GI Surgeries Flashcards
Retroperitoneal Structures
SADPUCKER S - suprarenal (adrenal) glands A - aorta D - duodenum P - pancreas U - ureters C - colon (ascending and descending) K - kidneys E - oesophagus R - rectum
Complications from major surgery
Anastomotic Leak Adhesions Incisional Hernia Bleeding Paralytic Ileus Infection Shock Peri-op mortality
Anastomotic leak can cause what
sepsis
multi organ failure -> death
pain and fever 5-7 days post op
Bleeding degrees
Primary = continuous, starts during surgery Reactive = when increased BP, within 24 hours Secondary = infection, 7-14 days post op
Oesophagectomy what?
- trans hiatal or transthoracic (Ivor-Lewis)
- stomach segment pulled up into chest
- connected to remaining oesophagus
Oesophagectomy when?
Advanced Barrett’s oesophagus
Non-metastatic oesophageal cancer
Gastrectomy types?
-hemi (50%)
- antrectomy (30% gone)
subtotal (80% fone)
gastrectomy when
Cancer
LT hiatus hernia
Barrett’s
Gastrectomy complications
Increased osmotic load to duodenum = palpitations, light headedness, crampy abdo pain
Cholecystectomy
Laparoscopic
Gallbladder remove
Gallstones
Right hemicolectomy
Ascending colon and caecum removal
Laparotomy or laparoscopy through midline
If Cancer
Anterior resection
Upper 2/3 of rectum resected
End colostomy
Rectal cancer
Diverticulitis
Abdomino-perineal excision of rectum
Anus rectum and sigmoid colon remove
Remaining sigmoid brought as colostomy
Rectal carcinoma
Recurrent anal carcinoma
Hartmann’s operation
Midline incision Sigmoid colon exposed and mobilised Dissection of proximal and distal to the affected Colostomy Rectal carcinoma Recurrent anal carcinoma
Haemorrhoids features
Painless rectal bleeding
Pruritis
Soiling
Types of haemorrhoids
External = below dentate line, thrombosis often, may be painful Internal = above dentate line, not painful
Grading of internal haemorrhoids
1 = do not prolapse out of anal canal 2 = prolapse on defecation but reduce spontaneously 3 = manually reduced 4 = cannot be reduced
management of haemorrhoids
- soften stools = increase fibre and fluids
- local steroids/anaesthetics
- outpatient rubber band ligation>injection sclerotherapy
- surgery if large symptomatic
- new = doppler artery ligation
Acutely thrombosed external haemorrhoids
- significant pain
- purple, oedematous, tender perianal mass
- if within 72 hours = refer for excision
- otherwise stool softners, ice, analgesia
- symptoms settle in 10 days
Medical treatment of fissures
- relieve constipation
- intra-anal nitroglycerin apply
- fibre and stool softners
- botulinum toxin
Surgical treatment of fissures
- if acute and symptomatic after 3-4 weeks of medical therapy
- sphincter dilatation
- lateral internal sphincterotomy
Preoperative Tx for fistulas in ano
- rectal irrigation
- AB
- anaesthesia
Surgery Tx for fistulas in ano
- fistulotomy
- seton
Perianal fistula with Crohns
- no surgery if asymptomatic
- loose setons
Rectovaginal fistulas
- no surgery
- draining seton
- endorectal advancement flap + sphincteroplasty
