Abdomen Regions

Right Hypochondrium

Left Hypochondrium

Epigastrium

Organs
Liver, Gallbladder, Right Kidney, Small Intestine

Spleen, Colon, Left Kidney, Pancreas

Stomach, Liver, Pancreas, Duodenum, Spleen, Adrenal Glands

Right Lumber Region

Gallbladder, Liver, Right Colon

Left Lumber Region

Descending Colon, Left Kidney

Umbilical Region

Umbilicus, Jejunum, Ileum, Duodenum

Right Iliac Fossa

Appendix, Cecum

Left Iliac Fossa

Descending Colon, Sigmoid Colon

Hypogastrium

Urinary Bladder, Sigmoid Colon, Female Reproductive Organs

Types of surgery

Surgical procedures are commonly categorized by urgency, type of

procedure, body system involved, degree of invasiveness, and special
instrumentation.
Based on timing:Elective surgeryis done to correct a non-lifethreatening condition, and is carried out at the patient's request,
subject to the surgeon's and the surgical facility's availability.
Emergency surgeryis surgery which must be done promptly to save
life, limb, or functional capacity. Asemi-elective surgeryis one that
must be done to avoid permanent disability or death, but can be
postponed for a short time.
Based on purpose:Exploratory surgeryis performed to aid or
confirm a diagnosis. Therapeutic surgery treats a previously
diagnosed condition.Cosmetic surgeryis done to improve the
appearance of an otherwise normal structure.
By type of procedure:Amputationinvolves cutting off a body part,
usually a limb or digit; castration is also an example.Resectionis the
removal of all or part of an internal organ or part of the body.
Replantationinvolves reattaching a severed body part.
Reconstructive surgeryinvolves reconstruction of an injured,

By body part: When surgery is performed on one organ system or

structure, it may be classed by the organ, organ system or tissue
involved. Examples include cardiac surgery (performed on the
heart), gastrointestinal surgery (performed within the digestive
tract and its accessory organs), and orthopedic surgery (performed
on bones and/or muscles).
By degree of invasiveness of surgical procedures:
Minimally-invasive surgeryinvolves smaller outer incision(s) to
insert miniaturized instruments within a body cavity or structure, as
inlaparoscopic surgeryorangioplasty. By contrast, an
open surgical proceduresuch as alaparotomyrequires a large
incision to access the area of interest.
By equipment used:Laser surgeryinvolves use of alaserfor
cutting tissue instead of ascalpelor similar surgical instruments.
Microsurgeryinvolves the use of an operatingmicroscopefor the
surgeon to see small structures.

Physical examination
Physical examination should address not only areas affected
by the surgical procedure but also the cardiopulmonary
system as well as a search for any signs of ongoing infection
(eg, upper respiratory tract, skin). When spinal anesthesia is
likely to be used, patients should be evaluated for scoliosis
and other anatomic abnormalities that may complicate
lumbar puncture. Any cognitive dysfunction, especially in
elderly patients who will be given a general anesthetic,
should be noted. Preexisting dysfunction may become more
apparent postoperatively and, if undetected beforehand, may
be misinterpreted as a surgical complication.

Testing
CBC and urinalysis (glucose, protein, and cells) usually are done.
Serum electrolytes and creatinine and plasma glucose are measured
unless patients are extremely healthy and<50 yr of age, the
procedure is considered very low risk, and use of nephrotoxic drugs is
not expected.
Liver enzymes are measured if abnormalities are suspected based on
the patients history or examination.
Coagulation studies and bleeding time are needed only if patients
have a history of bleeding diathesis or a disorder associated with
bleeding.
ECG is done for patients at risk ofcoronary artery disease(CAD),
including all men>45 and women>50.
If a general anesthetic is to be used, a chest x-ray typically is done (or
a recent x-ray is reviewed), but its usefulness is limited, particularly in
younger patients and in patients without suspicion of heart or lung
disease.
Pulmonary function testing may be done if patients have a known
chronic pulmonary disorder or symptoms or signs of pulmonary
disease.
Patients with symptomatic CAD need additional tests (eg, stress
testing, coronary angiography) before surgery.

Patient Risk Factors

History of CAD
History of heart failure
History of cerebrovascular disease
Diabetes requiring treatment with insulin
Infections
Pulmonary Disease

Fluid and electrolyte imbalances

Fluid and electrolyte imbalances should be corrected
before surgery. Hypokalemia and hyperkalemia must be
corrected before general anesthesia to decrease risk of
potentially lethal arrhythmias. Dehydration and
hypovolemia should be treated with IV fluids before
general anesthesia to prevent severe hypotension on
inductionBP tends to fall when general anesthesia is
induced.

Nutritional disorders
Undernutritionincreases risk of postoperative
complications in adults. Nutritional status is assessed
preoperatively using history, physical examination, and
laboratory tests. Indicators of undernutrition include the
following:
A history of weight loss > 10% of body weight over 6 mo
or 5% over 1 mo
Suggestive physical examination findings (eg, muscle
wasting, signs of specific nutritional deficiencies)
Low serum albumin levels