GI Surgeries Flashcards

1
Q

What are the most common complications which can occur from major abdominal surgery?

A
adhesions
bleeding
infection
paralytic ileus
perioperative mortality
shock
scarring
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2
Q

When is an oesophagectomy indicated?

A

advanced Barrett’s

non-metastatic cancer

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3
Q

What types of oesophagectomy are there and what is the premise of the operation?

A

trans-Hiatal or transthoracic

a segment of stomach is pulled up into the chest + connected with the remaining oesophagus

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4
Q

What are the potential complications of oesophagectomy?

A

intra-op:
haemorrhage
injury to surrounding structures
anaesthetic risks

early:
pain
infection
chyle leak
anastomotic leak
blood clots
stroke, MI, AKI, death

late:
recurrence
weight loss
reduced nutrition

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5
Q

What are the indications for gastrectomy? What types of procedure are there?

A

indicated in:
cancer, long-term hiatus hernia, Barrett’s

antrectomy = 30% resection
hemigastrectomy = 50% resection
subtotal gastrectomy = 80% resection

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6
Q

What complications can occur as a result of a gastrectomy?

A

intra:
injury to adjacent structures
bleeding
anaesthetic risks

early:
post-op bleeding
luminal bleeding
pain etc

late:
increased osmotic load to duodenum –> fluid shift from intravascular compartment –> hyperperistaltic response from duodenum –> lightheadedness, palpitations, crampy abdo pain
recurrent ulcer

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7
Q

What are the indications for laparoscopic cholecystectomy?

A

gallstone disease

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8
Q

What complications can occur as a result of laparoscopic cholecystectomy?

A

intra: usual stuff
bile duct injury
conversion to open surgery
subtotal + drain insertion

early: usual
bile leak
seroma
scarring

late: usual
adhesions
hernia
bile duct stricture
diarrhoea or reflux gastritis
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9
Q

When is a R Hemi-colectomy performed and how?

A

normally cancer treatment - maybe IBD

remove ascending colon + caecum
laparotomy or laparoscopic mid-line approach
all major organs inc uterus and ovaries inspected and palpated

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10
Q

What complications can occur as a result of a R Hemi-colectomy?

A

intra: usual
injury to liver + ureter
stoma formation

early: usual
late: usual, hernia, adhesions

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11
Q

What complications can occur as a result of an anterior resection?

A

intra: usual
injury to liver + ureter
stoma formation

early: usual
late: usual, hernia, adhesions

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12
Q

When is an anterior resection performed and what is involved?

A

rectal cancer
remove the diseased portion of bowel with diverticulitis

upper 2/3rds of rectum resected
end colostomy formed

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13
Q

When is a Hartmann’s procedure performed?

A
complicated diverticulitis
rectosigmoid cancer
volvulus
perforation
lymphoma
IBD etc
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14
Q

Describe the Hartmann’s procedure

A
midline incision down through fascia 
abdomen examined to confirm diagnosis and normalisation
sigmoid colon exposed and mobilised
lateral peritoneal reflection incised
dissection carried out at proximal and distal ends
proximal transected bowel selected
descending colon divided
colostomy created
midline incision closed
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15
Q

What complications can occur as a result from Hartmann’s procedure?

A
wound infection
rectal stump leak
abscesses
fistula
retraction
parastomal hernia
skin irritation
paralytic ileus
wound dehiscence 
ureteral injury
general surgical consequences
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16
Q

When would you perform and abdominoperineal excision of the rectum? How would you do it?

A

rectal carcinoma
recurrent or residual anal carcinoma

incisions made in abdomen and perineum
anus –> sigmoid removed with associated lymph nodes
remaining sigmoid brought out as colostomy

17
Q

What complications can occur with an abdominoperineal excision of rectum?

A
haemorrhage
infection
CR 
damage to ureter 
hernia
DVT/PE
colostomy blockage
18
Q

Why would you decide to make a stoma in surgery?

A

anastomosis doesn’t look secure/inflammation is too great

temporarily, to allow bowel that was operated on to heal
removing the rectum/cannot

19
Q

How can surgery be used to treat haemorrhoids?

A

internal:
grade III or IV - surgical haemorrhoidectomy, stapling, operative resection

external:
office excision or operative resection

20
Q

How can you surgically treat fissures?

A

for anal fissures which are still symptomatic after 3-4 weeks of medical therapy

sphincter dilation - controlled stretch under anaesthetic, helps allow fissure to heal by correcting abnormality

lateral internal sphinctecretomy - cut hypertrophied internal sphincter –> relieves tension and allows fissure to heal

21
Q

How can you surgically treat an anal fistula?

A

fistulotomy
pass probe through internal and external openings
cut overlying tissue –> open entire fibrous tract

seton +/- fistulotomy

22
Q

How can surgery be used to treat a rectovaginal fistula?

A

draining seton

endorectal advancement flap +/- sphincteroplasty