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GI > Procedures > Flashcards

Procedures Flashcards

1
Q

define a appendidectomy

A

surgical removal of the veniform appendix

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2
Q

summarise the indications for an appendidectomy?

A

normally performed as emergency procedure for acute appendicitis

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3
Q

what are the possibel complications of an appendidectomy?

A

bleeding

wound infection

peritonitis

blocked bowels

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4
Q

define cholecystectomy?

A

surgical removal of gallbladder

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5
Q

what are the 2 types of cholecystectomy?

A

laproscopic cholecystectomy: first choice, small incisions made in abdomen

allow insertion of small tubes through surgical instruments and a video camera are placed into abdominal cavity

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6
Q

summarise the indications for cholecystectomy?

A

Gall bladder stones (symptomatic)

Acute cholecystitis

Gallstone pancreatitis

Choledocholithiasis

Cholecystoduodenal fistula

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7
Q

what are the complications of cholecystectomy?

A

Damage to bile ducts which can cause bile leak

Post cholecystectomy syndrome– RUQ pain, dyspepsia, nausea/vomiting

Post site hernia

Bleeding

Infection

Fat intolerancedue to inability to secrete a large amount of bile into the intestine as pt no longer has a gall bladder

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8
Q

define a colonoscopy?

A

endoscopic examination of large bowel and distal part of small bowel

sedation and analgesisa given first-> flexible colonoscope is passed and guided around colon

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9
Q

summarise the indications for colonoscopy?

A

rectal bleeding

iron deficiency anaemia

persistent diarrhoea

biospy of lesion seen on barium enema

assessment or suspicion of IBD

colon cancer surveillance

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10
Q

what are the possible complications of a colonoscopy?

A

Abdominal discomfort

Incomplete examination

Haemorrhage after biopsy or polypectomy

Perforation

Infection

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11
Q

how is a flexible sigmoidoscopy different?

A

covers only sigmoid

requires less bowel prep

less invasive

older patients more tolerant

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12
Q

define ERCP?

A

Endoscopic retrograde cholangiopancreatography – combines endoscopy and fluoroscopy to diagnose and treat problems of biliary or pancreatic ductal systems.

A catheter is advanced from a side-viewing duodenoscope via the ampulla into the common bile duct. Contrast medium is injected and x-rays taken to show lesions in the biliary tree and pancreatic ducts.

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13
Q

summarise the indications for ERCP?

A

No longer routinely used for diagnosis

Significant therapeutic role

  • Common bile duct stones
  • Stenting of benign or malignant strictures (narrowings)
  • Obtaining brushings to diagnose nature of a strictures
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14
Q

What are the possible complications of ERCP ?

A

Pancreatitis

Bleeding

Cholangitis

Perforation

Aspiration pneumonia

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15
Q

Define endoscopy?

A

Procedure in which an endoscope is used to examine the interior of a hollow organ or cavity in the body.

NBM 6 hours before + prokinetic (e.g. metoclopramide) given 1 hour before

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16
Q

what are the different types of endoscopy?

A

Oesophagus, stomach and duodenum = oesophagogastroduodenoscopy (OGD) aka upper GI endoscopy

Small intestine = enteroscopy

Large intestine/colon = colonoscopy, sigmoidoscopy

Bile duct = ERCP

Rectum (rectoscopy) and anus (anoscopy) = both is proctoscopy

17
Q

summarise the indications for an endoscopy?

A

Haematemesis

New dyspepsia (if >/= 55 y/o)

Gastric biopsy

Duodenal biopsy

Persistent vomiting

Iron deficiency

Note – these are all indications for upper GI endoscopy

18
Q

what are the possible complications of an endoscopy?

A

For upper GI endoscopy

  • Sore throat
  • Amnesia from sedation
  • Perforation
  • Cardiorespiratory arrest
  • Bleeding
19
Q

Define enteral nutrition?

A

nutrition given into the GI tract

if possible-> given by mouth- if danger of choking/aspiration, semi-solid diet to be considered

20
Q

what is tube feeding?

A

liquid nutrition via tube-> placed endoscopically, radiologically or surgically directly into stomach

21
Q

what is parenteral nutrition?

A

Intravenous nutrition given through a central venous line

22
Q

what are the indications for enteral feeding?

A

MALNUTRITION

  • Increased nutritional requirements e.g. sepsis, surgery
  • Increases nutritional losses e.g. malabsorption
  • Decreased intake e.g. dysphagia, nausea, sedation, coma
  • Effect of treatment, e.g. nausea, diarrhoea
  • Enforced starvation e.g. prolonged NBM period
  • Difficulty with feeding
  • Unappetising food
23
Q

What are the indications for parenteral nutrition?

A
  • GI tract not functioning e.g. bowel obstruction
  • Poor absorption e.g. short bowel syndrome or active Crohn’s
  • High risk of malnutrition
24
Q

what are the complications of enteral nutrition?

A

Aspiration

25
Q

what are the complications of parenteral nutrition?

A

Sepsis

Thrombosis of central vein leading to pulmonary embolism or superior vena caval obstruction

Metabolic imbalance

Refeeding syndrome

  • Low potassium, magnesium and phosphate as a large release of insulin in refeeding syndrome causes a rapid shift of K+, Mg2+ and PO4- into cells

Mechanical issues such as pneumothorax, embolism of IV line tip

26
Q

what monitoring is essential for patients on parenteral nutrition?

A

Check Temperature, obs and line regularly-> possible line infection

monitor blood glucose-> TPN has high sugar content , even those with no history of diabetes can develop significant blood sugar derangement on TPN -> increases the risk of line infection

Fluid balance-> goes wrong for those on TPN, either because losses (from NG, fistula, high output stoma etc.) are not adequately corrected on top of the TPN volume, or because people forget that the TPN contains a significant amount of fluid (usually about 1.5 litres) and overprescribe standard IV fluids in addition. As TPN patients often have difficult fluid balance, with high losses, third space fluid accumulations etc.

Electrolytes -> GI fluid contains a lot of electrolytes in particular Na, K and Mg. Additionally electrolytes can be dramatically affected by refeeding syndrome

27
Q

define laproscopic abdominal surgery?

A

Aka keyhole surgery or laparoscopy

A procedure performed in the abdomen or pelvis through small incisions with the aid of a camera

28
Q

state an advantage of laproscopic abdominal surgery?

A

minimally invasive so reduced pain, reduced risk of hemorrhaging and shorter recovery time, smaller scar, fewer wound-related infections

29
Q

summarise the indications for laproscopic abdominal surgery?

A
  • To diagnose conditions such as pelvic inflammatory disease, endometriosis, ectopic pregnancy, appendicitis, liver cancer, pancreatic cancer, ovarian cancer, cancer of bile duct and gallbladder
  • Appendicitis
  • To remove gallbladder
  • Resection of intestine e.g. in Crohn’s
  • Hernia repair
  • Repairing stomach ulcers
  • Weight loss surgery
  • Removing organs affected by cancer
  • Treating ectopic pregnancy
  • Hysterectomy
30
Q

what are the possible complications of laproscopic abdominal surgery?

A

Trocar injuries during insertion

Accidental damage to other intra-abdominal organs

Risk of conversion to open procedure

31
Q

define open abdominal surgery?

A

Broad term including any procedure which involves opening the abdomen – appendectomy, Caesarean section, inguinal hernia surgery, laparotomy

32
Q

what is a laparotomy?

A

surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity

33
Q

what are the indications for a laparotomy?

A

Rupture of an organ e.g. spleen, aorta, ectopic pregnancy

Peritonitis (perforation of a peptic ulcer/duodenal ulcer, diverticulum, appendix, bowel, gallbladder)

34
Q

what are the possible complications of open abdominal surgery?

A
  • Adhesions – fibrous bands which form between tissues and organs
  • Bleeding
  • Infection
  • Paralytic ileus
  • Shock
  • Incisional hernia (20%)
  • Post op ileus: bowels basics going on a strike after surgery so must wait until they fart or pass stool so you know their bowels are working
35
Q

define nasogastric tube insertion?

A

A medical procedure for gastric intubation via the nasal passage, to provide access to the stomach for diagnostic and therapeutic purposes.

Tubes passed into the stomach via the nose and drain externally

Large are good for drainage but can be uncomfortable for patients. Small are more comfortable for feeding but can be difficult to aspirate and are poor for drainage.

36
Q

summarise the indications for NG tube insertion?

A

To decompress the stomach/GI tract especially when there is obstruction e.g. ileus

For gastric lavage

To administer feed/drugs

37
Q

what are the possible complications of NG tube insertion?

A

Pain

Rare: loss of electrolytes, oesophagitis, tracheal/duodenal intubation, necrosis (retro/nasopharyngeal), stomach perforation

GI (51 decks)

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