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Exam 3: Surgery of the Liver, Biliary Tract, Pancreas and Spleen

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Question 1

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

A) Kupffer cells; phagocytes
B) sinusoid cells; lymphocytes
C) hepatocytes; bile
D) portal triad cells; ductal epithelium

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Question 2

Multiple Choice

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

A) laparoscopic splenic resection with sutured mesh overlay.
B) open splenic lobectomy with vascular ligation.
C) open total splenectomy.
D) open splenic repair with sutured anastomosis and argon plasma coagulation vessel sealing.

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Question 3

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

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

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

Joanne Grizwald, a 24-year-old woman with type 1 diabetes who is in end-stage kidney failure, is scheduled for a combined kidney-pancreas transplant. She is relatively healthy and at normal weight for her height in spite of her disease process. Her bleeding time and coagulation parameters are within normal limits. The circulating nurse has set up the autotransfusion system, verified Joanne's blood type, and crossmatched blood availability. The scrub person, while organizing the sterile back table, identified several instruments that she will not need. She organizes those instruments on the most distant part of the back table. What instruments is the scrub person unlikely to need during this procedure?

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

The recipient liver OR is arranged for a major laparotomy and vascular procedure with customized instruments, supplies, and sutures according to the transplant surgeon's preference. In addition to the general patient care accessories, equipment, and supplies needed for any large surgery, also included are intraoperative laboratory testing and an autotransfusion system. Describe the boundaries of the surgical skin prep for the patient about to receive a liver transplant.

An example of an indication for liver transplantation would be:

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

The head of the pancreas is fixed to the:

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

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

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

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

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