abdo Flashcards
subtotal colectomy stoma?
removal of whole colon and part of sigmoid–> end ileostomy and rectal stump closed up
purpose of loop ileostomy?
defunctioning of colon post rectal cancer surgery
does not decompress colon (if ileocaecal valves competent)
spigelian hernia?
intra parietal - rare. between the muscles of the abdo wall–>usually between the internal and external oblique
lateral to the rectus abdominis
open repair IF strangulated
Richter’s hernia?
anti mesenteric border of the small bowel goes into the hernia
therefore luminal patency maintianed–> can still strangulat e
usually at laparoscopic port sites
lumbar hernia?
iliac crest inf
latissimus medially
external oblique laterally
usually following renal surgery
littres hernia
hernia contianing meckels diverticulum
bochdalek hernia
left sided diaphragmatic hernia -
commoner in males and
associated hypoplasia,
contains stomach and
requires repair due to high mortality
Morgagni hernia
R sided (usually) herniation through foramen of morgagni.
direct anatomical repair
can contain transverese colon
less severe usually than bochdalek
umbilical hernia
herniation thorugh weak umbilicus
repair after 3rd birthday as usually will resolve by 2 years old
paraumbilical hernia
defect in linea alba
commoner in females
multiparity and obesity
repaired using Mayo’s technique
best abdominal access incision for kids?
transverse supra umbilical
mesenteric cyst?
kids
smooth and mobile
nil pain nless torsion etc
usually an incidental finding
–> USS and CT
when do you perform a loop colostomy?
obstructing rectal cancer below the peritneal refelction (ie likley going to be a lower anterior resection)
loop ileostomy?
following a right hemi
-to protect the anastomosis
in in the context of rectal cancer…to protect a primary anastomosis
recurrent RIF abdo pain and iron deficiiency anaemia. negative gastroscopy and colonoscopy?
Meckels’s - ectopic gastric mucousa is secreting acid and causing ulceration
psoas abscess causes?
primary - immunocompromised, haematogenous spread
secondary -to ibd like Crohn’s.
back pain +/- mass in inguinal/femoral area
a burst abdomen is most common X days after surgery?
6
best incision for pancreas resection?
Rooftop
(NOT Kochers)
features of microscopic colitiis?
normal endoscopic appearance
inflammation (lymphocytes) in the subepithelial collagen layer
no granulomas
possibly a preceding bout of infective diarrhoea
spleic vein causes and treatement?
causes:pacreatitits, panc ca, trauma, hypecoaguability
–> gastric varices (oesophageal rare)
tx: splenectomy
causes of post op abdo compartment syndrome?
obese
use of mesh
–> increased NG aspirates, met acidosis, reduced urine output
defined as: sustain IAP > 20 mmhg +new organ dysfunction
normal range 12-25. low in crit ill patiens 5-7
treatments for abdo compartment syndrome?
gastric deocmpression
meds to relax gastric wall e.g. sedative/relaxants
drain fluid collections
fluid restrict/diuretics
—-> lapartomoy and bogota bag/vac
pancreas ca
usu - head
CT scan - panc protocol
metastatic disease–> no resection. palliation with stent
resectable disease –> adjuvent chemo
Ivor lewis oesophagectomies are used for?
middle and lower third adenocarcinoma - NO mets.
local nodal involvement is okay
laparotomy plus thorax
proximal oesophagela cancer requires?
McEowan resection - ie total oesophagectomy with anastomosis to the cervical oeshopagus
transhiatal approach to oesphagectomy can be used in ?
very distal tumours
endsocopic mucosal resection can be used for ?
in situ disease
oesophageal carcinoma plus met
ablative therapy and stents–> NO surgery
staging process for oesophagela cancer?
CT CAP
then
staging lap
THEN
Pet for occult mets
(RUQ) sepsis +jaundice =
cholangitis
-gallbladder empyema etc will not usu exhibit jaundice
tx fluid resus, broad spec abx, correct coagulopathy and ERCP
acute cholecytitis picture?
sepsis, mildy deranged lfts, RUQ pain
USS+cholecytectomy within 48 hrs…
swingin fever, RUQ pain, prodromal illness….
gallbladder abscess–>
USS or CT
sub total chole (if calots triangle is hostile)
percutaneous drainaige if unfit patient.
acalculous cholcystitis?
other illness e.g. organ failure/diabetes +
high fever
cholecystitis without prescence of stones
tx - chole or perc drain
stone stuck in CBD - cannot surgically remove?
choledochoduedonostomy
–> make an opening from the cbd to the duodenum and anastomose
can get an unused bit of bile duct that causes SUMP where all the debirs and stones collect
best feeding option post oesophageal perf?
TPN
what does a roux en y look like?
what are the side effects of roux en y?
dumping syndrome ->sugary food moves into intestine, distention, insuline release cramy abdo pain diarrhoea and hypogylcaemia ensue
-afferent and efferent limb syndrome
bile gastritis
metabolic bone disease
b12 deficiceny
bile leaks/biliary damage
….leaking bile, jaundice
ERCP, then can decide if need stent or sphincterotomy.
treatement for varices?
banding/sclerotherapy
sBS/minnesota tube
medical therapy and tipps to reduced portal pressures
gall stone ileus
leave the gall bladder alone!!!
difficulty intubating the oesophagus?
pharyngeal puch
SCC of upper 1/3 od oesophagus can be treated with ?
radical chemoradiotherapy
mirrizzi syndrome +surgery
very inflamed Calot’s triangle —> opt for cholecystostomy
hepatocellular carcinoma protocol?
serum AFP and liver USS 6-12 months
MRI if suspicious
pancreatitis sequelae?
peripancreatic fluic
4 weeks > walled off grnaulmoa/fibrous wall–> pseudocyst. pesistent mildly raised amylase and likely retrogastric.even symptomatic cases can be observed for 12 weeks as 50%resolve. if not tx cystgastrostomy
pancreatic necrosis–>FNA then decidec if necrosectomy
abscess–> usually following psudocyst–> drains
pharnygeal puch is a contraindication to …
endoscopy
obstructive picture LFTS +HIV patient
scleorinsing choangitis secindary to infection e.g. CMV, cryptosporidium etc
difference between tx for obstructiong colonic lesion vs rectal lesion?
colonic -stent or resect. can use chemo as adjunct
rectal - do NOT resect without staging. includes mri
defunction using loop colostomy.
irradiation as extraperiotneal -if present in nodes
then resect either AR or APER. meso rectum dissected out
anal cancer
HPV 16
biopsies with EUA
staging with CT
chemoradiotherapy orrrr radical APEAR
chronic fissure
>6/52
sentinel pile, enlarged anal papillae and ulcer
investigations for carcinoid?
5hiaa in 24 hr urine
somtostatin receptor scintopgrpahy
CT
blood chormogranin A
