Disease and management definitions

Question 1

Actinomycosis

Answer 1

A rare, chronic, and slowly progressive granulomatous disease caused by filamentous Gram positive anaerobic bacteria from the Actinomycetaceae family (genus Actinomyces)

Question 2

Hartmann’s procedure - indications

Answer 2

• L sided pathology (sigmoid or rectosigmoid) when making an anastomosis is unsafe (diverticulitis, perforation due to cancer, large bowel obstruction)
• elderly patients with rectal cancer and concerns for post-op continence (elective)

Question 3

Hartmann’s procedure - definition

Answer 3

A laparotomy with the creation of a proximal colostomy and sigmoid resection with the closure of the rectal stump

Question 4

The Whipple procedure

Answer 4

Pancreaticoduodenectomy

• large midline incision or bilateral subcostal incision
• cholecystectomy and portal dissection
• duodenal transection
• division of pancreas
• removal and orientation of specimen - marking for pathology
• vascular reconstruction
• pancreatic reconstruction - pancreaticojejunal anastomosis, pancreaticojejunostomy
• biliary reconstruction - hepaticojejunostomy
• enteric reconstruction - antecolic anastomosis
• feeding jejunostomy