Surgery Flashcards
Which IBD can be cured with surgery.
UC
What 3 factors are best to differentiate UC from CD?
- Transmural Inflammation: CD
- Crypt Abscess: UC
- Goblet Cell Depletion: UC
Study of choice for UC and Dx.
Study of Choice: colonoscopy
Dx: biopsy
What are the 4 steps of a stricturoplasty?
(used during an obstruction or stricture caused b CD.
Incision is made along the length of the bowel
Sides are pulled widely open
Stitched shut side to side
Can be performed in multiple locations
Why do diverticula tend to bleed and when do they bleed?
The “pockets” that form will stretch the colon wall including the blood vessels contained within the wall making them very susceptible to tearing and leaking into the lumen. The don’t bleed during inflammation (diverticulitis).
Most common location of diverticula and location where the don’t form.
- Most common: sigmoid
2. Don’t occur in rectum
One test you do NOT order when you suspect diverticulitis.
Colonoscopy
Main treatment for mild, uncomplicated diverticulitis.
Antibiotics
Surgical treatment for severe diverticulitis in an otherwise healthy patient.
Resection with primary anastomosis:
ex. Sigmoid resection with anastomosis with no stoma
Surgical treatment for severe diverticulitis in a patient with below standard health.
Resection with primary anastomosis with a diversion loop ileostomy.
What is the treatment for ruptured diverticulitis?
Hartmann Procedure
-sigmoid resection with end colostomy with rectal stump.
-external ileostomy for 8 weeks, then restore the intestinal continuity.
Best diagnostic test for diverticulitis.
CT
Treatment for sigmoid volvulus.
1st try colonoscopic decompression
If that is unsuccessful, then surgical sigmoid resection.
if there is ischemia: Hartmann procedure
Treatment for cecal volvulus.
Right colectomy with ileal-transverse colon anastomosis.
3 most common causes of lower GI bleed.
- Hemorrhoids
- Diverticulosis
- Ateriovenous Malformations
Imaging test ordered to locate a lower GI bleed.
Nuclear Medicine: Technetium-tagged RBCs
Test of choice to diagnose colon cancer.
Colonoscopy
Test of choice to Dx metastases of colon cancer.
CT
3 categories used to stage tumors.
T - Tumor size
N - Nodal metastases
M - Malignancy (designated by distant disease)
What is standard procedure when surgically resecting a region of the colon with malignant cancer?
The entire region of the colon with the same blood supply and lymphatic drainage must also be removed. (ex. entire right colon, entire transverse colon etc.)
What is the followup for office visits after colostomy due to colon cancer?
- Every 3 months for two years
then - Every 6 months for three years
What is the followup for colonoscopies after colostomy due to colon cancer?
Every year if polyps are found
Every 3 years if polyps aren’t found
Describe the 4 grades of internal hemorrhoids
I Bleeding without prolapse
II Prolapse, spontaneous reduction
III Prolapse with manual reduction
IV Incarcerated, irreducible prolapse
3 best NON-operative treatments for hemorrhoids.
- Increase fiber
- stool softeners
- mineral oil
Two outpatient operations to fix internal hemorrhoids.
- Rubber Band Ligation (best for grade II)
2. Infrared Coagulation
Main operative treatment for anal fissures.
Lateral internal anal sphincterotomy
Treatment for anorectal abscess.
Surgical drainage - Unroof the abscess with elliptical incision and allow wide drainage with loose packing
Most important factor to determine type of treatment for anal fistulas.
Amount of external anal sphincter involved
How does a Seton Placement treat anal fistulas?
Silk suture is placed through tract and tied TIGHTLY
Tissue is slowly cut through by tight ligature
Scar tissue forms as seton advances
New suture is placed and re-tied regularly
Good for any fistula that involves much of the external anal sphincter muscle
