colorectal and gen surg teaching

Question 1

4 stages of wound healing

Answer 1

Inflammation
cellular proliferation and matrix formation
matrix remodelling
wound contracture

Question 2

inflammation

Answer 2

(platelets activated, coagulation cascade, vasodilation, increased cap perm and oedema), monocytes to become macrophages –> growth factors for fibroblasts and endothelial cells, smooth muscle and extracellular matrix deposition. Necrotic tissue and debris is phagocytosed

Question 3

Cellular proliferation and matrix formation

Answer 3

fibroblasts and endothelial cells migrate to wound producing new capillaries, collagen, proteoglycan and glycoproteins. Vascular granulation tissue is formed

Question 4

Matrix remodelling -

Answer 4

wound becomes less vascular and cellular whilst collagen synthesis and degradation continue

Question 5

Wound contracture -

Answer 5

contraction reduces size of tissue defect by myofibroblasts

Question 6

basic requirements for wound healing -

Answer 6

protein for formation of granulation tissue, vitamin C and A, minerals like zinc, oxygen carrying capacity

Question 7

Causes of impaired wound healing:

Answer 7

uncontrolled diabetes, alcoholics, malignancy, immunocompromised patients, long term steroids, foreign bodies in wound

Question 8

hernia definition

Answer 8

protrusion of normal cavity contents through fascial and muscular layers

Question 9

Causes of acquired hernia:

Answer 9

Causes of acquired hernia: incisional, smoking, manual labourours, AAA and abnormal collagen, cirrhosis, peritoneal dialysis

Question 10

Congenital hernias:

Answer 10

diaphragmatic, umbilical, inguinal

Question 11

Incarceration vs strangulation

Answer 11

Incarceration = contents remain viable, strangulation = blood supply cut off so becomes ischaemic, neck of sack is compromising blood supply to contents, can become necrotic

Question 12

Things to be aware of in hernias:

Answer 12

rupture of contents, involvement in a disease process (mesothelioma, carcinoma, endometriosis, inflammation, peritonitis, appendicitis), sliding hernia, herniation of female genitalia, pregnancy, testicular complications