Surgery for IBD Flashcards
What are some examples of elective operations in Crohns?
Resection
Stricturoplasty
Fistulas
Anal disease
What are some examples of elective operations in UC?
Proctocolectomy with end ileostomy
Proctocolectomy with ileroecatl anastomosis
What is a Proctocolectomy?
Proctocolectomy is the surgical removal of the rectum and all or part of the colon
What might be some indications for elective surgery in UC?
Medically unresponsive disease Intolerability Dysplasia/malignany Growth retardation in children Attempted resolution of extra intestinal disease
Describe pouches in UC?
They are more popular with younger patients
Not perfect
Create a reservoir
Describe the functional outcomes of having a pouch?
Pouch patients average 6 bowel movements in 24hours
There can be leaking and spotting
Can fail
When are the emergency in UC?
Severe attack of UC
Describe what the truelove and Witt criteria is used for\?
To assess the severity (ESR, Hb, bloody stools, temp, HR)
Easy to use and practically relevant
What happens to the rectum when you remove the colon usually?
Tends to settle rectal disease
No rush to deal with the rectum
Manage with meds
Describe the cancer risk and IBD?
Should do a colonoscopy to look for cancer 10years post diagnosis
Describe toxic megacolon?
Sepsis Distention Pain Required decompression Ma perforate Can be fatal
(complication of UC)
Describe surgery for UC?
Patient cured
People live with stoma
What are some indications for surgery in Crohns?
Stenosis causing obstruction Enterocutaneous fistulas Intra-abdominal distils Abscesses Bleeding (Acute or chronic) Free perforation
Describe ilecolic disease and crohns?
Up to 80% of patients need an op for ileocolic disease in CD
Describe perianal disease?
Primary lesions (fissures, ulcer) Secondary lesions (abscess, tags, fistula) Incidental lesions (piles, hidradenitis)
