lower GI diseases - surgical Flashcards
1
Q
incision
A
cutting with a sharp instrument
2
Q
retract
A
the method of increasing space
3
Q
suture
A
to join structures with lengths of material
4
Q
ligate
A
to tie or close a lumen
5
Q
staple
A
to join structures with metal
6
Q
anastomosis
A
a connection between 2 structures
7
Q
dissect
A
to separate 2 structures - often through natural planes
8
Q
Meckel’s diverticulum pathogenesis/aetiology
A
persistence of the vitelline duct which forms an outpouching of ileum
some contain gastric mucosa which can secrete HCl and cause ulceration
9
Q
Meckel’s diverticulum patient group
A
symptomatic cases at 2 years
males 2x more likely
can also present in adults
10
Q
meckels diverticulum signs and symptoms
A
usually asymptomatic and an incidental finding
only symptomatic if complications arise
fresh, painless, rectal bleeding
symptoms mimicking appendicitis
11
Q
Meckel’s diverticulum complications
A
ulceration, perforation and haemorrhage
diverticulitis
obstruction
malignant change
12
Q
Meckel’s diverticulum treatment and management
A
surgical removal if complications arise
13
Q
the rule of 2’s
A
2% of population 2 inches long 2 feet from ileocecal valve 2 years of age twice as often in males
14
Q
atresia
A
congenital absence or abnormal closure of a body cavity
15
Q
atresia pathogenesis/aetiology
A
usually due to problems in GI tract development oesophageal intestinal biliary presents in newborns
16
Q
atresia signs and symptoms
A
oesophageal - US scan increases amniotic fluid, swallowing or breathing difficulties
intestinal - signs of obstruction, green vomit, swollen abdomen
biliary - post hepatic jaundice
17
Q
meconium ileus pathogenesis/aetiology
A
meconium ileus is a intestinal obstruction caused by meconium that is difficult to pass because it is too sticky
90% of patients have CF
18
Q
meconium ileus signs and symptoms
A
meconium is slow to pass
symptoms of obstruction
green vomit
swollen abdomen
19
Q
omphalocele pathogenesis/aetiology
A
intestinal loop does not return to the abdomen during development
it herniates out into the umbilical cord and is contained within the peritoneal layer of the umbilical cord
20
Q
omphalocele signs and symptoms
A
shiny sac at the base of the umbilical cord
intestines enclosed
21
Q
gastroschisis
A
protrusion of the abdominal contents through a defect in the anterior abdominal wall lateral to the umbilical cord
not covered in peritoneum
22
Q
intestinal malrotation +/- volvulus
A
a congenital issue in which the intestines are twisted into the gut incorrectly due to incorrect connection to the brick wall
can be accompanied by Ladd’s bands
twisting can obstruct the lumen of the intestine or block off the blood supply
90% diagnosed before 1
23
Q
volvulus
A
when a loop of intestine is wrapped around its own mesentery
24
Q
intestinal malrotation symptoms
A
obstruction symptoms green vomit abdominal pain - leg drawing abdominal distention failure to thrive diagnosed by x ray
25
intestinal malrotation management
Ladd's procedure - open or laproscopic, Ladd's bands are dissected off
26
intussusception
when a segment of the intestine telescopes inside another
mechanism of intestinal blockage
commonly at ileocaecal junction
more common in children
27
intussesception symptoms
blood and mucus stool
vomiting and diarrhoea
lethargy
abdominal mass
28
intussesception investigations
USS
x-ray / CT
air or barium enema
29
intussusception management
905 can be fixed with an enema
| surgical release - RLQ transverse incision , manual reduction, segmental bowel resection
30
anal fissures
a small tear in the mucosa that lines the anus
| can be very small to severe
31
anal fissures risk factors
common in very young and very old
traumatic - passing large/hard stools, recurrent straining, chronic diarrhoea, anal intercourse, childbirth
non traumatic - IBD, anal cancers, HIV, TB, syphilis
32
anal fissures symptoms
pain during or after bowel movements
bright red on paper after wiping
visible crack in the skin or small lump/tag
33
anal fissures investigation
good history and direct exam
longer than 8 weeks chronic
scoping - anoscopy, flexible sigmoidoscopy or colonoscopy
34
anal fissures treatment
conservative - topical nitroglycerin, topical anaesthetic, botox injection
surgical - lateral internal sphincterotomy, a small incision is made into the sphincter muscles, not cutting the fissures away
35
colorectal cancer
adenoma/adenocarcinoma
36
colorectal cancer risk factors
red meat, low fibre diet, smoking, IBD, familial adenoma polyposis (FAP), lynch syndrome
37
colorectal cancer signs and symptoms
pain, change in bowel habits, tenemus, abdominal mass
38
colorectal cancer investigations
colonoscopy/flexible sigmoidoscopy, pill endoscopy, CT colonography
39
colorectal cancer management
surgery
chemo has limited use
radiotherapy - adjuvant or post surgery
40
colorectal cancer surgery
```
right hemicolectomy
extended right hemicolectomy
transverse colectomy
left hemicolectomy
sigmoid colectomy
subtotal colectomy
```
41
anorectal cancer
adenocarcinomas from colon or SCC from the adjacent skin
investigations and management are same as colorectal, local excision is more often used - also consider function of schincter and cosmesis
42
diverticulum
an outpouching of the gut wall
43
diverticulitis
presence of diverticula
44
diverticular disease
diverticula which are symptomatic
45
diverticulitis
inflammation of a diverticulum
46
complicated diverticular disease/diverticulitis
diverticulitis with complications
47
uncmplicated diveticular disease/diverticulitis
diverticulitis without complications
48
diverticulitis pathogenesis
low fibre diet
colon has to work harder to move feaces - higher pressure in the lumen - diverticula form as mucosa herniates through the muscle layer to form an outpouching
most common in sigmoid colon
49
diverticulitis risk factors
western lifestyle
processed fods with low fibre diet
older patients
50
diverticular disease signs and symptoms
altered/erratic bowel habit
left iliac fossa colic
similar to IBS
51
diverticulitis signs and symptoms
```
severe pain in the iliac fossa
fever
tachycardia
tenderness and guarding of the left side of the abdomen on examination
similar to appendicitis but on the left
```
52
diverticular disease investigations
colonoscopy/sigmoidoscopy
| barium enema
53
diverticulitis investigations
increase ESR and CRP
CT
don't scope in acute attack - can cause perforation
54
complicated diverticulitis
perforation - peritonitis, abscess
haemorrhage
fistula
stricture
55
acute diverticulitis stage 1 Hinchey classification
pericolic abscess
| surgery rarely needed
56
diverticulitis stage 2
pelvic abscess
| may resolve without surgery
57
diverticulitis stage 3
purulent peritonitis
| surgery required
58
diverticulitis stage 4
faecal peritonitis
| surgery required
59
diverticular disease management
balanced diet with enough fibre and fluid intake
analgesia
bulking laxative
60
uncomplicated diverticulitis management
watchful waiting
analgesi
antibiotics
IV fluid, IV antibiotics and bowel rest
61
complicated diverticulitis abscess/peritonitis management
percutaneous drainage of large abscess
laparoscopic peritonel lavage and drainage
Hartmann's procedure
primary resection/anastomosisi
62
colonic polyps
abnormal growth of tissue projecting from the colonic mucosa
63
colonic polyps types
adenoma
serrated
inflammatory - IBD
hamartomatous - Peutz-Jeghers syndrome
64
colonic polyps pathogenesis
adenoma - adenocarcinoma
65
colonic polyps signs and symptoms
```
asympomatic incidental finding
rectal bleeding - anaemia
mucus in stool
abdominal pain
diarrhoea or constipation
```
66
colonic polyps investigations
family history - inherited conditions, family history of colon cancer
genetic testing
colonoscopy - screening, incidental
biopsy of removed polyp
67
colonic polyp complications
cancer
majority of colonic cancer arise from pre-existing adenomatous polyps
transformation of polyp to cancer - 3-5 years
68
colonic polyps management
screening with colonoscopy
all adenomas removed due to cancer risk
FAP - prophylactic surgery - colectomy
lynch syndrome - prophylactic surgery in some cases
69
hernias
a protrusion of an organ or tissue out of the body cavity it is supposed to be in
70
hernia aetiology
structural - normal anatomical weakness, congenital abnormality resulting in a weakness
surgical scar
increased pressure - strenuous activity, chronic cough, pregnancy, straining
71
hernia classification
reducible - can be pushed back in
irreducible - can't be pushed back
incarcerated - contents of the hernia are stuck inside it by adhesions
obstructed - causes bowel obstruction and bowel contents are unable to pass
strangulated - vascular supply to the hernia contents is compromised
72
hernias signs and symptoms
swelling in a particular location
patient may be able to reduce the hernia
may protrude on coughing or standing
pain and tenderness at the site of hernia
73
hernia investigations
examination of the swelling
| ultrasound
74
hernia complications
irreducible
incarceration
strangulation
obstruction
75
hernia management
conservative or surgical
76
hernia types
```
inguinal
hiatus
epigastric
spigelian
femoral
lumbar
incisional
parastomal
paraumbilical
umbilical
```
77
direct inguinal hernia
bowel herniates through a weakness in the floor of the inguinal canal and out the superficial ring
78
indirect inguinal hernia
bowel herniates through the deep and out the superficial ring
doesn't reappear after reduction
79
hasselbach's triangle
area of potential weakness in the abdominal wall through which direct inguinal herniation can occur
inferior epigastric artery
rectus abdominus
inguinal ligament
80
hiatus hernia
herniation of the stomach through the diaphragm at the oesophageal hiatus
presents with reflux
81
haemorrhoids
enlargement of the vascular cushions in the wall of the anus and rectum due to increased pressure
82
haemorrhoids signs and symptoms
painless bright red PR bleeding
perianal itch
no change in bowel habit or weight
83
haemorrhoids complications
can become strangulated causing pain
84
haemorrhoids management
conservative - increased fluid and fibre to prevent constipation - bulking laxatives and analgesia if necessary, anal hygiene to aid healing
non-surgical - sclerosation therapy, rubber band ligation
surgical - haemorrhoidectomy, stapled haemorrhoidectomy, HALO/THD procedure
85
rectal varices
due to portal hypertension
| another cause of PR bleeding
86
bowel obstruction
blockage of the boel leading to - accumulation of fluid/gas, ischaemia or perforation
intraluminal, luminal, extraluminal
87
bowel obstruction symptoms
```
colicky central abdomen pain
absolute constipation
vomiting
borborygmus
abdominal distention
```
88
bowel obstruction investigation
tinkling bowel sounds
AXR or contrast CT
ABGs and bloods
89
ischaemic colitis
commonest problem of bowel ischaemia
inflammation but not total tissue death due to ischaemia
atherosclerosis
90
ischaemic colitis symptoms
abdominal pain
fresh blood in stool]urgency
diarrhoea
nausea
91
ischaemic colitis investigations
USS/AXR/CT
CT/MRI angiography
colonoscopy
92
ischaemic colitis
mild - self resolve, analgesi, IV fluid and fix cause
| major - embolectomy, bypass of the afflicted artery, colectomy assorted if an area is non salvageable
93
"true" bowel ischaemia/infarction
death of colonic tissue due to lack of blood supply
often due to an atherosclerotic event
can be due to obstruction
94
bowel infarction symptoms
sudden often severe abdominal pain
blood in stool
forceful/painful bowel movements
confusion can occur in elderly patients
95
bowel infarction investigation
exploratory laparotomy
| CT/MRI angiography
96
bowel infarction management
colectomy to remove the infarcted tissue
embolectomy
bypass
grafting
97
classification of complications
```
immediate - 24hrs
early - 2-3 weeks
late
genera - affecting any of the body systems
local - specific to the operation
```
98
cardiovascular complication
MI
haemorrhage
DVT
99
respiratory complication
atelectasis
pneumonia
PE
100
GI complications
ileus
anastamosis dehiscence
adhesions
short gut syndrome
101
wound complications
infection
dehiscence
hernia
102
urinary complications
retention of urine
UTI
urethral stricture
AKI
103
neurological complications
confusion
stroke
peripheral nerve injury
104
pyrexia 5 W
```
wind - atelectasis or pneumonia
water - UTI
wound - infection
walking - DVT
wonder drugs - drug induced fever
```
