GI Surgeries

Question 1

Retroperitoneal Structures

Answer 1

SADPUCKER
S - suprarenal (adrenal) glands
A - aorta
D - duodenum
P - pancreas
U - ureters
C - colon (ascending and descending)
K - kidneys
E - oesophagus
R - rectum

Question 2

Complications from major surgery

Answer 2

Anastomotic Leak
Adhesions
Incisional Hernia
Bleeding
Paralytic Ileus
Infection
Shock
Peri-op mortality

Question 3

Anastomotic leak can cause what

Answer 3

sepsis
multi organ failure -> death
pain and fever 5-7 days post op

Question 4

Bleeding degrees

Answer 4

Primary = continuous, starts during surgery
Reactive = when increased BP, within 24 hours
Secondary = infection, 7-14 days post op

Question 5

Oesophagectomy what?

Answer 5

• trans hiatal or transthoracic (Ivor-Lewis)
• stomach segment pulled up into chest
• connected to remaining oesophagus

Question 6

Oesophagectomy when?

Answer 6

Advanced Barrett’s oesophagus

Non-metastatic oesophageal cancer

Question 7

Gastrectomy types?

Answer 7

-hemi (50%)
- antrectomy (30% gone)
subtotal (80% fone)

Question 8

gastrectomy when

Answer 8

Cancer
LT hiatus hernia
Barrett’s

Question 9

Gastrectomy complications

Answer 9

Increased osmotic load to duodenum = palpitations, light headedness, crampy abdo pain

Question 10

Cholecystectomy

Answer 10

Laparoscopic
Gallbladder remove
Gallstones

Question 11

Right hemicolectomy

Answer 11

Ascending colon and caecum removal
Laparotomy or laparoscopy through midline
If Cancer

Question 12

Anterior resection

Answer 12

Upper 2/3 of rectum resected
End colostomy
Rectal cancer
Diverticulitis

Question 13

Abdomino-perineal excision of rectum

Answer 13

Anus rectum and sigmoid colon remove
Remaining sigmoid brought as colostomy
Rectal carcinoma
Recurrent anal carcinoma

Question 14

Hartmann’s operation

Answer 14

Midline incision
Sigmoid colon exposed and mobilised
Dissection of proximal and distal to the affected
Colostomy
Rectal carcinoma
Recurrent anal carcinoma

Question 15

Haemorrhoids features

Answer 15

Painless rectal bleeding
Pruritis
Soiling

Question 16

Types of haemorrhoids

Answer 16

External = below dentate line, thrombosis often, may be painful
Internal = above dentate line, not painful

Question 17

Grading of internal haemorrhoids

Answer 17

1 = do not prolapse out of anal canal
2 = prolapse on defecation but reduce spontaneously
3 = manually reduced
4 = cannot be reduced

Question 18

management of haemorrhoids

Answer 18

• soften stools = increase fibre and fluids
• local steroids/anaesthetics
• outpatient rubber band ligation>injection sclerotherapy
• surgery if large symptomatic
• new = doppler artery ligation

Question 19

Acutely thrombosed external haemorrhoids

Answer 19

• significant pain
• purple, oedematous, tender perianal mass
• if within 72 hours = refer for excision
• otherwise stool softners, ice, analgesia
• symptoms settle in 10 days

Question 20

Medical treatment of fissures

Answer 20

• relieve constipation
• intra-anal nitroglycerin apply
• fibre and stool softners
• botulinum toxin

Question 21

Surgical treatment of fissures

Answer 21

• if acute and symptomatic after 3-4 weeks of medical therapy
• sphincter dilatation
• lateral internal sphincterotomy

Question 22

Preoperative Tx for fistulas in ano

Answer 22

• rectal irrigation
• AB
• anaesthesia

Question 23

Surgery Tx for fistulas in ano

Answer 23

• fistulotomy

- seton

Question 24

Perianal fistula with Crohns

Answer 24

• no surgery if asymptomatic

- loose setons

Question 25

Rectovaginal fistulas

Answer 25

• no surgery
• draining seton
• endorectal advancement flap + sphincteroplasty