3- surgical therapies for IBD Flashcards
what are elective operations in IBD?
= planned, on waiting list
- crohn’s resection, strictureplasty = amending shape of bowel (less common), fistulas, anal disease
- ulcerative colitis - proctocolectomy
what is ileostomy?
when have stoma due to ileum cut and poking out abdomen wall into bag - it looks like closed rose
(loop ileostomy can be done to protect more distal ileostomosis as stuff coming out nasty and burns)
what is colostomy?
when have stoma due to ileum cut and poking out abdomen wall into bag - looks like opened up rose, more soft than ileostomy, flatter
where is
a) colostomy stoma
b) ileostomy stoma
and what goes into stoma from each?
a) usually on left = get just poo in bag
b) usually on right = get small bowel content
when do you do elective surgery for ulcerative colitis?
when:
- failed on medical therapy (medically unresponsive disease or allergy etc)
- intolerability
- dysplasia/malignancy →after a long time in UC
- growth retardation in children
- attempted resolution of extra-intestinal disease e.g. PBC - gets better after colon out (rare)
what is ulcerative colitis pouching procedure?
when young people don’t want stoma - colon + rectum removed and small intestine (ileum) is made into pouch for reservoir of stool and anastomosed to anus
- can be W, S or J pouch
what is negatives with pouching procedure for ulcerative colitis?
with normal rectum you can tell if has poo or gas and consistency/urgency etc but since no rectum you can’t tell so average pouch empties 5 or 6 times a day and then 2 at night (might be more likely to have accidents) →this can mean a bit more like having disease back
what are immediate complications for pouching of ulcerative colitis? (local and systemic)
local = haemorrhage, enterotomy
systemic = anaphylaxis
what are early complications for pouching of ulcerative colitis? (local and systemic)
local = urinary dysfunction, wound infection, pelvic abscess, anastomotic leak
systemic = atelectasis, ileus, portal vein thrombosis
what are late complications for pouching of ulcerative colitis? (local and systemic)
local = impotence, infertility, pouchitis (big impact on sexual function - impact on orgasms and ability to conceive)
systemic = DVT/PE and small bowel obstruction
what is peritonitis?
is bacteria leaks into abdomen (serious complication of bowel surgeries)
what percentage of severe ulcerative colitis flares lead to colectomy?
50%
what are Truelove and Witt criteria?
assess disease severity, helps monitor progress of patients (getting better or not)
→number of stools important part but lots of criteria
what is subtotal colectomy?
= first aid operation when UC flare up - the colon is removed but rectum left at first when super inflamed
- when acutely inflamed, the bowel wall is very inflamed and thick so impossible to deal with rectum safely without dealing nerves
- if rectum dead looking then do mucous fistula (rare where rectum directed to skin surface to allow drainage of mucous secretions) →usually just staple and left but this is very risky as can leak and cause even more infection so tend to leave drain for first few days
what can happen with rectum once subtotal colectomy?
once rectum calmed down, often does after colon removed as less stress on it you can then discuss fate of rectum →sometimes can leave alone just having regular check for dysplasia (good to have rectum means little medication)
