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Medicine and Surgery Mushkies > Surgical Scars and Colonic Resection Mushkies > Flashcards

Surgical Scars and Colonic Resection Mushkies Flashcards

1
Q

When is a midline laparotomy incision used?

A
  1. Emergency = Perforated DU, Trauma, Ruptured AAA, Hartmans
  2. Elective = Colectomy, AAA, Vascular Bypass
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2
Q

When is a right paramedian incision used?

A

Not commonly used now as closure techniques have improved

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3
Q

When is a Kocher’s (subcostal) incision used?

A
  1. Open cholecystectomy

2. A L Kocher’s is used for a splenectomy

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4
Q

When is a rooftop incision used?

A
  1. Oesophageal surgery e.g. oesophaegectomy
  2. Gastric surgery e.g. gastrectomy
  3. Bilateral Adrenalectomy
  4. Liver Resection
  5. Liver Transplant
  6. Whipple’s
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5
Q

What is a Whipple’s procedure?

A

A pancreatico-duodenectomy, performed to remove the head of the pancreas, the first part of the small intestine (duodenum), the gallbladder and the bile duct.

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6
Q

When is a Pfannenstiel incision used?

A
  1. Gynae surgery = LSCS, hysterectomy, oopherectomy

2. Lower Urinary Tract surgery

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7
Q

What incisions are used for an appendicectomy?

A 
McBurney's = Oblique
Lanz = Transverse
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8
Q

Why is a Lanz incision preferred over a McBurney’s incision?

A

As it is hidden in the natural skin crease

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9
Q

When is a thoracoabdominal incision used?

A

Oesophago-gastrectomy

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10
Q

When is a Transverse Muscle Splitting incision used?

A

Right Hemicolectomy

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11
Q

What incision is used for a right hemicolectomy?

A

A Transverse Muscle Splitting incision

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12
Q

When is an inguinal incision used?

A
  1. Open inguinal hernia repair

2. Orchidectomy

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13
Q

What is half a Pfannenstiel scar called?

When is it used?

A

McEvedy incision for an Emergency femoral hernia

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14
Q

When is a loin incision made?

A

Nephrectomy

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15
Q

What are vascular access scars used for?

A
  1. Bypass
  2. Embolectomy
  3. EVAR/TEVAR
  4. Stent insertion
  5. Femoral Endarterectomy
  6. Angioplasty
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16
Q

What system can you use when discussing colonic resections?

A

DIS SAD

  1. Definition/Description
  2. Indication
  3. Scars
  4. Stoma
  5. Anastomosis
  6. Differential
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17
Q

What is a right hemicolectomy?

A 
D = surgical resection of the ascending colon with subsequent formation of an ileocolic anastomosis 
I = tumours in the caecum and proximal ascending colon
S = midline laparotomy, transverse muscle splitting, laparoscopic ports
S = none
A = ileocolic
D = midline laparotomy differential
18
Q

What is an extended right hemicolectomy?

A 
D = surgical resection of the ascending colon with  extension of the distal resection margin to the splenic flexure, with subsequent formation of an ileocolic anastomosis 
I = tumours in the distal ascending colon or transverse colon
S = midline laparotomy, laparoscopic ports
S = none 
A = ileocolic 
D = midline laparotomy differential
19
Q

What is a left hemicolectomy?

A 
D = surgical resection of the transverse colon left of the middle colic vessels to the level of the upper rectum, with subsequent formation of a colocolic anastomosis
I = tumours in the descending colon 
S = midline laparotomy, laparoscopic ports
S = none 
A = colocolic 
D = midline laparotomy differential
20
Q

What is a Hartmann’s procedure?

A 
D = surgical resection of the rectosigmoid colon with the formation of an anorectal stump and an end colostomy
I = Obstruction or perforation secondary to sigmoid tumour or diverticulitis 
S = Midline laparotomy, ?stoma scar in LIF with reversal
S = single lumen colostomy in the LIF
A = none
D = AP resection
21
Q

What is an Abdomino-Perineal Resection?

A 
D = surgical resection of  the anus, rectum, and part of the sigmoid colon with formation of an end colostomy 
I = rectal Ca <4-5cm from anal verge 
S = Midline laparotomy, no anus
S = single lumen colostomy in the LIF
A = none
D = Hartmann's procedure
22
Q

What is an Anterior Resection?

A

D = surgical resection of part of the rectum and sigmoid colon, may be high or low depending on site of the tumour + total mesorectal excision for tumours in the middle or lower 1/3rd
I = rectal Ca >4-5cm from anal verge
S = midline laparotomy, laparoscopic ports, scar/stoma in RIF
S = double lumen loop ileostomy in the RIF
A = Colorectal
D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior Resection or Crohns)
Additional Mushkie: Rectal blood supply is poor, therefore the colorectal anastomosis is covered by a temporary loop ileostomy

23
Q

What is a Subtotal Colectomy?

A

D = surgical resection of the entire colon except for distal sigmoid and rectum, rectosigmoid stump may be exteriorised as a mucous fistula
I = acute severe UC
S = midline laparotomy, laparoscopic ports
S = single lumen (temporary) end ileostomy in the RIF
A = none
D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior resection or Crohns)
Additional Mushkie: Followed after 3m by either a completion proctectomy + IPAA or permanent end ileostomy OR an ileorectal anastomosis

24
Q

What is a Panproctocolectomy?

A 
D = surgical resection of the entirety of the colon, rectum and anus with formation of a permanent end ileostomy 
I = UC or FAP 
S = midline laparotomy, laparoscopic ports
S = single lumen end ileostomy in the RIF
A = none
D = End Ileostomy (panproctocolectomy (UC,FAP), subtotal colectomy (acute severe UC), cystectomy and ileal conduit) or Loop Ileostomy (for e.g. Anterior resection or Crohns)
25
Q

How many different colonic resections do we need to know? What are they?

A

8

  1. Right hemicolectomy
  2. Extended right hemicolectomy
  3. Left hemicolectomy
  4. Hartmann’s procedure
  5. AP resection
  6. Anterior resection
  7. Subtotal colectomy
  8. Panproctocolectomy
26
Q

When is a Mercedes Benz incision used?

A

Liver transplant

27
Q

When is a Rutherford Morrison incision used?

A

Kidney transplant

28
Q

What are common indications for a kidney transplant?

A
  1. Diabetic nephropathy
  2. PCKD
  3. Glomerulonephritis
29
Q

Jenkin’s rule?

A

It is a rule for closure of the abdominal wound. It states that for a continuous suture, the length of suture used should be at least four times the length of the wound with sutures 1cm apart and with 1cm bites of the wound edge

30
Q

What incision has high rates of chronic neuropathic pain?

A

Inguinal hernia incision

31
Q

UC indications for surgery?

A
  1. Acute = megacolon, perforation, haemorrhage

2. Chronic = medical mx failure, malignancy, maturation failure in children

32
Q

CD indications for surgery?

A
  1. Acute = obstruction, perforation, haemorrhage

2. Chronic = perianal disease, intra-abdominal abscess, medical mx failure, entero-cutaneous fistulae

33
Q

Surgical options for UC?

A
  1. Subtotal colectomy with end ileostomy +/- mucus fistula
  2. Proctocolectomy and permanent ileostomy
  3. Restorative proctocolectomy with IPAA
34
Q

What % CD pts need at least 1 operation in their life?

35
Q

CD surgery principles?

A
  1. Never curative

2. Must be as conservative as possible ut avoid SGS

36
Q

Surgical options for CD?

A
  1. Ileocaecostomy
  2. Drainage of abscesses
  3. Stricturoplasty
  4. Colonic defunctioning for failed medical therapy
  5. Occasionally a subtotal colectomy + permanent end ileostomy may be needed
37
Q

DDX of RIF mass?

A
  1. Commonest = transplanted kidney, caecal cancer, Crohns/appendix mass/abscess, incisional hernia
  2. Skin and soft tissues = sebaceous cyst, lipoma, sarcoma
  3. Gynae = ovarian tumour, fibroids
  4. Male repro = undescended/ectopic testis
  5. Urology = ectopic kidney/bladder diverticulum
  6. Blood vessels = external iliac/common iliac artery aneurysm
  7. Lymph nodes
38
Q

DDx of LIF mass?

A
  1. Commonest = faecal mass, colon Ca, iverticular mass, transplanted kidney
  2. Skin and soft tissues = sebaceous cyst, lipoma, sarcoma
  3. Gynae = ovarian tumour, fibroids
  4. Male repro = undescended/ectopic testis
  5. Urology = ectopic kidney/bladder diverticulum
  6. Blood vessels = external iliac/common iliac artery aneurysm
  7. Lymph nodes
39
Q

DDx of suprapubic mass?

A
  1. Skin and soft tissue = sebaceous cyst, lipoma, sarcoma
  2. Urological = bladder, bladded mass, bladder diverticulum
  3. Gynae = gravid uterus, fibroid uterus, ovarian tumour
40
Q

DDx of RUQ mass?

A
  1. Skin and soft tissue = sebaceous cyst, lipoma, sarcoma
  2. Hepatic = hepatomegaly, mass (cyst, abscess, hepatoma)
  3. Gallbladder
  4. Right kidney
41
Q

DDx of LUQ mass?

A
  1. Skin and soft tissue = sebaceous cyst, lipoma, sarcoma
  2. Splenomegaly
  3. Left kidney
  4. Gastric cancer
42
Q

DDx of epigastric mass?

A
  1. Skin and soft tissue = sebaceous cyst, lipoma, sarcoma, epigastric hernia
  2. Gastric = cancer
  3. Hepatic = hepatomegaly/mass
  4. Pancreas = cancer, pseudocyst
  5. Vascular = AAA

Medicine and Surgery Mushkies (52 decks)

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