Lecture 13: Intro GI surgery

Question 1

indications for surgical intervention in lower GIT?

Answer 1

IBD refractory, abscess, GI obstruction, malignant masses, acute emergencies

Question 2

what is an abscess?

Answer 2

collection of pus indicative of infection

Question 3

when remove part of GIT, fxn is inhibited and changes in ______ which impact ___ status

Answer 3

motility, absorption, waste handling; nutritional

Question 4

fluid absorptive capacity of bowel is about ___ L

Answer 4

9.2

Question 5

determinants of fluid absorption in GIT?

Answer 5

SA, luminal osmolarity, mucosal integrity, motility

Question 6

which surgery is preferred: laparoscopic or open?

Answer 6

laparoscopic (minimal scarring, wound healing, less recovery time needed)

Question 7

procedure to remove all or part of large intestine

Answer 7

colectomy

Question 8

what is proctocolectomy?

Answer 8

removal of both colon and rectum

Question 9

most common nutrition considerations after colon surgery

Answer 9

diarrhea, dehydration

Question 10

nutrition therapy after colon surgery?

Answer 10

maintain hydration/electrolyte repletion, consume easily digested foods, normal diet as tolerated

Question 11

what is an ostomy?

Answer 11

surgically created opening from intestine to skin

Question 12

what is a stoma?

Answer 12

artificial opening made into abdomen to divert flow of feces and/or urine (usually left side of body)

Question 13

restorative proctolectomy with ileal pouch anal anastomosis is also called:

Answer 13

J pouch (small intestine attached to anus)

Question 14

why give ileostomy?

Answer 14

give rest of bowel time to heal, then can reverse (common in UC)

Question 15

probs with ostomies?

Answer 15

irritation, odour and gas control

Question 16

do colostomies need specialized diet?

Answer 16

no, just smaller portions and cook foods well, chew thoroughly

Question 17

hydration can be an issue in ____ colostomy

Answer 17

ascending

Question 18

foods that may control odor?

Answer 18

buttermilk, cranberry juice, orange juice, yogurt, parsley, spinach, tomato juice

Question 19

___ valve controls rate of mvmt from small intestine to colon

Answer 19

ileocecal

Question 20

biggest discharge output (liquid/paste like discharge) and probs w/ food blockage associated with this type of ostomy:

Answer 20

ileostomy

Question 21

colostomies usually start functioning ___ days post surgery

Answer 21

2-5

Question 22

ileostomies start function ___h after surgery

Answer 22

24

Question 23

considerations for diet in ileostomy?

Answer 23

^ fluid, liberalize salt consumption, consider oral electrolyte replacement solution if output >1L/d, foods to thicken stool

Question 24

gas and odours more of a concern with which type of ostomy?

Answer 24

colostomy

Question 25

examples of gut slowing meds to use for ileostomies?

Answer 25

loperamide (imodium)

Question 26

an abnormal opening or passage between two internal organs or from an internal organ to surface of body (skin or wounds)

Answer 26

GI fistulas

Question 27

types of fistulas are classified by:

Answer 27

localization/anatomical location, physiology, etiology

Question 28

what is an internal fistula?

Answer 28

abnormal communication between adjacent hollow viscera

Question 29

what is enterocutaneous fistula?

Answer 29

abnormal communication/passage between GI tract and surface of skin

Question 30

spontaneous fistula are ___% of fistulas and caused by:

Answer 30

10-25; crohn's, cancer, diverticulitis, radiation enteritis

Question 31

surgical fistula are ___% of fistulas and caused by:

Answer 31

75-90; iatrogenic lesion(sutures), anastamotic failure, surgical wound dehiscence

Question 32

traumatic fistula are ___% of fistulas and caused by:

Answer 32

<5; diagnostic intervention(puncture), trauma/accident, gunshot, stab

Question 33

high output fistula is > ___ mL/24 h

Answer 33

500