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Phase 2 - Peri-Op > Specific Surgeries > Flashcards

Specific Surgeries Flashcards

1
Q

What is a Nissen Fundoplication?

A

A complete 360 wrapping of the fundus of the stomach around the lower OG sphincter
The right crus of the diaphragm is also tightened

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2
Q

What are the Complications of a Nissen Fundoplication?

A 
Can be done too tight
Not able to burp or vomit
Excess wind (Gas Bloat Syndrome)
Dysphagia
Diarrhoea
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3
Q

What other surgeries can you do for Hiatus Hernias/GORD?

A

Anterior/Posterior Wrap
Sympathectomy
`

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4
Q

Surgery for Oesophageal Cancer?

A

Removal of the affected part and using the stomach or small bowel as an oesophagus

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5
Q

What is ERCP?

A

Enterograde retroscopic cholangiopanceatography

X Ray guide imaging of the bile ducts and can use it to remove bile stones, image obstructions, balloon dilatation and stent the ducts

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6
Q

What are the risks of ERCP?

A

Perforation
Pancreatitis
Worsen the obstruction

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7
Q

How do you treat a gastric cancer surgically?

A

Roux en Y procedure

Gastrectomy (in proximal)

Subtotal Gastrectomy (if pylorus/antrum)

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8
Q

What is a roux en Y?

A

Bypassing the stomach and attaching the oesophagus to the small bowel
The duodenum is closed off proximally, but attached to the small bowel so bile can flow

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9
Q

What are complications of a roux-en-Y?

A

Dumping syndrome
B12 deficiency
Anastomotic Leak
Death

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10
Q

What is dumping syndrome?

How do you avoid it?

A

Where partial undigested (hyperosmotic) food e.g. sugars passes into the duodenum causing lots of H2O influx
Leads to pain, distention

Can also cause large increase of insulin causing hypoglycaemia, hypokalaemia

Small meals
Avoid certain foods
Drink with meals

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11
Q

What is a gastric sleeve?

A

When part of the stomach is banded or sewn off to create a smaller stomach (sleeve)

It is a weight loss procedure
Can have the same complications as REY

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12
Q

How do you treat a hernia surgically?

A

You remove the hernia from its hole created and do a mesh repair

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13
Q

What are the mesh options?

A

Nylon
Polypropylene
Biomesh

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14
Q

What is a Whipple’s procedure?

A

A pancreatoduodenectomy

Removal of those parts due to pancreatitis (chronic), pancreatic cancer. Normally leave the tail/body of the pancreas and reattach it to preserve function

It is normally palliative

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15
Q

What is a possible complication of a Whipple’s?

A

Pancreatic Fistula

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16
Q

What is a Hartmann’s Procedure?

A

Emergency resection of the sigmoid colon
Normally forms a end colostomy and a rectal stump.
Can be reversed.
Not anastomosed at the time due to risk of leakage

17
Q

Why do a Hartmann’s procedure?

A

Acute perforation or obstruction

18
Q

What is a Hemicolectomy?
Types?
Why?

A

Removal of one portion of the bowel and its associated mesentery (with artery, vein and lymph nodes that supply it)
Normally due to malignancy, can due due to UC or any other cause of obstruction/perforation

Right (SMA)
Left (IMA and Left Middle Colic)
Extended right (if problem is in transverse colon)
Sigmoidectomy (IMA all removed)

19
Q

What can you do following a hemicolectomy?

A

Re-anastomose
End colostomy or ileostomy
Covering stoma (for bowel rest, can be reversed)

20
Q

What is an Anterior resection

A

Resection of the rectum, if problem/cancer is over 5cm away from the anus
Leaves sphincter intact and can anastomose

Can be a low or high approach

21
Q

What is an AP resection?

A

Abdominoperineal resection
If the malignancy is <5cm away from anus

Removal of the sigmoid, rectum and anus

Form a permanent end colostomy

22
Q

What is a Total Colectomy?

Why is it different from a Pan Proctocolectomy?

A

Total is emergency - removal of everything except the rectum and anus, can later from an ilioanal pouch

PP is non emergency, it also removes the rectum and anus and has a permanent iliostomy

23
Q

When do you do a PP or Total Colectomy?

A

In UC, Crohn’s, FAP

24
Q

What is an ilioanal pouch?

A

When an anastomosis is formed between the terminal ileum and the anus
The ileum is formed into a J shape and attached to the anal canal

25
Q

What are the complications of an ilioanal pouch?

A 
Urgency
Frequency
Loose, watery Stools
Pouchitis
Leak
26
Q

What is a stoma?

A

A surgically created opening to the skin from a hollow organ

27
Q

Differences between colostomy and ileostomy?

Urostomy?

A

Colostomy:
More solid stools
LIQ (can be right side)
Flush with the skin

Ileostomy:
Watery
RIQ
Spouted

Urostomy:
Spouted
Yellow, liquid contents
Can be either side

28
Q

What are the types of stoma?

A

Colostomy
Ileostomy
- Can be permanent or temporary
- Can be single or looped

Urostomy

29
Q

What is a looped stoma?

A

When both ends of the bowel are brought up to the surface

Can be used for resting the bowel and be reversed

Can be used as a mucus stoma in a defunctioned bowel the distal end will still be producing mucus etc and to prevent that building up it can overflow into a stoma

30
Q

Complications of stomas

A 
Herniation
Retraction
Strangulation
Infection
Leakage
Prolapse
31
Q

What is a tracheostomy?

A

When a tube is inserted into the trachea to allow the patient to breathe if there is an upper airway problem (closed larynx)

Can be done at the bedside or in surgery

Can be acute or chronic

32
Q

What is a urostomy?

A

When there is a problem with the lower urinary tract (malignancy etc)
A small segment of bowel is used to connect both ureters to the skin and allow urine to flow.
It is spouted

33
Q

Why is an ileostomy spouted?

A

The contents are more liquid and alkali so likely to irritate the skin and cause skin excoriation

34
Q

What are some side effects of ileostomies?

A

Hypokalaemia
Dehydration
Vitamin Deficiencies

35
Q

Complications of Tracheostomies?

A

Haemorrhage
Hypoxia
RL Nerve palsy
Prevents speech, swallowing and humidification of air

Phase 2 - Peri-Op (5 decks)

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