8: IBD surgery

Question 1

“planned” emergency - over course of 3-4 days, patient consulted, examined and comes to terms with surgery

unexpected emergency - surgery for appendicitis et al reveals chronic IBD

Question 2

removal of terminal ileum is typical elective crohn’s surgery

patients will need vit b12 injections

Question 3

What is a fistula?

Answer 3

Communication between two epithelial surfaces

Question 4

sinus is a blind end

fistula is a communication

Question 5

ileostomy is pink, with a spout, found on the right

Question 6

loop ileostomy - two holes for decompression

Question 7

colostomy is much softer looking

usually on the left

Question 8

pouches are crap

Question 9

truelove and witt criteria used to assess the severity of ibd

Question 10

rigler’s sign

Question 11

lots of septic complications, failure to heal etc. in immunosuppressed ibd patients during surgery

Question 12

emphasis that crohn’s surgery isn’t curative - probably will require >1 operation, aim is to reduce bowel resection

Question 13

SNAP of fistulating disease (things to address):

Sepsis (scoop out pus)

Nutrition

Anatomy

Plan / prolonged hospital stay

Question 14

anal fistula goes from anal glands to skin outside it