Surgery for IBD Flashcards
What is a fistula
An abnormal communication between two epithelial surfaces
What is an anastomosis
The reconnection of two streams that previously branhced out, such as blood vessels
What 5 reasons might elective surgery be required in Ulcerative colitis
Medically unresponsive disease (cant’t get off steroids)
Intolerability
Dysplasia / malginancy
Growth retardation in children
Attempted resolution of extra-intestinal disease
What are the operation types for UC
Elective proctocolectomy
with end ileostomy
With a pouch
Ileorectal anastomosis
What is the appearance of a colostomy
Usually on the left side
Usually flush with the skin
Stool usually comes out of it
What is the appearance of an ileostomy
Usually on the right
Usually spouted
Usually effluent
Why would a patient have pouch
Instead of having a stoma
usually for younger patients who are more likely to be self conscious
What are the 3 different types of pouches that can be created
W pouch
J pouch
S pouch
What are the functional outcomes of a pouch
6 bowel movements a day
some minor incontinence
20% nocturnal incontinence
50% nocturnal leakage and spotting for the first 6 months
Pouch failure 10% at 10 years to be reversed to an ileostomy
What are some long term complications of a proctocolectomy
Impotence
Infertility
Pouchitis
What does the Truelove and Witt Criteria Assess
The severity of IBD
What is assessed in the Trulove and Witt criteria
ESR Haemoglobin Bloody stools temperature heart rate
What is a subtotal colectomy
First aid operation that can be done lap or open depending on the expertise
How often do patients have a colonoscopy in IBD and why?
every 10 years post diagnosis because there is an increased risk of colorectal cancer
What is Rigler’s sign
Gas on the outside of the bowel wall
What are the symptoms of toxic megacolon
Sepsis
Pain
Distension
What are the complications of toxic megacolon
May perforate
Can be fatal
requires urgent decompression
How successful is surgery for UC
Generally the patient is cured and does not need further surgery
How successful is surgery for Crohn’s
Not very - most require further surgery in the future
What makes surgery more difficult in Crohn’s disease
Immunosuppressive therapy
Biologicals cause increased sepsis
Steroids impact on healing
What is one of the largest dilemmas in Crohn’s disease surgery
Whether the appendix is removed or left in place
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