IBD 4 - Surgical therapies Flashcards

1
Q

What are the differences between UC and CD in terms of surgery? (2)

A

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

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2
Q

What is the name of the surgical curative option for UC?

A

Panproctocolectomy - removal of the entire colon, rectum and anal canal.

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3
Q

What are the indications for a pancproctocolectomy for UC?

A

failure of medical therapytoxic megacolondysplasia or carcinomadebility: poor QoLintolerance to medicationsmassive haemorrhage/ perforationintractable pyoderma, haemolysis

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4
Q

What are the indications for surgery for Crohns?

A

Directed to specific complications: symptomatic obstructionSymptomatic strictureSymptomatic fistulaehaemorrhagedysplasia or carcinomasymptomatic perianal disease

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5
Q

How much small intestine must you have to survive if you have a colon?

A

60cm

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6
Q

What is always performed in patents with toxic megacolon?

A

Ileostomy (nothing is joined as it would just fall apart)

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7
Q

Types of surgery for UC?

A

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)

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8
Q

What must be performed when a subtotal colectomy has been done?

A

Regular colonoscopies

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9
Q

What are the 2 options for finishing a panproctocolectomy?

A

Stoma in RIFJ-pouch maddest of the small intestine and a very small part of the rectum left and these parts joined

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10
Q

What are the possible surgeries for Crohns disease?

A

If severe disease, resection of affected tract e.g. Hemicolectomy Stricturoplasty for stricturesSurgery for peri-anal disease if required

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11
Q

Why is a right hemicolectomy required sometimes in Crohns disease?What does this involve?

A

For terminal ileum diseaseProcedure 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

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12
Q

What surgery is performed for repair of a stricture?

A

Stricturoplasty

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13
Q

How does a fistula develop in Crohns disease?

A

Inflammatory process causes abscess formation - abscess then drains into the nearest area causing a fistula

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14
Q

How are asymptomatic fistulas treated?

A

no treatment

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15
Q

How are peri-anal fistulas treated? (4)

A

Antibioticsdraining (seton stitch)Patient can get a stoma to redirect flow if requiredPig skin used as a mesh and injected into the fistula once it is adequately drained

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