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4th Year Surgery > GI - surgical proceedures > Flashcards

GI - surgical proceedures Flashcards

1
Q

What surgical procedure is used when the bowel has perforated?

A

Hartmann’s procedure

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2
Q

Why is a Hartmann’s procedure used in an emergency/

A

To high a risk of anastomoses failing / leaking

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3
Q

Describe a Hartman’s surgical procedure:

A

Surgical resection of the colon, while the distal segment is left in-situ and closed off with sutures.
An end colostomy is fashioned in the proximal end.
This allows for possible reversal at a later date

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4
Q

What surgical resection is used in upper rectum cancer?

A

Anterior resection

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5
Q

What surgical resection is used in cancer of the distal transverse and descending colon?

A

Left hemicolectomy

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6
Q

What anastomosis is done in a left hemicolectomy?

A

Colo-colon

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7
Q

What surgical resection is done for sigmoidal cancers?

A

High Anterior resection

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8
Q

What type of anastomosis is done in a high anterior resection of a sigmoid cancer?

A

Colo-rectal

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9
Q

In caecal, ascending and proximal distal colonic tumours, what is the best surgical approach?

A

Right hemicolectomy

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10
Q

What is the best anastomosis for a right hemicolectomy?

A

Ileo-colic

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11
Q

in patients with cancer of the anal verge, what type of surgical procedure is carried out?

A

Abdominoperineal excision of the rectum

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12
Q

What anastomosis is done in an abdominoperineal excision of the rectum?

A

None

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13
Q

What stoma is used after an APER surgery for rectal cancer?

A

Defunctioning loop colostomy

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14
Q

What sort of stoma is used in a total colectomy?

A

End ileostomy

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15
Q

What sort of stoma is flushed to the skin and found in the LL Quadrant?

A

End colostomy

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16
Q

What sort of stoma is used to defunction the distal segment of the colon

A

Loop colostomy

17
Q

What are some of the benefits of defunctioning stomas?

A

Stop digested products reaching the distal bowel
Allow for healing of anastomosis
Allow for infection to resolve before reversal

18
Q

What stomas will be located in the right lower quadrant?

A

End ileostomy
Defunctioning loop ileostomy
Caecostomy

19
Q

What type of stoma may be used for feeding purposes?

A

Percutaneous jejunostomy

Sited in the LUQ

20
Q

What are some of the consequences of stomas?

A

Diarrhoea / constipation
Necrosis, prolapse and stenosis of the stoma
Parastomal hernia
Ileostomy : electrolyte imbalances following large output of fluid

21
Q

What type of stomas are spouted and why?

A

Ileostomies
The digestive secretory products in small bowel can be in the ileostomy which can cause skin irritation (lots of enzymes in the fluid)

22
Q

Why might an epidural be given to a patient post operatively for pain control following bowel surgery?

A

There is a lot of evidence to suggest it helps accelerate the return of normal bowel function

23
Q

What is afferent loop syndrome?

A

This occurs post gastrectomy.

The afferent loop will fill with bile after a meal leading to abdo pain, nausea and vomiting bile.

24
Q

What are the main complications of peptic ulcers which may lead to surgical intervention?

A

Perforation
haemorrhage
Pyloric stenosis

25
Q

What is the initial management of a perforated peptic ulcer?

A

NG tube
IV antibiotics
Nil by Mouth

26
Q

How often is non-surgical intervention of perforated ulcers successful?

A

Roughly 50% of the time

27
Q

What are some non surgical management options for a haemorrhaging peptic ulcer?

A

Endoscopic adrenaline injection
Diathermy
Laser coagulation

28
Q

How is a haemorrhaging ulcer managed surgically?

A

The bleeding ulcer base is underrun or oversewn

29
Q

Describe a highly selective vagotomy and its indictions:

A

Used in patients who cannot tolerate the medical management of peptic ulcers.
Vagus nerve is denervated in the areas of the lower oesophagus and stomach while the nerve to the pylorus is left intact so that gastric emptying is not affected

30
Q

What are some complications from a laparoscopic fundoplication?

A

inability to belch
New onset diarrhoea
Dysphagia (too tight a wrap)

31
Q

What mode of imaging is best to confirm a diagnosis of acute diverticulitis?

A

CT abdomen

32
Q

What surgery may be used for fissures in ano?

A

Lateral partial internal sphincterotomy

33
Q

How are anorectal abscesses managed?

A

Incision and drainage under GA

34
Q

What is required in patient with a “high fistula” i.e. fistula involving the continence muscles of the anus?

A

Seton suture

35
Q

How are anal fistulas managed?

A

Fistulotomy and excision
Low fistula - left open for secondary healing
high fistula - seton suture

36
Q

What is the management for biliary colic?

A

(Symptomatic gallstones)
Analgesia and hydration
Elective laparoscopic cholecystectomy

37
Q

What type of surgical management is preferred in acalculous cholecystitis?

A

Cholecystotomy

4th Year Surgery (1 decks)

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