20. Inflammatory bowel disease – surgical aspects

Question 1

IBDs

Answer 1

Chrons

Ulcerative collitis

Question 2

Etiology

Answer 2

Idiopathic, multifactorial

Question 3

Increased risk

Answer 3

NSAIDs, oral contraceptives, high socioeconomic status

Question 4

Chron’s disease

Answer 4

• Women, third decade, sugar consumption, smoking

- Any part of GI tract, segmental, transmural, abdominal pain, bloating, diarrhea, bleeding, weight loss, fever

Question 5

Ulcerative cholitis

Answer 5

• Men, fourth decade
• Smoking and appendectomy is protective
• Spreads from rectum, continuous, mucosal, bloody diarrhea, cramps
• 20-30% require surgery

Question 6

Indications for emergency surgery

Answer 6

free perforation, rupture of abscess, massive

uncontrollable bleeding, acute obstruction

Question 7

Indications for urgent surgery

Answer 7

fulminant Chron’s colitis, toxic megacolon, severe perianal sepsis

Question 8

Indications for elective surgery

Answer 8

abscess, obstruction, intractable course of disease

Question 9

Chron’s surgery

Answer 9

▪ Bypass
▪ Stoma
▪ Stricture plasties (Heinecke-Mikulitz, Finney, Michelassi)
▪ Resection (as little as possible)

Question 10

Ulcerative collitis surgery

Answer 10

▪ Total proctocolectomy & Brooke ileostomy
▪ Total proctocolectomy & continent ileostomy
▪ Abdominal colectomy & ileorectal anastomosis
▪ Total proctocolectomy & ileal pouch – anal anastomosis