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Surgery > Gastrointestinal Surgery: Part 3 > Flashcards

Gastrointestinal Surgery: Part 3 Flashcards

(48 cards)

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1
Q

Types of Stoma

A
  1. End stoma: 1 end is taken out
  2. Double barrel: 2 ends taken out, not joined to each other
  3. Loop stoma: 2 ends taken out but are joined
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2
Q

Technical difficulties b/w Ileostomy and Colostomy

A

Ileostomy: Raised above the skin (Pouting)
Colostomy: Flat (Same level as skin)

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3
Q

Complications of Stoma

A
  1. Skin excoriation: M/C
  2. Parastomal herniation: M/C long term complication
  3. Necrosis: Earliest
  4. Fluid and electrolyte imbalance
  5. Bowel obstruction
  6. Prolapse
  7. Retraction
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4
Q

Factors favoring spontaneous closure of Fecal fistula

A
  1. Esophageal, duodenal, jejunal stump
  2. Enteric wall defects <1 cm
  3. Fistula tract >2 cm
  4. No abdominal wall defects
  5. Good nutrition (Albumin >25 g/L)
  6. Low output fistula (<200 mL/day)
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5
Q

FRIEND factors
Just study

A
  1. Foreign body
  2. Radiation
  3. Inflammation,infection,IBD
  4. Epithelialisation of fistula tract
  5. Neoplasm
  6. Distal obstruction
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6
Q

Management of Fecal fistula

A

Spontaneous closure
If +: Conservative Mx
If -: SNAP protocol

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7
Q

What is SNAP protocol?

A

Skin care, sepsis control
Nutrition
Anatomical delineation (Imaging)
Planned surgery

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8
Q

Prognostic grouping for Fecal fistula

A

I. II. III
Degree of complexity of fistula Low Intermediate. High
Mortality. Low. 10-25%. >25%
Rx goals. Spontaneous closure. Early surgical closure. Late surgical closure

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9
Q

What is Short bowel syndrome?

A

<200 cm of small intestine
Net secretors: <100 cm of SI
Net absorbers: >100 cm of SI

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10
Q

Causes of Small bowel syndrome

A
  1. Crohn’s disease (M/C)
  2. SMA syndrome
  3. Trauma
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11
Q

C/F of Small bowel syndrome

A
  1. Malabsorption
  2. Diarrhoea
  3. Weight loss
  4. Bacterial overgrowth
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12
Q

Management of Short bowel syndrome

A
  1. TPN
  2. Small intestine transplantation
  3. Teduglutide (GLP2 analogue)
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13
Q

Types of Bowel lengthening procedures

A
  1. BIANCHI
  2. STEP (Serial transverse enteroplasty)
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14
Q

M/C site of Diverticular disease

A

Sigmoid colon

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15
Q

Features of Diverticular disease
Just study

A
  1. False diverticulae (Mucosal herniation)
  2. Forms along Mesenteric border
  3. 4th-5th decade; A/w constipation
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16
Q

M/C cause of lower GI hemorrhage

A

Diverticular disease

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17
Q

IOC of diverticulosis

A

Barium enema -> Sawtooth appearance

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18
Q

Complications of Diverticular disease

A
  1. Bleeding: Right > Left (SMA > IMA)
  2. Diverticulitis
  3. Colorectal cancers
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19
Q

C/F of Diverticulitis

A
  1. Left lower quadrant pain
  2. Diarrhoea
  3. Fever
  4. Raised TLC
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20
Q

Hinchey staging system

Study These Flashcards
A

Stage I: Colonic inflammation with pericolic abscess
Stage II: Colonic inflammation with pelvic abscess
Stage III: Purulent peritonitis
Stage IV: Fecal peritonitis

21
Q

Management of Diverticulitis

Study These Flashcards
A

Stage I & II: Pigtail catheter
Stage III & IV: Laparotomy and Hartmann procedure

22
Q

2nd M/C cause of lower GI bleed

Study These Flashcards
A

Angiodysplasia

23
Q

Features of Angiodysplasia

Study These Flashcards
A
  1. Dilated arterioles +
  2. M/C site: Caecum
24
Q

C/F of Angiodysplasia

Study These Flashcards
A

Heyde syndrome: Angiodysplasia + Aortic stenosis

25
Investigation of Angiodysplasia
1. Colonscopy 2. Capsule endoscopy
26
Treatment of Angiodysplasia
Coagulation/Cauterisation
27
Types of Inflammatory bowel disease
1. Crohn’s disease 2. Ulcerative colitis
28
Smoking effects on diff types of IBD
Crohn’s: Inc risk UC: Protective
29
Skin lesions present in
Crohn’s disease
30
Features of Crohn’s disease Just study
1. Any portion: Lips to anus 2. Anal involvement is common 3. Relative rectal sparing 4. Creeping fat 5. Non-caseating granuloma
31
Features of Ulcerative colitis Just study
1. Rectum -> Pancolitis -> Backwash ileitis 2. Continuous lesion 3. Anal involvement uncommon 4. Inc risk of toxic megacolon 5. Mucosal/Submucosal involvement -> Pseudopolyps
32
Transmural involvement seen in
Crohn’s disease 1. Strictures 2. Colovesical/colovaginal fistulae
33
C/F of Crohn’s disease
1. Mimics acute appendicitis 2. Abdominal pain + diarrhea
34
C/F of Ulcerative colitis
1. Bloody diarrhea 2. Toxic megacolon
35
Diagnosis of IBD
Biopsy
36
Radiological sign of Crohn’s disease
String sign of Kantor: 1. Terminal ileum stricture 2. Also seen in TB
37
Radiological sign of Ulcerative colitis
Toxic megacolon (Diameter >6 cm) -> Inc risk of perforation
38
Surgical management of Crohn’s disease
Conservative resection (Inc resection -> Short bowel syndrome)
39
Surgical management of Ulcerative colitis
Total proctocolectomy + Ileocanal pouch anastomosis
40
Extra intestinal manifestations of IBD
1. Erythema nodosum 2. Primary sclerosing cholangitis 3. Episcleritis, uveitis 4. Ankylosis spondylitis (A/w HLA B27)
41
Indications for Sx of IBD
1. Not responding to medical Mx 2. Steroid toxicity 3. Complications of IBD 4. Extra intestinal manifestations
42
Types of Colonic polyps
1. Inflammatory 2. Hamartomatous 3. Adenomatous
43
Types of Hamartomatous polyps
1. Single juvenile polyp: Not premalignant 2. Juvenile polyposis: Inc risk of cancer
44
Hamartomatous polyps are seen in
Peutz Jegher syndrome
45
M/C location of Peutz Jegher syndrome
Jejunum
46
Gene involved in Peutz Jegher syndrome
STK II (Chr 19)
47
Peutz Jegher syndrome inc risk of
1. Pancreatic cancer 2. Duodenal cancer 3. Thyroid cancer 4. Colonic cancer
48
M/C presentation of Peutz Jegher syndrome
Intussusception

Surgery (12 decks)

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