Surgical Abdomen Flashcards
Ascending Colon Issue (Op + Stoma)
Right Hemicolectomy
No Stoma
Ileo-colic Anastomosis
Right and Mid Colic Arteries Ligated
Ascending + Transverse Colon Issue
(Op + Stoma)
Extended Right Hemicolectomy
No Stoma
Ileo-colic Anastomosis
Right, Mid and Left Colic arteries ligated
Descending Colon Issue
Op + Stoma
Left Hemicolectomy
No Stoma
Colo-colic Anastomosis
L.Colic ligated
Sigmoid Issue
Op + Stoma
Proctosigmoidectoy Emergency= Hartmann's End Colostomy No Anastomosis Sigmoidal Artery Ligated
Anal/Rectal Tumour Crossing the Anal Verge
Op + Stoma
Abdominoperineal Resection
End Colostomy
No Anastomosis
Sigmoidal and superior rectal arteries ligated
Upper Rectal Tumour
Op + Stoma
Anterior Resection (w/total mesorectal excision)
Loop Ileostomy
Colorectal anastomosis
Lower Rectal Tumour
Op + Stoma
Anterior Resection (w/low total mesorectal excision)
Loop Ileostomy
Colorectal anastomosis
Sigmoidal Tumour
Op + Stoma
High Anterior Resection
Loop Ileostomy
Colorectal anastomosis
Extensive Disease sparing the anus
Op + Stoma
Subtotal Colectomy
End Ileostomy
No Anastomosis
Open Anus
Extensive Disease Involving the Anus
Op + Stoma
Pan-proctocolectomy
End Ileostomy
No Anastomosis
Closed Anus
What is a Hernia?
Protrusion of a viscous through a defect in the wall of the cavity containing it
Borders of the inguinal caanal
Deep --> Superficial Ring Anterior: Aponeuroses of Internal Oblique and External Oblique Roof: Transversus Abdominus Posterior: Transversalis Fascia Floor: Inguinal Ligment
Hesselbach’s Triangle (direct inguinal hernia)
Medial: Rectus Abdominus
Inferior: Inguinal Ligament
Superior: Epigastric Vessel’s
Direct Hernias
Medial to Epigastric vessels
Indirect Hernias location
Lateral to the Epigastric vessels
How to distinguish Inguinal Hernias
Block deep ring and ask patient to cough
If hernia appears: Direct
If it disappears: Indirect
Indirect hernias also extend into the scrotum
Management of Inguinal Hernias
Cons: Weight Loss
Medical: Pain
Surgical:
- Open: Mesh- Lichtenstein or Suture: Shouldice
- Lap: TAPP or TEP
- Herniotomy (removal of hernial sac), -rrhaphy (herniotomy plus repair of the posterior wall of the inguinal canal) or -plasty (herniotomy plus reinforcement of the posterior wall of the inguinal canal with a synthetic mesh)
Borders of the Femoral Canal
Lateral: Femoral Vein
Medial: Lacunar Ligament
Anterior: Inguinal Ligament
Posterior: Pectineus
Inguinal vs Femoral hernia
Femoral: Inferolateral
Inguinal: Superomedial
Other Hernias
Incisional: in the midline
Umbilical: Hemispherical Umbilicus
Para-umbilical: Cresent Umbilicus
Epigastric: Lipomas or port-site incisional hernia
Pantaloon: Most common (both direct and indirect)
Associations with a sigmoid volvulus
older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia
Associations with caecal volvulus
all ages
adhesions
pregnancy
Mucous Fistula vs. Stoma
mucous fistula is to allow decompression of DISTAL end of bowl after an end colostomy normally
Types of anal fistulae and Mx
- Superficial/submucosal Fistula → Fistula laid open using a drainage seton
- Intersphincteric → Cutting Seton to progressively tighten
- Transphincteric → Fibrin glue to plug
- Extrasphincteric
- Suprasphincteric
GoodSall’s Law
Anterior Fistuale will have a direct radial tract
Posterior Fistulae will have a curvilinear course
Haemarrhoids
1st degree: never prolapse
2nd: prolapse on defecation but spontaneously reduce
3rd: prolapse on defecation but require digital reduction
4th: remain permanently prolapsed
What are causes of hernial incarcerations
Long irreducible hernia will have epithelisation and adhesions
Causes of mechanical Large bowel obstruction?
EXTRINSIC Tumours Adhesions Hernia Volvulus Intussusception Inflammatory masses (Abdominal Lymphoma) Congenital bands
INTRINSIC Crohn’s Carcinoma TB Congenital atresia
LUMINAL Gallstones Foreign Bodies Polypoid tumours Bezoars Parasites
Causes of small bowel obstruction? (ABC)
adhesions, bulge (hernia), cancer
Differentials for a groin mass?
Herniae Lipomas Lymph nodes Undescended testis Femoral aneurysm Saphena varix (more a swelling than a mass!)
What ix can you do prior to reversal of a loop ileostomy to ensure there is no anastamotic leak?
Gastrografin enema
What type of op can be used for some T1 colorectal cancers?
en-bloc endoscopic mucosal resection or endoscopic submucosal dissection
Indications for laparoscopic hernia repair?
Bilateral hernias
Recurrent hernia
Chronic pain
Main 3 branches of abdominal aorta - where do they come off and what do they supply?
Coeliac trunk: T12 –> splits into left gastric, common hepatic and splenic artery
- liver
- spleen
- stomach
- abdominal oesophagus
- superior duodenum
- superior pancreas
Superior mesenteric artery: L1
- distal duodenum
- jejunum/ileum
- ascending colon
- part of transverse colon
Inferior mesenteric artery: L3
- large intestine from splenic flexure to upper rectum
