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GU Surgery

Surg Tech GU

most important lab exam used in dx problems affecting urinary tract urinalysis (UA)
KUB kidneys, ureters, bladder
KUB has an ____ radiographic view anteroposterior
IVU intravenous urogram; previously called intravenous pyelogram - enhancement of KUB that involves injection of contrast medium into pt's vein
Rigid endo instrumentation: sheath outfitted with stopcocks affixed to either side to allow for inflow and outflow of irrigation
Rigid endo instrumentation: obturator blunt tip that fits inside sheath to facilitate introduction of sheath into urethra without causing damage
Rigid endo instrumentation: bridge to accommodate added length of telescope; may have additional parts for introducing caths, probes, electrodes, and forceps
Rigid endo instrumentation: deflecting mechanism movable deflector that extends to end of sheath aids in placing accessories such as caths or probes into ureters
Rigid endo instrumentation: telescopic lens primary viewing component; start with 0 degrees straight lens first and then a 120 degree lens for retrograde viewing
Resectoscope sheaths differ from cystoscope with insulation to allow for use of ESU
How much and what kind of irrigation fluid is used for cystoscope? 3-6L; 3% sorbital or 1.5% glycine
Position for cystoscopy low lithotomy
Ellik evacuator or Toomey syringe forcefully removes tumor segments and blood clots from bladder
The mesh-bottom fluid drain pain attached at the end of the table is used for... to "catch" tissue specimens or stones; aka "strainer"
Different types of caths Pezzer, Robinson, Coude, whistle tipped, multi-eyed
Inguinal incision used to access scrotal contents - cryptorchidism and radial orchiectomy
Scrotal incision used to access scrotal contents - vasectomy, testicular biopsy, simple orchiectomy, orchipexy
Gibson incision extraperitoneal abdominal approach designed for access to lower portion or ureter but sometimes used for implantation of donor kidney
Flank incision direct access is provided to adrenal gland, kidney, and proximal ureter - peritoneal cavity is not entered
Subcostal flank incision used when kidney is low lying or if mid to upper ureter in intended target
Muscles transected in flank incision (with ESU) latissimus dorsi (on back), external oblique, and internal oblique
Transcostal flank incision used to expose entire kidney, especially if it's high in retroperitoneal space and involves resection of rib - incision is made directly over rib selected for removal (usually 11th or 12th)
Lumbar incision provides limited exposure by making an incision below the 12th rib lateral to sacrospinalis muscles and extends pas tip of rib; used for adrenalectomy, renal biopsy, or removal of a small low-lying kidney
Another name for adrenal glands suprarenal glands
Cortex of adrenal gland secretes steroid-type hormones essential to control of fluid and electrolyte balance
Medulla of adrenal gland secretes two catecholamines: epi and norepi
Another name for Wilms tumor congenital nephroblastoma
Wilms tumor eventually... replaces most of involved kidney, causing hemorrhage and eventual necrosis
Peak occurrence of Wilms tumor ages 3 - 8
Position for Wilms tumor excision supine with small roll positioned under affected side to slightly elevate tumor
Nephrectomy total or subtotal removal of kidney
Partial nephrectomy obtain a specimen for biopsy, remove small cancers, remove calculi that have caused damage to surrounding parenchymal tissue, or to treat traumatic injury
Incision used for nephrectomy Gibson's
Radical nephrectomy removal of kidney, adrenal gland, perirenal fat, upper ureter, and Gerota's fascia
Incision and position used for radical nephrectomy abdominal incision (transperitoneal) in supine
Why is 3% sorbital or 1.5% glycine used for ESU endoscopy? it's nonelectrolytic and nonhemolytic
The (left/right) kidney is larger than the other left
The (left/right) kidney is slightly lower than the other right
Where does the pancreas lie in relation to the left kidney? across the hilum
Functional unit of kidney nephron
How many nephrons are there? 1 million
Nephrons are subdivided into 2 types: juxtamedullary and cortical
2 basic units of nephron renal corpuscle and renal tuble
Blood supply to kidney renal arteries follow a transverse course from abdominal aorta to hilum of kidney
Where is juxtamedullary nephron located? extends deep into medulla
Where is the cortical located? in cortex
Why is a simple nephrectomy performed? small malignancies, chronic obstructive disorders, benign tumors, or removal of a kidney for transplant
Drain superior, middle, and inferior portions of kidney into renal pelvis Major calyces
Location of renal pelvis in hilum of kidney and continues to ureter
Glomerulus network of capillaries in renal corpuscles
Position for simple nephrectomy lateral with affected side up
Incision for simple nephrectomy subcostal flank approx. 2 cm below 12th rib
2 ways to preserve donor kidney Collin's solution or sterile ice slush in Lahey intestinal bag
During a simple nephrectomy, is the renal artery or renal vein clamped first? Renal artery
3 muscles cut through during simple nephrectomy external oblique, latissimus dorsi, external oblique
Morcellator cuts pieces of kidney to remove with suction during lap simple nephrectomy
What is used to place a ureteral cath during a lap simple nephrectomy? cystoscope (short) then ureteroscope (long)
PKD polycystic kidney disease; cysts form in tubular portions of nephrons and enlarge substintially
3 types of PKD autosomal dominant, autosomal recessive, acquired
Autosomal dominant PKD inherited form, usually develops between ages 30 - 40
Autosomal recessive PKD inherited form, affects young children (extremely rare)
Acquired PKD develops in pts with long-term kidney disorders
How does uncontrolled DM affect urinary system? causes sclerosis to glomerular apparatus of kidney making filtering blood more difficult
Results of progressive PKD chronic renal failure and ESRD within 2 - 6 yrs
2 tx for ESRD dialysis and transplant
ESRD end stage renal disease; >10% normal capacity
Why is Collins solution NOT used as perfusion solution for a living donor kidney? residual perfusion solution could inc serum K in recipient
Before the surgeon clamps and divides renal vessels, what meds will anesthesia give and why? heparin and mannitol to promote diuresis and prevent clotting in arteries and veins
What meds are given to pt after kidney removal and why? protamine sulfate to reverse heparinization and furosemide and mannitol to promote urinary output
What is done with the harvested kidney? it's placed in a basin on back table containing sterile ice slush and flushed with electrolyte solution
What is the electrolyte solution a mixture of? Ringer's lactate with procaine and heparin
What instrument is used to extend a venotomy in a kidney recipient transplant? 45 degree Potts scissors
Why are stockinettes used to hold the donor kidney? aids in keeping friable kidney tissue from being injured during handling by OR team
What type of suture is used to anastomose donor renal vein and recipient's internal iliac vein? double-armed polypropylene (Prolene)
Before the surgeon places the final stitch in each anastomosis, what should the ST remind them to do? irrigate the vessels with heparin sodium using a 10-mL syringe or cath
What is placed to maintain patency or ureter after kidney transplant? 5 Fr ureteral stent - inserted through ureteroneocystostomy up to renal pelvis and exteriorized through urethra
Ureteroneocystostomy procedure of connecting a donor ureter to a recipient bladder
Urinary tract endoscopy is commonly referred to as cystoscopy
TURP transurethral resection of the prostate
TURBT transurethral resection of a bladder tumor
Main role of ST during cystoscopy do NOT run out of irrigation to avoid bubbles
CBI cont. bladder irrigation - used postop on TURP or TURBT procedures to slowly flush bladder and aid in hemostasis by avoiding blood clots
Type of cath used in CBI 3-way foley
Position for ureteroscopy low lithotomy
Order of scope use for ureteroscopy cystoscope (short) and ureteroscope (long)
Will fluoroscopy be used for a ureteroscopy? yes
If a stone is too large for basket stone forceps, what is used to break up the stone into smaller pieces? holmium laser
What kind of stent is inserted after ureteroscope and why? JJ stent "pigtail stent" - ureteroscope causes swelling of ureter which will obstruct urine flow to bladder and cause reflux into kidney
Pyelolithotomy excision of a calculus from renal pelvis - stone is lodged in hilum
Position for pyelolithotomy lateral if stone is in renal pelvis or upper part of ureter, supine if stone is located in distal ureter
Muscle responsible for emptying bladder and closing bladder orifice detrusor
Where is bladder located in males? lies on and is attached to base of prostate gland
Where is bladder located in females? lies on pelvic diaphragm
Position for TURBT low lithotomy - knees and legs are well padded and protected from pressure, especially in popliteal region
Irrigation solution for TURBT NONhemolitic and NONelectrolytic and isotonic - glycine, sorbitol, water
Difference in setups between TURP and TURBT cystoscopy in TURP, a resectoscope (including sheath and obturator and working element) and cutting loops (ESU) is added
Created by: fyrevalkyrie
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