GI surgery (Yr4) Flashcards
what are halsteads principles?
gentle tissue handling
meticulous haemostasis
preservation of blood supply
strict asepsis
minimal tension
accurate tissue apposition
obliteration of dead space
what is the duodenal dam manoeuvre?
grasp duodenum and retract over to the left, this exposes the right abdominal roof
what is the colonic dam manoeuvre?
grasp colon and retract over the right, this exposes the left abdominal roof
what can excessive handling of the gut cause?
ileus
where should incisions be made into the gut?
least vascular part of walls…
stomach - greater/lesser curvature
duodenum, jejunum, colon - antimesenteric border
what is the Pringle manoeuvre used for?
occlude blood from liver for 15 minutes by applying pressure to the celiac artery and portal vein
why does electrocautery have limited use in the liver?
can ablate parenchyma and make bleeding worse
what subjective criteria can be used to assess intestinal viability?
colour (healthy pink)
arterial pulsations should be present
peristalsis
when should prophylactic antibiotics be used for GI surgery?
any clean-contaminated or contaminated procedures (most GI surgery)
what antibiotic should be used prophylactically for GI surgery?
clavulanate-amoxicillin
(with metronidazole for colonic or hepatic surgery)
what suture material is acceptable for most intestinal surgery?
2 or 1.5 metric monofilament synthetic absorbable suture material (polydioxanone)
what suture patterns are used for most GI tract wound closures?
simple interrupted or continuous (appositional patterns)
what suture pattern should be used to close the stomach?
two layers (simple continuous then simple inverting such as cushings or lembert)
what are inverting suture patterns not used in the intestine?
they narrow the lumen
what is short bowel syndrome?
when 80% of the small intestine is removed there is maldigestion, malabsorption and bile salt deficiency
