GI - surgical proceedures

Question 1

What surgical procedure is used when the bowel has perforated?

Answer 1

Hartmann’s procedure

Question 2

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

Answer 2

To high a risk of anastomoses failing / leaking

Question 3

Describe a Hartman’s surgical procedure:

Answer 3

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

Question 4

What surgical resection is used in upper rectum cancer?

Answer 4

Anterior resection

Question 5

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

Answer 5

Left hemicolectomy

Question 6

What anastomosis is done in a left hemicolectomy?

Answer 6

Colo-colon

Question 7

What surgical resection is done for sigmoidal cancers?

Answer 7

High Anterior resection

Question 8

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

Answer 8

Colo-rectal

Question 9

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

Answer 9

Right hemicolectomy

Question 10

What is the best anastomosis for a right hemicolectomy?

Answer 10

Ileo-colic

Question 11

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

Answer 11

Abdominoperineal excision of the rectum

Question 12

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

Answer 12

None

Question 13

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

Answer 13

Defunctioning loop colostomy

Question 14

What sort of stoma is used in a total colectomy?

Answer 14

End ileostomy

Question 15

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

Answer 15

End colostomy

Question 16

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

Answer 16

Loop colostomy

Question 17

What are some of the benefits of defunctioning stomas?

Answer 17

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

Question 18

What stomas will be located in the right lower quadrant?

Answer 18

End ileostomy
Defunctioning loop ileostomy
Caecostomy

Question 19

What type of stoma may be used for feeding purposes?

Answer 19

Percutaneous jejunostomy

Sited in the LUQ

Question 20

What are some of the consequences of stomas?

Answer 20

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

Question 21

What type of stomas are spouted and why?

Answer 21

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

Question 22

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

Answer 22

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

Question 23

What is afferent loop syndrome?

Answer 23

This occurs post gastrectomy.

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

Question 24

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

Answer 24

Perforation
haemorrhage
Pyloric stenosis

Question 25

What is the initial management of a perforated peptic ulcer?

Answer 25

NG tube IV antibiotics Nil by Mouth

Question 26

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

Answer 26

Roughly 50% of the time

Question 27

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

Answer 27

Endoscopic adrenaline injection Diathermy Laser coagulation

Question 28

How is a haemorrhaging ulcer managed surgically?

Answer 28

The bleeding ulcer base is underrun or oversewn

Question 29

Describe a highly selective vagotomy and its indictions:

Answer 29

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

Question 30

What are some complications from a laparoscopic fundoplication?

Answer 30

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

Question 31

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

Answer 31

CT abdomen

Question 32

What surgery may be used for fissures in ano?

Answer 32

Lateral partial internal sphincterotomy

Question 33

How are anorectal abscesses managed?

Answer 33

Incision and drainage under GA

Question 34

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

Answer 34

Seton suture

Question 35

How are anal fistulas managed?

Answer 35

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

Question 36

What is the management for biliary colic?

Answer 36

(Symptomatic gallstones) Analgesia and hydration Elective laparoscopic cholecystectomy

Question 37

What type of surgical management is preferred in acalculous cholecystitis?

Answer 37

Cholecystotomy