select true statements concerning positioning, prepping, and draping for orthopedic surgery.

5. List special equipment and supplies used in orthopedic surgery.

6. Define special abbreviations used in orthopedic surgery.

7. List preoperative diagnostic work that may be required for orthopedic surgery.

8. Complete statements concerning the use of pneumatic tourniquets.

9. Match specialized orthopedic instruments with the correct uses.

10. Select true statements concerning the use of air-powered instruments.

11. List types of orthopedic surgery.

12. Arrange in order the five stages of bone healing.

13. Distinguish among the classifications of fractures.

14. Identify types of fractures.

15. Describe methods of treating fractures.

16. Select from a list the correct requirements of casts.

17. Distinguish between types of casting materials.

18. Complete statements concerning characteristics of plaster casts.

19. Match types of common casts with the correct descriptions.

20. Describe possible treatment for common fracture sites.

21. Select true statements concerning characteristics of tendon and ligament repairs.

22. Complete statements concerning characteristics of arthroscopic surgery.

23. Complete statements concerning the procedure for arthroscopic surgery of the knee

24. Select true statements concerning characteristics of reconstructive joint surgery.

25. Match procedures used in joint reconstructions with correct descriptions.

26. Describe common orthopedic procedures performed on selected parts of the body.

ORTHOPEDIC SURGERY

1. Terms and definitions A. Abduction - Withdrawal of a part away from the midline

B. Acetabulum - Depression in the hip bone which receives the head of the femur

C. Acromioclavicular (AC) joint - The point where the clavicle joins the acromion

process (lateral extension) of scapula

D. Adduction - Act of drawing a part toward the midline .

E. Arthritis -Inflammation of a joint

F. Arthrotomy - Surgical incision of a joint

G. Articular cartilage - A special type of dense connective tissue which covers bone

surfaces in a joint

H. Articulation - Junction of two or more bones; a joint

I. Atrophy - Wasting away or diminution in the size of a part

J. Bone - An individual part of the skeleton; osseous tissue

K Bone marrow - A vital substance found in the medullary canal of long bones

and in the porosities of cancellous bone

L. Bursa - Small closed sac lined with synovial membrane; facilitates the gliding of

muscles or tendons over bone or ligamentous surfaces

M. Cancellous bone - Spongy bone found at the ends of long bones and within flat

bones; contains red marrow

N. Cartilage - Elastic substance attached to articular bone surfaces; forms certain parts

of the skeleton

O. Compact bone - Hard bone tissue which forms the outer covering of bone

P. Condyle - A rounded projection at the end of a bone that anchors muscle ligaments

and articulates with adjacent bones

Q. Cortical bone - Hard bone that forms the shell of all bones to act as a supporting

structure

R. Curvature - Normal or abnormal bending or sloping away; a curve

S. Diaphysis - Shaft of a long bone

T. Dislocation - Displacement of a part of a joint

U. Distal- - Situated or directed farther away or remote from the area under

consideration; the opposite of proximal

V. Dorsiflexion - Flexion or bending of the foot toward the leg . Dysplasia - Abnormal

tissue growth and development

W. Endosteum - Lining inside bones (medullary or marrow cavity which makes

new bone)

X. Epiphysis - Two ends of a long bone

Y. Eversion - Turning outward

Z. Exostosis - A benign growth of the surface of a bone

AA. Extension - Movement which brings the limb into or toward a straight condition

BB. Fibroma - Tumor composed of fibrous or fully developed connective tissue

CC. Flexion - Act of bending or condition of being bent

DD. Foramen - Natural opening in bone through which nerves, vessels, and other ~

structures pass

EE. Foramen magnum - opening in the occipital bone through which the spinal cord

passes enroute to the vertebral column

FF. Fossa - Shallow depression in a bone

GG. Fracture - Break in the bone; loss of continuity of a bone

HH. Hallux - Great toe . Implant - To insert or graft . Inversion - Turning inward

II. Joint capsule - The fibrous sheath which encloses articular bone surfaces

JJ. Lamina - Thin plate or flat layer of bone V

KK. Lateral - Situated or directed away from the midline of the body or one of its parts

LL. Ligament - Band of exceptionally strong, flexible connective tissue which joins

articular bone surfaces - .

MM. Malleolus - A rounded bone process, such as the protuberance on each side of the

ankle

NN. Malunion - Union of the fragments of a fractured bone in faulty position . Medial -

Near or nearness to the midline

OO. Non-union - Failure of the ends of a fractured bone to unite; false union;

pseudoarthroisis

PP. Osteogenesis - The origin and development of bone tissue; ossification .

QQ. Osteomyelitis - Infection in the bone

RR. Osteoporosis - Diminished amount of calcium in the bone .

SS. Osteotomy - Surgical cutting of bone

TT. Pelvic girdle - Bone structure which supports the trunk and provides attachment

for the legs; the pelvic bone originally consists of three separate bones - the ilium,

ischium, and pubis, which fuse during development

UU. Periosteum - Membranes surrounding a bone; contains blood vessels that nourish

the bony tissue.

VV. Plantar flexion - Side of the foot in a condition of being bent; extension of the foot.

WW. Polydactylism - More than the usual number of fingers or toes

XX. Pronation - Act of turning the palm of the hand downward or toward posterior

surface of body

YY. . Proximal - Situated or directed nearer to the area under consideration; opposite of

distal.

ZZ. Pseudoarthrosis - False joint sometimes seen following a fracture or in a failure of

an arthrodesis or fusion

aa . Scoliosis - Abnormal curvature of the vertebral column

bb. Syndactylism - Webbing between adjacent digits.

cc. Synovial membrane - Lining of the joint capsule

dd. Tendon - Fibrous tissue structure which serves to connect muscle to bone and

other parts

ee. Traction - The pulling force exerted on bones or muscles by means of weights and

pulleys to align or to immobilize the part

ff. Valgus - Position in which a part is bent or twisted outward Examples: Talipes

valgus, hallux valgus

gg. Varus - Position in which a part is turned inward. Examples: Talipes varus

hh. Volar - Anterior or palmar surface

ii. Volkmann's contracture - Degenerative contracture and atrophy of a muscle

resulting from long continued interference with normal circulation.

II. Basic purpose of orthopedic surgery

III. Special features of orthopedic surgery

IV. Positioning, prepping, and draping for orthopedic surgery a. Positioning

b. Skin preparation and shave

c. Draping

V. Special equipment and supplies used in orthopedic surgery

a. Operating microscope

b. Power-driven instruments

c. Nerve stimulator

d. Fixation devices

e. Prosthetic implants

f. Electrical bone stimulator

g. Bone cement

h. Casts

i. Braces and immobilizers

j. Tourniquets

k. Conventional x-ray or image intensifiers

l. Traction devices

VI. Special abbreviations used in orthopedic surgery

a. ORIF - Open reduction, internal fixation

b. CRIF - Closed reduction, internal fixation

c. CRExt.F - Closed reduction, external fixation

d. For amputations

(1) BK - Below knee

(2) AK - Above knee

(3) BE - Below knee

(4) AE - Above elbow

VII. Preoperative diagnostic work that may be required for orthopedic surgery

a. X-rays (when fractures or joint instabilities are suspected)

b. Computerized tomography (CT)

c. Magnetic resonance imaging (MRI)

d. Bone densitometers

e. Arthroscopy (to visually inspect a joint)

VIII. Guidelines for use of pneumatic tourniquets

IX. Specialized instruments used in orthopedic surgery a. Bone clamps, bone hooks

b. Cutters

c. Drivers, impactors, extractors

d. Elevators

e. Knives

f. Measuring devices

g. Osteotomes, curettes, gouges, chisels

h. Rasps, files

i. Reamers

j. Retractors

k. Rongeurs

l. Saws, drills

m. Screwdrivers

n. Wrenches

X. Guidelines for use of air-powered instruments

XI. Types of orthopedic surgery a. Repair and management of fractures

b. Repair/reconstruction of tendons and ligaments

c. Diagnostic examinations of joints

d. Revision/reconstruction of joints

XII. Five stages of bone healing

a. Hemorrhage

b. Granulation

c. Callus formation

d. Consolidation

e. Remodeling

XIII. Classifications of fractures

a. Traumatic fracture

b. Pathologic fracture

c. Closed fracture

d. Open fracture

XIV. Types of fractures

a. Comminuted -

b. Greenstick -

c. Impacted -

d. Longitudinal-

e. Multiple -

f. Oblique -

g. Spiral

h. Transverse

XV. Methods for treating fractures

a. Closed reduction-

b. Open reduction -

c. External fixation -

d. Internal fixation-

XVI. Requirements of casts a.

b.

c.

d.

XVII. Types of casting materials a. Plaster of paris

b. Synthetic

XVIII. Characteristics of plaster casts

XIX. Types of common casts a. Upper body/extremities

1. Short arm cast - Applied from below the elbow to the knuckles for wrist

fractures.

2. Long arm cast - Applied from above the elbow to the knuckles for fractures

of the elbow or the forearm

3. Shoulder spica - Applied to the trunk, arm, and hand for fractures of the

humerus or following procedures on the shoulder or humerus when complete

immobilization is required.

4. Body jacket/cast - Applied to the trunk from the axillae to hips for

immobilization of the vertebrae

5. Minerva jacket - Applied to the trunk from the hips to or including the lower

portion of the head for fractures of the cervical or upper thoracic vertebrae

b. Lower body/extremities

1. Short leg cast - Applied from below the knee to the toes primarily for

fractures of the foot and ankle -

2. Long leg cast - Applied from the groin to the toes for distal fractures of the

femur and fractures of the tibia and fibula

3. Cylinder cast - Applied from groin to the ankle for fractures of the patella

and to immobilize the knee

4. Femoral cast brace - Designed to immobilize a femoral shaft fracture without

immobilizing the hip joint or the knee joint

5. Hip spica - Applied to the trunk and one or both legs for fractures of the

femur and following some hip operations

XX. Common fracture sites and treatment

a. Fractures of the clavicle

(1) Usually occur in the middle third of the clavicle

(2) May be treated by immobilization in a figure-of-eight splint if not displaced

(3) ORIF is indicated if displacement causes damage to underlying vessels

and/or the brachial plexus. A tubular plate and screws or intramedullary pins

are commonly used.

b. Fractures of the humeral head

(1) Usually require an ORIF with screws or pins

(2) Closed reduction may be accomplished and a humeral fixation device used

for immobilization

(3) Severely comminuted fractures may require prosthetic implant replacement

of the humeral head (humeral head arthroplasty)

c. Fractures of the humerus

(1) Reduction is usually accomplished by closed manipulation with

immobilization

(2) ORIF is usually accomplished with a nail, rod, or compression plate

(3) When fracture occurs distally (supracondylar, epicondylar, intercondylar),

closed reduction is rarely successful. Internal fixation may be accomplished

with screws, wires, or pins.

d. Fractures of the olecranon

(1) If fracture is small, the bone fragment(s) may be removed and the triceps

tendon reattached to the ulna shaft

(2) If fracture is large, internal fixation is required using screws, wires, or pins

e. Fractures of the radius and ulna

(1) Occur frequently in children and are usually treated by external fixation;

seldom need internal fixation

(2) When internal fixation is indicated, intramedullary pins or compression

plates are frequently used for one or both bones.

f. Fractures of the carpal bones

(1) Most are treated by closed reduction and immobilization

(2) Internal fixation is usually accomplished with wires, small plates, and/or

screw

g. Fractures of the hip

(1) Intertrochanteric fracture

(a) Occur most frequently in the elderly

(b) Require internal fixation because the lower extremity will be

externally rotated

(c) Fixation is accomplished by using compression hip plates, screws,

and/or nails

(2) Fractures of the femoral neck

(a) Have a high incidence of complications such as non-union and

aseptic necrosis of the femoral head

(b) In children may occur through the epiphyseal growth plate

(c) Require internal fixation by various designs of pins and screws

(d) Femoral head prosthetic replacement, an endoprosthesis, may be used

to replace the femoral neck and head when fixation cannot be

accomplished

h. Fractures of the femoral shaft

(1) Usually caused by high impact injuries

(2) Conservative treatment includes skeletal traction for 3-6 weeks followed by

cast immobilization

(3) Surgical treatment includes closed or open intramedullary nailing

(a) Closed - Fracture site is not exposed; requires one incision over the

greater trochanter

(b) Open - Fracture site is exposed; requires two incisions - one over

greater trochanter and one over the fracture site

(c) Skeletal traction (usually 3 weeks) and then closed nailing is often

the treatment of choice

i. Fractures involving the knee

(1) Fractures of the femoral condyle and tibial plateau

(a) Condylar fractures may be single condylar or multicondylar; referred

to as a T or Y fracture

(b) Non-displaced may be treated by casting for immobilization

(c) Displaced fractures are treated by open reduction and fixation with

screws or a right-angled condylar blade plate

(d) Tibial plateau fractures often involve compression of the lateral

condyle and articular surface

(e) Internal fixation includes the use of screws, buttress plates, and bone

graft

(2) Fractures of the patella

(a) May require partial removal of patella

(b) Internal fixation includes the use of suture and tension band wiring or

a screw

j. Fractures of the tibia

(1) Can usually be treated with closed reduction and immobilization

(2) Internal fixation includes the use of screws, compression plates, or

intramedullary nails

(3) Open fractures are more common in the tibia than any other bone

k. Fractures of the ankle

(1) Include the medial malleolus (tibia), lateral malleolus (fibula), and posterior

malleolus (articular surface of the distal malleolus)

(2) Medial and posterior fractures require open reduction using pins, malleolar

screws, or plates and screws

(3) When the lateral malleolus is displaced, open reduction with pins, rods, or

long bone screws is required

1. Fractures of the metatarsals

(1) Fractures occur in various sites

(2) Reduced healing is possible due to decreased vascularity

(3) Open reduction fixation is achieved using small pins, wires, screws, or plates

m. Fractures of the vertebral column

(1) Fractures occur in various sites

(2) Can often be treated by immobilization

Note: The type of immobilization needed depend on where the fracture occurs. For

example, cervical fractures may require a halo vest, thoracolumbar require traction

or body cast or jacket

(3) Open reduction and internal fixation may be achieved using wires, screws,

rods, and/or hooks

Note: All internal fixation devices for the spine have biomechanical advantages

and potential complication.

XXI. Characteristics of tendon and ligament repairs

XXII. Characteristics of arthroscopic surgery

XXIII. Procedure for arthroscopy of the knee

XXIV. Characteristics of reconstructive joint surgery

XXV. Procedures used in joint reconstructions a. Arthrodesis

b. Arthrotomy

c. Arthroscopy

d. Arthroplasty

e. Repair of joint dislocations

XXVI. Common orthopedic procedures performed on parts of the body

a. Hand

(1) Tendon grafts

(2) Peripheral nerve repair

(3) Palmar fasciectomy

(4) Carpal tunnel release

(5) Metacarpal arthroplasty

b. Shoulder

(1) Bristow procedure

(2) Repair of an AC separation

(3) Rotator cuff repair

(4) Total shoulder arthroplasty

c. Elbow

(1) Ulnar nerve transposition

(2) Total elbow arthroplasty

d. Total wrist arthroplasty

e. Total hip arthroplasty

f. Knee

(1) Patellectomy

(2) Repair of collateral or cruciate ligament tears

(3) Baker's cyst excision

(4) Meniscectomy

(5) Total knee arthroplasty g. Ankle and/or foot

(1) Triple arthrodesis

(2) Total ankle arthroplasty

(3) Bunionectomy

(4) Correction of hammer toe deformity

(5) Total metatasal arthroplasty

h. Vertebral column

(1) Laminectomy

(2) Spinal fusion

(3) Discectomy

coleman college for health sciences surgical technology ... · b. exploratory laparotomy - an...

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