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Surgery finals > Procedures > Flashcards

Procedures Flashcards

1
Q

Describe the indications for cholecystectomy

A
  • Symptomatic gallstones (biliary colic)
  • Acute cholecystitis or cholangitis
  • Gallstone pancreatitis (delayed)
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2
Q

Describe the procedure for cholecystectomy briefly with reference to key anatomy

A

Usually laparoscopic

  • Identify Calot’s triangle (cystic duct, hepatic duct, free liver edge)- important to ensure correct ligation of cystic artery
  • Dissect and ligate cystic duct + cystic artery
  • Removal GB
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3
Q

Describe the complications of cholecystectomy

A

Surgical: bile leak, damage to surrounding structures (eg hepatic artery), bleeding, conversion to open
Anaesthetic: N+V, sore throat, muscle aches, allergy/anaphylaxis, death
Short term post-op: pain, wound infection, DVT
Long term post-op: adhesions, recurrence of gallstones, steatorrhoea

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4
Q

Describe the indications for gastrectomy

A
  • Gastric malignancy
  • Bariatric surgery
  • Peptic ulcer
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5
Q

Describe the complications of gastrectomy

A

Surgical: damage to surrounding structures
Anaesthetic
Immediate post-op: bleeding, wound infection, pain, anastomotic leak
Long-term post-op: dumping syndrome, diarrhoea, vitamin deficiency, small stomach syndrome, adhesions

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6
Q

Describe the post-op care for gastrectomy

A

Immediate:

  • NBM, IV fluids/TPN for 1-2 weeks
  • NGT + suction

Long-term:

  • Vitamin supplementation (B12, iron)
  • Small frequent meals, low dairy
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7
Q

What are the types of gastrectomy?

A
  • Partial
  • Total
  • Sleeve (remove left side)
  • Oesophagogastrectomy
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8
Q

Describe the indications for Nissen fundoplication

A 
In following conditions when severe/not responding to medical Mx: 
-Severe GORD
-Barrett's oesophagus
-Hiatus hernia
To reduce acid moving up the oesophagus
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9
Q

Describe the procedure of fundoplication

A

Laparoscopic

  • Narrow the oesophageal hiatus
  • Wrap the fundus of the stomach around the lower oesophagus
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10
Q

Describe the complications of fundoplication

A

Surgical: damage to surrounding structures
Anaesthetic: see elsewhere
Short term post-op: pain, bleeding, infection, DVT
Long-term post-op: dysphagia, failure to control symptoms, adhesions

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11
Q

Describe the post-op care of fundoplication

A
  • May go home same/next day

- Soft food diet for first 1-2 weeks

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12
Q

Describe the indications for oesophagectomy

A

-Oesophageal malignancy

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13
Q

Describe the types of oesophagectomy

A
  • Ivor Lewis: abdo incision + right thoracotomy. Middle third tumours
  • Minimally invasive: w laparoscopy + thoracoscopy
  • Transhiatal: only neck and abdo incision
  • McKeown: upper third tumour. Three incision.
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14
Q

Describe the procedure of oesophagectomy briefly

A

Resect the tumour area
Mobilise stomach into chest
Anastomose the distal oesophagus to stomach

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15
Q

Describe the post-op care for oesophagectomy

A

Diet: clear liquid -> liquid -> soft food -> normal diet

Jejunostomy tube until eating normally eg. 4-6 weeks

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16
Q

Describe the complications of oesophagectomy

A

Surgical: bleeding, recurrent laryngeal nerve damage
Anaesthetic
Short term post-op: pain, wound infection, DVT, anastomotic leak
Long term post-op: dumping syndrome, weight loss, GORD, dysphagia, recurrence, adhesions

17
Q

Describe the indications for splenectomy

A
  • Splenomegaly
  • Ruptured spleen
  • Haematological malignancy
  • Abscess
18
Q

Describe the complications of splenectomy

A

Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: pain, wound infection/dehiscence, DVT
Long term post-op: adhesions, infections (encapsulated bacteria)

19
Q

Describe the indications for Whipple’s procedure

A

Pancreatic lesions: cancer, cysts

Cholangiocarcinoma

20
Q

Describe the process of a Whipple’s procedure (briefly)

A

Open surgery (Chevron, midline)

  • Dissect + move pancreas
  • Remove the antrum to duodenum + head of pancreas + GB
  • Anastomose stomach and jejunum
  • Attach pancreas to free end of jejunum
21
Q

Describe the complications of a Whipple’s procedure

A

Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: wound infection, bile leak, DVT, pancreatitis
Long term post-op: DM, recurrence, delayed gastric emptying

22
Q

Describe the complications of rectal prolapse repair

A

Intra-operative: bleeding, damage to surrounding structures
Anaesthetic
Short term post-op: wound infection, DVT, pain, bowel obstruction
Long term post-op: recurrence, fistula, sexual dysfunction, mesh complications

23
Q

Describe the process of rectal prolapse repair

A

Can be open/lap abdominal approach (rectopexy) or perineal
Abdo: use sutures/mesh sling to attach rectum to sacrum
Delorme: shorten rectum by removing mucosa
Altemeier: resect rectum segment + anastomose to sigmoid colon

24
Q

Describe the pros and cons of open vs laparoscopic abdominal surgery

A

Open:

  • Pros: better exposure, allows full resection/removal of large structures
  • Cons: longer recovery time, higher rate of complications (wound infection, pain, bleeding)

Laparoscopic:

  • Pros: smaller scars, decreased risk of complications, shorter recovery
  • Cons: may not be practical (eg. inserting large stents), reduced visibility, not used in emergencies
25
Q

Describe the indications for laparotomy

A

Perforation
Intraperitoneal bleeding
Penetrating trauma
Malignancy (resection)

26
Q

Describe the procedure for laparoscopy

A
  • Make 3-4 0.5mm incisions for entry, usually 1 umbilical
  • Tilt table, inflate abdo w carbon dioxide gas
  • Insert trocars + instruments
27
Q

Describe the post-op side effects of laparoscopic surgery + post-op care

A
  • Bloating
  • Nausea
  • Pain in chest/shoulders/neck

May go home same day depending on complications
Return to work after 1 week ish

28
Q

Describe the indications for liver transplant

A

Acute liver failure eg paracetamol OD, hepatitis
Cirrhosis
Malignancy

29
Q

Describe the complications of liver transplant

A

Intra-operative: bleeding, bile leak, damage to surrounding structures
Anaesthetic
Short term post-op: delayed graft function, pain, wound infection, anastomotic leak, DVT
Long term post-op: recurrence, graft rejection, comp of immunosuppression

30
Q

Describe the relevant liver anatomy + types of resection

A

Liver divided into 2 lobes + 8 segments
Each has own portal triad (hepatic A and V, portal V)

Anatomic resection: resection of lobes/segments
Non-anatomic resection: resection of lesion w/o regard to lobes/segments

31
Q

Describe the indications for haemorrhoidectomy

A

Grade 3-4
Failure of medical management
Incarcerated haemorrhoids

32
Q

What are the types of haemorroidectomy

A

Closed: excision + closure
Open: no closure of wound
Stapling + rubber band ligation

33
Q

Describe the complications of haemorrhoidectomy

A

Intra-operative: damage to surrounding structures, bleeding
Anaesthetic
Short term post-op: pain, bleeding, wound infection, urinary retention
Long term post-op: recurrence, incontinence, stricture

34
Q

Describe the types of bariatric surgery

A

Most common:

  • Roux-en-Y gastric bypass: resect stomach + connect gastric pouch to jejunum, leave stomach + duodenum in situ
  • Sleeve gastrectomy: remove left side of stomach-> smaller tube-like stomach, holds less food

Others:
-Gastric banding

35
Q

Describe the indications for bariatric surgery

A
  • Obesity (class III- BMI >40)

- Obesity (class II- BMI 35-39.9) + complications eg. OA, T2DM

36
Q

Describe the benefits of bariatric surgery

A
  • Considerable weight loss (usually in first 1-2 years)
  • Reduction in mortality due to obesity
  • Reduction in T2DM + other complications
37
Q

Describe the pre-op considerations for bariatric surgery

A
  • Suitability + anaesthetic review
  • OGD
  • Liver reduction diet for 3 weeks prior to surgery (strict calorie reduction to shrink liver)
38
Q

Describe the post-op care for bariatric surgery

A
  • Admission usually for 1 night
  • Diet: liquid 2 wk -> pureed 2 wk -> soft food
  • Thrombotic prophylaxis
  • Stop/change diabetes medication
  • Follow up with bariatric dietician
  • Supplementation (B12 for life)
39
Q

Describe the complications of bariatric surgery

A
  • Intra-operative: bleeding, damage to surrounding structures,
  • Anaesthetic: may be significant eg. difficulty intubating, cardiac complications, death
  • Short term post-op: DVT, pain, wound infection, pneumonia, anastomotic leak
  • Long term post-op: weight regain, change in bowel habits, dumping syndrome, strictures, adhesions, nutritional deficiency

Surgery finals (16 decks)

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