Procedures Flashcards
define a appendidectomy
surgical removal of the veniform appendix
summarise the indications for an appendidectomy?
normally performed as emergency procedure for acute appendicitis
what are the possibel complications of an appendidectomy?
bleeding
wound infection
peritonitis
blocked bowels
define cholecystectomy?
surgical removal of gallbladder
what are the 2 types of cholecystectomy?
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
summarise the indications for cholecystectomy?
Gall bladder stones (symptomatic)
Acute cholecystitis
Gallstone pancreatitis
Choledocholithiasis
Cholecystoduodenal fistula
what are the complications of cholecystectomy?
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
define a colonoscopy?
endoscopic examination of large bowel and distal part of small bowel
sedation and analgesisa given first-> flexible colonoscope is passed and guided around colon
summarise the indications for colonoscopy?
rectal bleeding
iron deficiency anaemia
persistent diarrhoea
biospy of lesion seen on barium enema
assessment or suspicion of IBD
colon cancer surveillance
what are the possible complications of a colonoscopy?
Abdominal discomfort
Incomplete examination
Haemorrhage after biopsy or polypectomy
Perforation
Infection
how is a flexible sigmoidoscopy different?
covers only sigmoid
requires less bowel prep
less invasive
older patients more tolerant
define ERCP?
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.
summarise the indications for ERCP?
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
What are the possible complications of ERCP ?
Pancreatitis
Bleeding
Cholangitis
Perforation
Aspiration pneumonia
Define endoscopy?
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
what are the different types of endoscopy?
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
summarise the indications for an endoscopy?
Haematemesis
New dyspepsia (if >/= 55 y/o)
Gastric biopsy
Duodenal biopsy
Persistent vomiting
Iron deficiency
Note – these are all indications for upper GI endoscopy
what are the possible complications of an endoscopy?
For upper GI endoscopy
- Sore throat
- Amnesia from sedation
- Perforation
- Cardiorespiratory arrest
- Bleeding
Define enteral nutrition?
nutrition given into the GI tract
if possible-> given by mouth- if danger of choking/aspiration, semi-solid diet to be considered
what is tube feeding?
liquid nutrition via tube-> placed endoscopically, radiologically or surgically directly into stomach
what is parenteral nutrition?
Intravenous nutrition given through a central venous line
what are the indications for enteral feeding?
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
What are the indications for parenteral nutrition?
- GI tract not functioning e.g. bowel obstruction
- Poor absorption e.g. short bowel syndrome or active Crohn’s
- High risk of malnutrition
what are the complications of enteral nutrition?
Aspiration
what are the complications of parenteral nutrition?
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
what monitoring is essential for patients on parenteral nutrition?
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
define laproscopic abdominal surgery?
Aka keyhole surgery or laparoscopy
A procedure performed in the abdomen or pelvis through small incisions with the aid of a camera
state an advantage of laproscopic abdominal surgery?
minimally invasive so reduced pain, reduced risk of hemorrhaging and shorter recovery time, smaller scar, fewer wound-related infections
summarise the indications for laproscopic abdominal surgery?
- 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
what are the possible complications of laproscopic abdominal surgery?
Trocar injuries during insertion
Accidental damage to other intra-abdominal organs
Risk of conversion to open procedure
define open abdominal surgery?
Broad term including any procedure which involves opening the abdomen – appendectomy, Caesarean section, inguinal hernia surgery, laparotomy
what is a laparotomy?
surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity
what are the indications for a laparotomy?
Rupture of an organ e.g. spleen, aorta, ectopic pregnancy
Peritonitis (perforation of a peptic ulcer/duodenal ulcer, diverticulum, appendix, bowel, gallbladder)
what are the possible complications of open abdominal surgery?
- 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
define nasogastric tube insertion?
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.
summarise the indications for NG tube insertion?
To decompress the stomach/GI tract especially when there is obstruction e.g. ileus
For gastric lavage
To administer feed/drugs
what are the possible complications of NG tube insertion?
Pain
Rare: loss of electrolytes, oesophagitis, tracheal/duodenal intubation, necrosis (retro/nasopharyngeal), stomach perforation
