Upper GI Resection And Anastomosis Flashcards
Bilious vomiting with DJ flexure on right in neonates
Ladd’s procedure for malrotation with volvulus
Fecal peritonitis with liver metastasis from sigmoid cancer
Heartmans procedure
Treatment of fulminant ulcerative colitis
RIF end ileostomy
Cecal tomorrow on barium enema with PR bleeding causing iron deficiency anemia
Right hemicolectomy
Blood gas of high output ureterosigmoidostomy
Metabolic acidosis with respiratory hyperventilation
Treatment if gallstone ileus
Remove some from proximal enterostomy and leaving the gall bladder alone
Obstructing sigmoid cancer on CT
Sigmoidectomy with end colostomy
Toxic megacolon from ulcerative colitis
End ileostomy
Stoma for colorectal anastomosis after Anterior resection
Loop ileostomy
Significant terminal ileal stricture from ulcerative colitis
Right hemicolectomy
Fixed rectal carcinoma found on laparotomy
Transverse loop colostomy for defunctioning
Generalized abdominal pain starting from left iliac fossa
Hartmann’s
Large invasive rectal carcinoma
Loop transverse colostomy
Most common site of this loop is transverse colon or sigmoid colon.
Investigation of meconium ileus
Sweat chloride test will be high
Following diagnostic work up rectal cancer of T2 N0 and 2 cm from anal verge
ELAPE
Treatment for sigmoid diverticular stricture
Hartmann’s
Sigmoid diverticular peritonitis
Heartmans
Stab injury of left colon
End colostomy after resection
Furosemide on plasma K
Hypo kalamia
Failure of medical therapy for ulcerative colitis
Definitive treatment
Emergency treatment
Subtotal in emergency
Pan procto colectomy is definitive
Bleeding from upper rectal tumor
Vs
Bleeding from lower rectal tumor
Anterior resection for upper
Total mesorectal excision for middle and lower & abdomino perineal when can’t get adequate margin through abdominal approach.
Adverse effect of TPN on liver function
Jaundice
Ulcer associated with Crohn’s disease
Pyoderma gangrenosum
Earliest complication of stoma
Necrosis
Most common complication of stoma
Dermatitis
Surgical treatment of biliary atresia
Roux-en-Y Porto jejunostomy
Best decompression for jaundice from carcinoma of head of pancreas
ERCP
If failed then
PCT and drain with stenting
In low rectal large invasive carcinoma
Anterior resection with LIF end colostomy
Patient most likely needs adjuvant chemotherapy for T2N1M0
Stoma after restorative proctocolectomy for ulcerative colitis
Loop ileostomy at RIF
for the anastomosis to heal
Loop is closed at 10 weeks
Which ganglion is affected in hirsprungs disease
Auerbach plexus and Meissner plexus
The myenteric plexus and Auerbach’s plexus are the same thing.
located between the inner circular and outer longitudinal layers of the muscularis externa
which ganglion is affected in achalasia cardia
Achalasia cardia is caused by a loss of inhibitory ganglion cells in the myenteric plexus of the esophagus
Immunohistochemical evidence of hirsprungs disease
Increased activity of acetylcholinesterase
Definitive treatment for hirsprungs disease
Pull through operation
But rectal irrigation or an emergency colostomy before that
Perforated caecal cancer
Right hemicolectomy
Spout end ileostomy
Mucous fistula
Confirmation of parastomal hernia
CT
Treatment of fulminant ulcerative colitis
Total colectomy with RIF end ileostomy
End point of subtotal colectomy for ulcerative colitis
Depending on recovery perform an ileo rectal anastomosis
Some causes of malabsorption
Primary biliary cirrhosis
Ileo colic bypass
Chronic pancreatitis
Whipple’s disease
Some indications for heartmann’s
Proctitis
Diverticulitis
Perforated diverticulum
Diverticular stricture
Procto sigmoid itis
Colon cancer
Stoma for low rectal invasive cancer
Permanent LIF colostomy after abdomino PERINEAL excision
Investigation for hirsprungs disease
Full thickness rectal biopsy
Definitive surgery for hirsprungs
Resection and anastomosis after 9-12 months of age
Until then stoma by laparotomy
ELAPE vs APE
Extralevator abdominoperineal excision (ELAPE) is a relatively new surgical technique for low rectal cancers. It is a more radical approach than conventional abdominoperineal excision (APE) with potentially better oncological outcome.
They can also be done for anal cancer
Parts to resect during ELAPE vs APE
ELAPE involves removing the anal canal, levators, and low mesorectum,
while APE is the operation of choice for tumors that infiltrate the sphincter or levatorani muscles.
Investigation for rectal cancer extension
MRI
The route of total mesorectal excision (TME)
The route of total mesorectal excision (TME) depends on several factors, including the size and height of the tumor, the width of the mesorectum and pelvis, and the extent of colonic mobilization. The two main routes are through an abdominal incision or transanally
Surgery for rectal cancer with sphincter invasion
Abdomino perineal excision
