Procedures

Question 1

define a appendidectomy

Answer 1

surgical removal of the veniform appendix

Question 2

summarise the indications for an appendidectomy?

Answer 2

normally performed as emergency procedure for acute appendicitis

Question 3

what are the possibel complications of an appendidectomy?

Answer 3

bleeding

wound infection

peritonitis

blocked bowels

Question 4

define cholecystectomy?

Answer 4

surgical removal of gallbladder

Question 5

what are the 2 types of cholecystectomy?

Answer 5

laproscopic cholecystectomy: first choice, small incisions made in abdomen

allow insertion of small tubes through surgical instruments and a video camera are placed into abdominal cavity

Question 6

summarise the indications for cholecystectomy?

Answer 6

Gall bladder stones (symptomatic)

Acute cholecystitis

Gallstone pancreatitis

Choledocholithiasis

Cholecystoduodenal fistula

Question 7

what are the complications of cholecystectomy?

Answer 7

Damage to bile ducts which can cause bile leak

Post cholecystectomy syndrome– RUQ pain, dyspepsia, nausea/vomiting

Post site hernia

Bleeding

Infection

Fat intolerancedue to inability to secrete a large amount of bile into the intestine as pt no longer has a gall bladder

Question 8

define a colonoscopy?

Answer 8

endoscopic examination of large bowel and distal part of small bowel

sedation and analgesisa given first-> flexible colonoscope is passed and guided around colon

Question 9

summarise the indications for colonoscopy?

Answer 9

rectal bleeding

iron deficiency anaemia

persistent diarrhoea

biospy of lesion seen on barium enema

assessment or suspicion of IBD

colon cancer surveillance

Question 10

what are the possible complications of a colonoscopy?

Answer 10

Abdominal discomfort

Incomplete examination

Haemorrhage after biopsy or polypectomy

Perforation

Infection

Question 11

how is a flexible sigmoidoscopy different?

Answer 11

covers only sigmoid

requires less bowel prep

less invasive

older patients more tolerant

Question 12

define ERCP?

Answer 12

Endoscopic retrograde cholangiopancreatography – combines endoscopy and fluoroscopy to diagnose and treat problems of biliary or pancreatic ductal systems.

A catheter is advanced from a side-viewing duodenoscope via the ampulla into the common bile duct. Contrast medium is injected and x-rays taken to show lesions in the biliary tree and pancreatic ducts.

Question 13

summarise the indications for ERCP?

Answer 13

No longer routinely used for diagnosis

Significant therapeutic role

• Common bile duct stones
• Stenting of benign or malignant strictures (narrowings)
• Obtaining brushings to diagnose nature of a strictures

Question 14

What are the possible complications of ERCP ?

Answer 14

Pancreatitis

Bleeding

Cholangitis

Perforation

Aspiration pneumonia

Question 15

Define endoscopy?

Answer 15

Procedure in which an endoscope is used to examine the interior of a hollow organ or cavity in the body.

NBM 6 hours before + prokinetic (e.g. metoclopramide) given 1 hour before

Question 16

what are the different types of endoscopy?

Answer 16

Oesophagus, stomach and duodenum = oesophagogastroduodenoscopy (OGD) aka upper GI endoscopy

Small intestine = enteroscopy

Large intestine/colon = colonoscopy, sigmoidoscopy

Bile duct = ERCP

Rectum (rectoscopy) and anus (anoscopy) = both is proctoscopy

Question 17

summarise the indications for an endoscopy?

Answer 17

Haematemesis

New dyspepsia (if >/= 55 y/o)

Gastric biopsy

Duodenal biopsy

Persistent vomiting

Iron deficiency

Note – these are all indications for upper GI endoscopy

Question 18

what are the possible complications of an endoscopy?

Answer 18

For upper GI endoscopy

• Sore throat
• Amnesia from sedation
• Perforation
• Cardiorespiratory arrest
• Bleeding

Question 19

Define enteral nutrition?

Answer 19

nutrition given into the GI tract

if possible-> given by mouth- if danger of choking/aspiration, semi-solid diet to be considered

Question 20

what is tube feeding?

Answer 20

liquid nutrition via tube-> placed endoscopically, radiologically or surgically directly into stomach

Question 21

what is parenteral nutrition?

Answer 21

Intravenous nutrition given through a central venous line

Question 22

what are the indications for enteral feeding?

Answer 22

MALNUTRITION

• Increased nutritional requirements e.g. sepsis, surgery
• Increases nutritional losses e.g. malabsorption
• Decreased intake e.g. dysphagia, nausea, sedation, coma
• Effect of treatment, e.g. nausea, diarrhoea
• Enforced starvation e.g. prolonged NBM period
• Difficulty with feeding
• Unappetising food

Question 23

What are the indications for parenteral nutrition?

Answer 23

• GI tract not functioning e.g. bowel obstruction
• Poor absorption e.g. short bowel syndrome or active Crohn’s
• High risk of malnutrition

Question 24

what are the complications of enteral nutrition?

Answer 24

Aspiration

Question 25

what are the complications of parenteral nutrition?

Answer 25

**Sepsis** **Thrombosis of central vein leading to pulmonary embolism or superior vena caval obstruction** **Metabolic imbalance** **Refeeding syndrome** * Low potassium, magnesium and phosphate as a large release of insulin in refeeding syndrome causes a rapid shift of K+, Mg2+ and PO4- into cells **Mechanical issues such as pneumothorax, embolism of IV line tip**

Question 26

what monitoring is essential for patients on parenteral nutrition?

Answer 26

**Check Temperature, obs and line regularly-\> possible line infection** **monitor blood glucose**-\> TPN has high sugar content , even those with no history of diabetes can develop significant blood sugar derangement on TPN -\> increases the risk of line infection **Fluid balance-\>** goes wrong for those on TPN, either because losses (from NG, fistula, high output stoma etc.) are not adequately corrected on top of the TPN volume, or because people forget that the TPN contains a significant amount of fluid (usually about 1.5 litres) and overprescribe standard IV fluids in addition. As TPN patients often have difficult fluid balance, with high losses, third space fluid accumulations etc. **Electrolytes -**\> GI fluid contains a lot of electrolytes in particular Na, K and Mg. Additionally electrolytes can be dramatically affected by refeeding syndrome

Question 27

define laproscopic abdominal surgery?

Answer 27

**Aka keyhole surgery or laparoscopy** **A procedure performed in the abdomen or pelvis through small incisions with the aid of a camera**

Question 28

state an advantage of laproscopic abdominal surgery?

Answer 28

**minimally invasive so reduced pain, reduced risk of hemorrhaging and shorter recovery time, smaller scar, fewer wound-related infections**

Question 29

summarise the indications for laproscopic abdominal surgery?

Answer 29

* **To diagnose conditions such as pelvic inflammatory disease, endometriosis, ectopic pregnancy, appendicitis, liver cancer, pancreatic cancer, ovarian cancer, cancer of bile duct and gallbladder** * Appendicitis * To remove gallbladder * Resection of intestine e.g. in Crohn’s * Hernia repair * Repairing stomach ulcers * Weight loss surgery * Removing organs affected by cancer * Treating ectopic pregnancy * Hysterectomy

Question 30

what are the possible complications of laproscopic abdominal surgery?

Answer 30

Trocar injuries during insertion Accidental damage to other intra-abdominal organs Risk of conversion to open procedure

Question 31

define open abdominal surgery?

Answer 31

**Broad term including any procedure which involves opening the abdomen – appendectomy, Caesarean section, inguinal hernia surgery, laparotomy**

Question 32

what is a laparotomy?

Answer 32

surgical procedure involving a large incision through the abdominal wall to gain access into the abdominal cavity

Question 33

what are the indications for a laparotomy?

Answer 33

Rupture of an organ e.g. spleen, aorta, ectopic pregnancy Peritonitis (perforation of a peptic ulcer/duodenal ulcer, diverticulum, appendix, bowel, gallbladder)

Question 34

what are the possible complications of open abdominal surgery?

Answer 34

* Adhesions – fibrous bands which form between tissues and organs * Bleeding * Infection * Paralytic ileus * Shock * Incisional hernia (20%) * Post op ileus: bowels basics going on a strike after surgery so must wait until they fart or pass stool so you know their bowels are working

Question 35

define nasogastric tube insertion?

Answer 35

**A medical procedure for gastric intubation via the nasal passage, to provide access to the stomach for diagnostic and therapeutic purposes.** Tubes passed into the stomach via the nose and drain externally Large are good for drainage but can be uncomfortable for patients. Small are more comfortable for feeding but can be difficult to aspirate and are poor for drainage.

Question 36

summarise the indications for NG tube insertion?

Answer 36

To decompress the stomach/GI tract especially when there is obstruction e.g. ileus For gastric lavage To administer feed/drugs

Question 37

what are the possible complications of NG tube insertion?

Answer 37

**Pain** **Rare: loss of electrolytes, oesophagitis, tracheal/duodenal intubation, necrosis (retro/nasopharyngeal), stomach perforation**