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Year 6 - Surgery > Intro Wk: GI > Flashcards

Intro Wk: GI Flashcards

1
Q

What are the three branches of the coeliac axis?

A

Left Gastric, Hepatic, Splenic

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2
Q

Where does the right gastric artery come from?

A

Hepatic

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3
Q

What are the three branches of the superior mesenteric artery?

A

Right Colic, Ileocolic, Middle Colic

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4
Q

What does the ileocolic artery supply?

A

Terminal Ileum, Caecum, Appendix

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5
Q

What are the three branches of the inferior mesenteric artery?

A

Left Colic, Sigmoid, Superior Rectal

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6
Q

Where are the watershed areas?

A

The second part of the duodenum: junction of the coeliac + SMA

The splenic flexure: junction of the superior + inferior mesenteric arteries

You either leave/take it you don’t anastomose around it

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7
Q

Why is knowledge of the arterial supply so important?

A

You require healthy ends to form an anastomosis + aids lymphadenectomy

Stage histologically, prognostic, chemo requirements

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8
Q

Why do you remove the blood vessels during GI surgery?

A

Lymphadenectomy

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9
Q

What is the indication for a right hemicolectomy?

A

Cancer in caecum, ascending colon, hepatic flexure

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10
Q

How many pple have a right colic artery?

A

5-10%

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11
Q

What blood supply is removed during a right hemicolectomy?

A

Right Colic

Ileocolic

Right branch of middle colic

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12
Q

What anastomosis do we do following a right hemicolectomy?

A

Side to side stapled small bowel to transverse colon

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13
Q

Sigmoid Colectomy vs Hartmann’s

A

Sigmoid Colectomy: only treats benign disease eg diverticular disease or strictures

Ant Resection: tx cancer in the sigmoid and forming a colorectal anastomosis

Hartmann’s: 
emergency
Bowel obstrc
pathology has to be removed and close off the distal sigmoid/rectum and bring out an end stoma
Can be done anywhere along the colon
\+/- reversible in the future
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14
Q

Why is a sigmoid colectomy NOT a cancer operation?

A

It doesn’t harvest every lymph node from the originating vessel but only the sigmoid artery

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15
Q

Anterior Resection vs APER

A

AR: leaves a variable length of rectum and the anus which you can anastomose

APER: removes rectum + anus for when the tumour is on or invading the anal sphincter

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16
Q

What are the requirements for an anterior resection?

A

You have to have a 1cm clearance of healthy bowel b/w tumour and anal sphincter so you can anastomose

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17
Q

What sx do pts complain of if the tumour is low lying?

A

Incontinence, urgency, bleed + the feeling of sitting on something if it’s that low

18
Q

What artery do you take during an AR or an APER?

A

Inf Mesenteric Artery

19
Q

How does the lower part of rectum and anus survive following an AR?

A

It has a dual blood supply: despite the superior rectal artery being removed it still has the inferior rectal artery coming from the pudendal artery

20
Q

Where are the majority of colorectal cancers?

A
  1. Rectum
  2. Sigmoid
  3. Caecum
21
Q

If you have a splenic flexure tumour you can not make an anastomsis here after

A

T

22
Q

What blood supply is removed during a left hemicolectomy?

A

Left Colic

Left branch of middle colic

23
Q

Extended R Hemi > L Hemi

A

Ileocolic, right colic, whole middle colic, left colic

Anastomose ileum to sigmoid colon

Better oncologically

Blood supply to small-large bowel anastomosis is better than large-large

24
Q

Why is a left hemi such a rare operation?

A

The Watershed Area + the difficulty of anastomosing the transverse colon

25
Q

What operation would you op for to tx a transverse colon tumour?

A

Either right hemi or extended right hemi depending where the tumour was along the transverse colon

26
Q

Defunction vs Hartmann’s

A

Both used in the emergency setting likely following bowel obstrc

If the pathology is left in it is NOT a Hartmann’s procedure

The defunctioning stoma is looped small/large bowel to rest the distal bowel before reversing

27
Q

How can you tell which stoma it is?

A

Spouted R - Ileostomy
Flattened L - Colostomy

If it’s on the right side of the abdomen it’ll be small bowel EXCEPT if it’s transverse colon

If it’s on the left side of the abdomen it’ll be large bowel

If still in doubt check the contents of the bag

28
Q

When else would you see a loop

Emerg op

A

After a low anterior resection and you want the anastomosis to heal

29
Q

Ix

A

CT - free air, points of obstrc, thickened bowel
US - hollow viscus w stones

OGD/Colonoscopy
Endoscopy - diagnostic + therapeutic (polypectomy, clip bleeding ulcer, colonic stent as a bridge to surgery)

CTC - order in clinic not acute, less severe bowel prep as colonscopy, leas invasive, virtual colonscopy, can’t take biopsy or polypectomy)

MRI - rectal cancers, solid viscus, high resolution defined tissue planes to determine who requires preop radiotherapy + what requires resection

Laparoscopy - diagnostic, drain cysts, appendectomy

30
Q

What is the telltale sign of a stone on US?

A

It casts an acoustic shadow

31
Q

What do you want to know if a pt has postop pyrexia?

A

The Time of Onset

Day 0-2: tissue damage and necrosis, haematoma formation, pulmonary collapse, infection at site of surgery

Day 3-5: sepsis + pneumonia

Day 5-7: anastamotic leak, fistula formation, DVT/PE

32
Q

How should you ix

A

Hx: cough, sputum, dysuria, freq, calf pain

O/e: wounds, drain sites, chest, abdomen, calves

Ix: cultures + CXR

33
Q

Postop Pain

A

Wound pain vs chest pain

Erythematous, hot, pus

Wound: maximal in first 72hrs but if worsening check for infection

Chest: cardiac retrosternal +/- arm radiation vs pleuritic sharp, localised, worse on inspiration

Abdo: sepsis, leak, urinary retention

34
Q

Urine Output

A

Physiological response to surgery/stress or

prerenal failure, acute renal failure, urinary retention

35
Q

Why TNM

A

Prognostic

Guide whether need adjuvant therapy after surgery

36
Q

How does the TNM and Dukes staging map up together?

A

Duke A = T1-2

Duke B = T3-4

Duke C = N1+

Duke D = M1+

37
Q

How do you examine a stoma?

A

Tbc

38
Q

When is a Whipple’s procedure appropriate for treating carcinoma of the head of pancreas?

A

Only in <20% of pts where no distant metastases and vascular invasion is still at a minimum otherwise perform ERCP and biliary stenting

39
Q

Which part of the colon is retroperitoneal?

A

Ascending, Descending, Rectum

40
Q

What lies on the transpyloric plane?

A

MSK: vertebra L1 and 9th costal cartilage

Vasc: origin of SMA and formation of portal vein

Visceral: pylorus, GB fundus, DJ junction, neck of pancreas and hila of kidneys

Year 6 - Surgery (27 decks)

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