OR ABBREVIATIONS AND TERMINOLOGIES INCLUDING PREFIXES AND SUFFIXES

Prefixes
 mono- : one, from the Greek μόνος, monos, "only, single"
 angio- : related to a blood vessel, from the Greek αγγήϊον angḗïon, "vessel", "containter",
"pot"
 arthr- : related to a joint, from the Greek άρθρον, árthron, "joint"
 bi- : two, from the Latin prefix *bi, meaning "two".
 colono- : related to large intestine colon, from the latin cōlon, "clause [of a poem]", itself
from the Greek χωλον, chōlon, "clause, memeber, part"
 colpo- : related to the vagina, from the Ancient Greek χόλπος, chólpos, meaning "hollow
space", but also a synonym for "womb"
 cysto- : related to the bladder, from the Greek χύστις, chústis, "bladder, pouch"
 encephal- : related to the brain, from the Ancient Greek εγκέφαλος, enchéphalos itself
from εν, en, "in", and κεφαλή, kephalḗ, meaning "head".
 gastr- : related to stomach, from the Greek γαστήρ, gastḗr, "stomach"
 hepat- : related to the liver, from the latin hēpatītis, from the latin hēpar, Greek loanword,
originally ηπαρ, hēpar, meaning "liver"
 hyster- : related to the uterus, from Neo-Latin hysteria, itself ultimately from the Greek
ύστέρα, hústéra, meaning "womb, uterus"
 lamino- : related to the lamina (posterior aspect of vertebra)
 lapar- : related to the abdominal cavity
o Etymology actually refers to soft, fleshy part of abdominal wall. The
term celio- is generally considered more accurate and more commonly used
in America.[citation needed]
 lobo- : related to a lobe (of the brain or lungs), from the latin lobo, ablative declension
of lobus, itself from the Greek λοβός, lobós, "lobe", "pea-pod"
 mammo- and masto-: related to the breasts, from the latin mammas, "breast", and Greek
μάσταζ mástaz, "chewer"
 myo- : related to muscle tissue, from the Greek μυς, mús, from μύσκυλος múskulos,
"little mouse", so called because the Greeks believed that muscles looked like little mice.
 nephro- : related to the kidney from the Greek νεφρόν, nephrón, accusative declension
of νεφρός, kidney
 oophor- : related to the ovary, from ωοφόρος, oophóros, meaning "egg-bearing"
 orchid- : related to the testicles, from the latin orchis, itself from the Greek όρχις, órchis,
meaning "testicle" or sometimes "orchid" so called because the Greeks
believed orchid roots looked like testicles.
 rhino- : related to the nose, from the Greek ρινός rinós, genitive declension of ρίς rís,
"nose"
 thoraco- : related to the chest
 vas- : related to a duct, usually the vas deferens, from the latin vas, meaning "vessel", or
"vein"

Suffixes
 -centesis : surgical puncture
  -tripsy : crushing or breaking up
 -desis : fusion of two parts into one, stabilization
 -ectomy : surgical removal (see List of -ectomies). The term 'resection' is also used,
especially when referring to a tumor.
 -opsy : looking at
 -oscopy : viewing of, normally with a scope
 -ostomy or -stomy : surgically creating a hole (a new "mouth" or "stoma", from the Greek
στόμα (stóma), meaning "body", see List of -ostomies)
 -otomy or -tomy : surgical incision (see List of -otomies)
 -pexy : to fix or secure
 -plasty : to modify or reshape (sometimes entails replacement with a prosthesis), from
the Ancient Greek πλάστος, plástos, meaning "molded".
 -rrhaphy : to strengthen, usually with suture

DIFFERENT TYPES OF SURGICAL PROCEDURES

Types Of Surgery
I) Immediate
When life, limb or organ-saving intervention is required and resuscitation is performed
simultaneous with intervention.
Normally it occurs within minutes of decision to operate.
Expected location: next available operating theatre, if required “break-in” to existing lists
E.g. Repair of ruptured aortic aneurysm; Laparotomy for control of haemorrhage.
II) Urgent
Intervention for acute onset or clinical deterioration of life, limb or organ survival; for fixation of
multiple fractures; and for relief of pain or other distressing symptoms.
Normally it occurs within hours of decision to operate and once resuscitation is completed
Expected location: day time “emergency” list or Out-of-hours emergency theatre
E.g. Debridement plus fixation of fracture; Laparotomy for perforation
III) Expedited
When a patient is stable but requires early intervention for a condition that is not an immediate
threat to life, limb or organ survival.
Normally it occurs within days of decision to operate
Expected Location: Elective list with “spare” capacity or Day time “emergency” list (except at
night)
E.g. Retinal detachment; Excision of tumour with potential to bleed or obstruct
IV) Elective
Surgical procedure planned or booked in advance of routine admission to hospital.
It occurs within a planned time that suits patient, hospital and staff.
Expected Location: Elective theatre list (after being booked and planned prior to admission)
E.g. all other conditions not classified as immediate, urgent, or expedited; example, Cystoscopy

With technical advances today, surgery does not necessarily mean large incisions, as in the
past. Depending on the type of surgery, there are several surgery methods that may be
performed:

 Open surgery - an "open" surgery means the cutting of skin and tissues so that the
surgeon has a full view of the structures or organs involved. Examples of open surgery
are the removal of the organs, such as the gallbladder or kidneys.
 Minimally invasive surgery - minimally invasive surgery is any technique involved in
surgery that does not require a large incision. This relatively new approach allows the
patient to recuperate faster with less pain. Not all conditions are suitable for minimally
invasive surgery.
Many surgery techniques now fall under minimally invasive surgery:

 Laparoscopy
 Endoscopy
 Arthroscopy
 Bronchoscopy
 Cystoscopy
 Gastroscopy
 Hysteroscopy
 Laryngoscopy
 Sigmoidoscopy

In addition to using traditional surgical knives in surgery, both open and minimally invasive
surgery can use the following alternative techniques, depending on diagnosis:

 Laser surgery
 Electrosurgery

MAJOR CLASSIFICATION OF INSTRUMENTS

  Cutting surgical instruments – Such as blades, knives, scissors and scalpels.

 Grasping surgical instruments – Anything you use to hold something in place, such as
forceps.
 Retracting surgical instruments – For holding incisions open, or for holding organs and
tissues out of the way while you operate.

CLASSIFICATIONS OF SUTURES AND LIGATURES

 Absorbable sutures
commonly used for deep tissues and tissues that heal rapidly; as a result, they may be
used in small bowel anastomosis, suturing in the urinary or biliary tracts, or tying off small
vessels near the skin.

 Non-absorbable sutures
used to provide long-term tissue support, remaining walled-off by the body’s
inflammatory processes (until removed manually if required). Uses include for tissues that heal
slowly, such as fascia or tendons, closure of abdominal wall, or vascular anastomoses.

 Natural
made of natural fibres (e.g. silk or catgut). They are less frequently used, as they tend to
provoke a greater tissue reaction. However, suturing silk is still utilised regularly in the securing
of surgical drains.

 Synthetic
comprised of man-made materials (e.g. PDS or nylon). They tend to be more predictable
than the natural sutures, particularly in their loss of tensile strength and absorption.

 Monofilament sutures
a single stranded filament suture. They have a lower infection risk but also have a poor
knot security and ease of handling.

 Multifilament sutures
made of several filaments that are twisted together. They handle easier and hold their
shape for good knot security yet can harbour infections.
CLASSIFICATION OF SKIN PREPARATION
 ABDOMINAL SURGICAL SITES OF OPERATION AND INDICATIONS
Abdominal surgical sites of operation and indications:

 Midline incision: incision that follows the linea alba (a relatively avascular structure) to
access most of the abdominal viscera; performed on a wide variety of abdominal
surgeries, including emergency procedures, as this incision causes minimal blood loss;
the downside is the susceptibility of significant scars.
 Paramedian incision: incision 2-5cm lateral to the midline; used to access mostly the
lateral viscera (such as kidneys, spleen, and adrenal glands); the anterior rectus sheath
is separated and moved laterally, preventing any division of the rectus muscle; however
this approach takes a long time and is often technically difficult; it also can damage
blood and nerve supply of the muscles, which may result in the atrophy of the muscle;
this technique is rarely perform in the UK.
 Kocher incision: subcostal incision made parallel to the costal margin, starting below
the xiphoid and extending laterally; used to access the gall bladder; these subcoastal
incisions provide good abdominal viscera exposure and good healing. Other variations
of Kocher incision are:
o Chevron / rooftop incision: the extension of the incision to the other side of the
abdomen; used to access the oesophagus, the stomach, and the liver.
o Mercedes Benz incision: Chevron incision with a vertical incision and break
through the xiphisternum; same indication as Chevron incision, but mostly
performed in liver transplantation.

 Transverse Incision: they vary in size and location; when a full-length transverse incision
is made some muscles (the oblique, the transverse and the rectus abdominis) and linea
alba are cut in a horizontal plane, causing more blood loss than the midline incision and
being more time-consuming; surgeons may also perform smaller transverse incisions
and remain unilateral.
o Supraumbilical transverse incision: offers excellent exposure of the upper
abdomen;
o Pfannenstiel incision: infraumbilical transverse incision in the lower abdomen;
mostly used for gynaecological and obstetric procedures. The skin is incised
transversely, often with a convexity downward to avoid dissection of blood
vessels and nerves.
 Lanz incision and Gridiron incisions: used to access the appendix, mostly to perform
appendicetomy; both are made at McBurney’s point. In comparison to Gridiron incision,
Lanz incision produces better aesthetics results with reduced scarring as it follows the
Langer’s lines.
 Rutherford-Morison incision: similar with the Gridiron incision but the surgeon extends
the incision into an oblique and curvilinear orientation, facilitating access to the
ascending colon and sigmoid; also used for kidney transplantation.
 ETHICO-LEGAL ISSUES IN OPERATING ROOM
Noel Casumpang, et al vs. Nelson Cortejo,
G.R. No. 171127, March 11, 2015
Facts:
Mrs. Jesusa Cortejo brought her 11-year old son, Edmer Cortejo (Edmer), to the
Emergency Room of the San Juan de Dios Hospital (SJDH) because of difficulty in breathing,
chest pain, stomach pain, and fever. r. Ramoncito Livelo (Dr. Livelo) initially attended to and
examined Edmer. Dr. Livelo took his vital signs, body temperature, and blood pressure.6 Based
on these initial examinations and the chest x-ray test that followed, Dr. Livelo diagnosed Edmer
with "bronchopneumonia.7 " Edmer’s blood was also taken for testing, typing, and for purposes
of administering antibiotics. Afterwards, Dr. Livelo gave Edmer an antibiotic medication to
lessen his fever and to loosen his phlegm.
At 5:30 in the afternoon of the same day, Dr. Casumpang for the first time examined
Edmer in his room. Using only a stethoscope, he confirmed the initial diagnosis of
"Bronchopneumonia.
At that moment, Mrs. Cortejo recalled entertaining doubts on the doctor’s diagnosis. She
immediately advised Dr. Casumpang that Edmer had a high fever, and had no colds or cough10
but Dr. Casumpang merely told her that her son’s "blood pressure is just being active,"11 and
remarked that "that’s the usual bronchopneumonia, no colds, no phlegm."12 Dr. Casumpang
next visited and examined Edmer at 9:00 in the morning the following day.13 Still suspicious
about his son’s illness, Mrs. Cortejo again called Dr. Casumpang’s attention and stated that
Edmer had a fever, throat irritation, as well as chest and stomach pain. Mrs. Cortejo also alerted
Dr. Casumpang about the traces of blood in Edmer’s sputum. Despite these pieces of
information, however, Dr. Casumpang simply nodded, inquired if Edmer has an asthma, and
reassured Mrs. Cortejo that Edmer’s illness is bronchopneumonia.
In the morning of April 23, 1988, Edmer vomited "phlegm with blood streak"15 prompting
the respondent (Edmer’s father) to request for a doctor at the nurses’ station.16 Forty-five
minutes later, Dr. Ruby Miranda-Sanga (Dr. Sanga), one of the resident physicians of SJDH,
arrived. She claimed that although aware that Edmer had vomited "phlegm with blood streak,"
she failed to examine the blood specimen because the respondent washed it away. She then
advised the respondent to preserve the specimen for examination.
Thereafter, Dr. Sanga conducted a physical check-up covering Edmer’s head, eyes,
nose, throat, lungs, skin and abdomen; and found that Edmer had a low-grade non-continuing
fever, and rashes that were not typical of dengue fever.17 Her medical findings state:
the patient’s rapid breathing and then the lung showed sibilant and the patient’s nose is
flaring which is a sign that the patient is in respiratory distress; the abdomen has negative
finding; the patient has low grade fever and not continuing; and the rashes in the patient’s skin
were not
"Herman’s Rash" and not typical of dengue fever.
 Dr. Sanga then examined Edmer’s "sputum with blood" and noted that he was bleeding.
Suspecting that he could be afflicted with dengue, she inserted a plastic tube in his nose,
drained the liquid from his stomach with ice cold normal saline solution, and gave an instruction
not to pull out the tube, or give the patient any oral medication.
Dr. Sanga advised Edmer’s parents that the blood test results showed that Edmer was
suffering from "Dengue Hemorrhagic Fever." One hour later, Dr. Casumpang arrived at Edmer’s
room and he recommended his transfer to the Intensive Care Unit (ICU), to which the
respondent consented. Since the ICU was then full, Dr. Casumpang suggested to the
respondent that they hire a private nurse. The respondent, however, insisted on transferring his
son to Makati Medical Center.
After the respondent had signed the waiver, Dr. Casumpang, for the last time, checked
Edmer’s condition, found that his blood pressure was stable, and noted that he was
"comfortable." The respondent requested for an ambulance but he was informed that the driver
was nowhere to be found.
At 12:00 midnight, Edmer, accompanied by his parents and by Dr. Casumpang, was
transferred to Makati Medical Center.
Dr. Casumpang immediately gave the attending physician the patient’s clinical history
and laboratory exam results. Upon examination, the attending physician diagnosed "Dengue
Fever Stage IV" that was already in its irreversible stage.
Edmer died at 4:00 in the morning of April 24, 1988. Believing that Edmer’s death was
caused by the negligent and erroneous diagnosis of his doctors, the respondent instituted an
action for damages against SJDH, and its attending physicians: Dr. Casumpang and Dr. Sanga
(collectively referred to as the "petitioners") before the RTC of Makati City.
RTC held that the doctors were negligent. CA affirmed the decision of RTC in toto.
Issue:
Whether or not the petitioning doctors had committed "inexcusable lack of
precaution" in diagnosing and in treating the patient.
Held:
YES. Dr. Casumpang is Liable. attending physician
Dr. Sanga is Not Liable for Negligence because the latter is only a resident doctor
The elements of medical negligence are: (1) duty; (2) breach; (3) injury; and (4) proximate
causation.
Duty refers to the standard of behavior that imposes restrictions on one's conduct.35 It
requires proof of professional relationship between the physician and the patient. Without the
professional relationship, a physician owes no duty to the patient, and cannot therefore incur
any liability.
A physician-patient relationship is created when a patient engages the services of a
physician,36 and the latter accepts or agrees to provide care to the patient.37 The
establishment of this relationship is consensual,38 and the acceptance by the physician
essential. The mere fact that an individual approaches a physician and seeks diagnosis, advice
or treatment does not create the duty of care unless the physician agrees.

Once a physician-patient relationship is established, the legal duty of care follows. The
doctor accordingly becomes duty-bound to use at least the same standard of care that a
reasonably competent doctor would use to treat a medical condition under similar
circumstances.
REACTION
The effects of malpractice in the health care field are a major issue in today’s society.
Working on a more profitable and safe way to ensure the prevention of malpractice is what
should be worked on to promote a safe and comfortable environment for the people. There are
many errors that malpractice portrays in the healthcare field such handling medical situations:
informed consent, foreign objects, and operating on the wrong body part. Also with these
mistakes come major lawsuits against the healthcare system and liability on the doctors become
crueler. Many of the doctors are leaving and that remain practice in fear and silence. Making
sure that the healthcare professionals are fit to do the job is what needs to be accomplished in
order to have a structure and effective healthcare system.