*IBD 4 (Lecture 4) Flashcards
What are the differences between UC and CD in terms of surgery? (2)
UC patients tend to only require 1 surgery where as Crohns disease patients tend to require several
There is no surgical cure for Crohns, unlike UC
What is the name of the surgical curative option for UC?
Panproctocolectomy -
removal of the entire colon, rectum and anal canal.
What are the indications for a pancproctocolectomy for UC?
failure of medical therapy toxic megacolon dysplasia or carcinoma debility: poor QoL intolerance to medications massive haemorrhage/ perforation intractable pyoderma, haemolysis
What are the indications for surgery for Crohns?
Directed to specific complications: symptomatic obstruction Symptomatic stricture Symptomatic fistulae haemorrhage dysplasia or carcinoma symptomatic perianal disease
How much small intestine must you have to survive if you have a colon?
60cm
What is always performed in patents with toxic megacolon?
Ileostomy (nothing is joined as it would just fall apart)
Types of surgery for UC?
Panproctocolectomy (all colon, rectum and anal canal is removed) Subtotal colectomy (resection of part of the colon or all of the colon leaving the rectum)
What must be performed when a subtotal colectomy has been done?
Regular colonoscopies
What are the 2 options for finishing a panproctocolectomy?
Stoma in RIF
J-pouch maddest of the small intestine and a very small part of the rectum left and these parts joined
What are the possible surgeries for Crohns disease?
If severe disease, resection of affected tract e.g. Hemicolectomy
Stricturoplasty for strictures
Surgery for peri-anal disease if required
Why is a right hemicolectomy required sometimes in Crohns disease?
What does this involve?
For terminal ileum disease
Procedure that involves removing the cecum, the ascending colon, the hepatic flexure (where the ascending colon joins the transverse colon), the first one-third of the transverse colon, and part of the terminal ileum, along with fat and lymph node
What surgery is performed for repair of a stricture?
Stricturoplasty
How does a fistula develop in Crohns disease?
Inflammatory process causes abscess formation - abscess then drains into the nearest area causing a fistula
How are asymptomatic fistulas treated?
no treatment
How are peri-anal fistulas treated? (4)
Antibiotics
draining (seton stitch)
Patient can get a stoma to redirect flow if required
Pig skin used as a mesh and injected into the fistula once it is adequately drained
