Surgery - Miscellaneous Flashcards
What is a rigid proctoscopy?
Endoscopic examination of anal canal using proctoscope
What is rigid sigmoidiscopy?
Endoscopic examination of rectum - recto sigmoid junction using rigid sigmoidoscope
What are the indications for rigid proctoscopy/sigmoidoscopy?
Suspicion of colonic neoplasia Investigation of IBD Biopsies under direct vision Treatment of haemorrhoids Prior to ano-rectal operations
What is flexible sigmoidoscopy?
Endoscopic examination visualising up to splenic flexure
What are the indications for flexible sigmoidoscopy?
Colorectal cancer screening
Surveillance of prev diagnosed malignancy
Endoluminal stent insertion for strictures
Prior to ano-rectal operations
Haematochezia requiring haemostasis
What are the indications for tube thoracotomy?
Pneumothorax Pleural effusion/empyema Post-op -thoracotomy -oesophagectomy -cardiac surgery
What are the steps for inserting a tube thoracotomy?
Inject LA to infiltrate skin/parietal pleura
Make 2cm incision near upper border of lower rib, in triangle of safety
Blunt dissect to parietal pleura
Insert drain & attach to underwater seal
Apply airtight dressing
Sit patient at 45o
Check position w/ CXR (repeat daily)
What are the borders of the triangle of safety?
B/w lat border of pec major & lat dorsi
Sup to 5th ics
Inf to axillary border
What is a stoma?
External opening in lumenated organ
What are the common types of stoma?
Ileostomy Colostomy Urostomy Gastrostomy Jejunostomy
What is an ileostomy?
Stoma formed from the small bowel
What are the features of an ileostomy?
Spouted, prominent mucosal folds Usually on RHS Bilious contents in bag One lumen -end ileostomy, permanent Two lumens -loop ileostomy, temporary
What is a colostomy?
Stoma formed form large bowel
What are the features of a colostomy?
Flush to skin, flat mucosal folds
Usually on LHS
Contents often faeculent
Can be loop/end
What are the indications for a colostomy?
Hartmann’s procedure
Left heimolectomy
Abdo-perineal resection
What are the indications for an ilostomy?
One lumen
-definitive surgery to remove colon in UC
Two lumens
-rest distal bowel (IBD)
-protect distal anastomoses post op
-functional relief from severe incontinence
What is a urostomy?
Stoma formed from short section of disconnected ileum, into which 1/2 ureters are directed after radical urinary tract surgery
What is a gastrostomy?
Connect from ant stomach to ant abdo wall
What are the features of a gastrostomy?
Narrow in calibre
Flush to skin
Usually LUQ
Indwelling access devices
What are the indications for a gastrostomy?
Stomach drainage
Direct feeding
What is a jejunostomy?
Connection from jejunum to abdo wall for direct feeding
What are the potential early complications of a stoma?
Infarction/necrosis
Infection
High output from stoma –> severe dehydration
What are the potential late complications of a stoma?
Parastomal hernia
Stoma prolapse
Stoma retraction
Stenosis
How should a stoma be examined?
?pt pain
Gently palpate abo (?distension/tenderness)
Ask pt to cough (?parastomal hernia)
?signs of infection
Identify type of stoma
?complications (infarction, prolapse, retraction)
Listen for bowel sounds (below umbilicus)
View pts fluid balance chart
