Spørsmål Flashcards
(26 cards)
- Disorders of esophageal motility(types, pathological background)
- Achalasia (unknown, Chagas’ disease)
- Diffuse esophageal spasm (unknown)
- Segmental esophageal spasm (unknown)
- Scleroderma
- Hypertensive LES
- Indications and contraindications for upper GI diagnostic endoscopy
Elective:
-Gastroscopy (dysphagia, pain, heartburn, weight loss)
- ERCP (biliary tree obstruction)
- Colonoscopy (blood in stools, anemia, changes in bowel habits)
Emergency:
-Gastroscopy (bleeding, foreign bodies, burns)
-ERCP (biliary pancreatitis, cholangitis, biliary/pancreatic fistula)
CI:
Patient refusal
Active colonic diverticulitis
Perforation
- Hiatal hernia; types, symptoms, indications for treatment
Displacement of the stomach (cardia or fundus) or other intraabd. organs into the chest through an esophageal hiatus.
Types:
1.Sliding hernia: most common, asymptomatic in 70-80%, sympt same as for GERD, no treatment needed.
2.Paraesophageal/rolling hernia: part of stomach herniates and lies beside the esophagus. Can incarcerate, surgery needed.
3.mixed: surgery needed
4.Complex: involvement of other organs. Usually after trauma
Symptoms: 2-4: chest pain, GERD, acute symptoms (strangulation, necrosis, mediastinitis)
Treatment: Nissen fundoplication: indicated for type 2-4, acute symptoms, intractable symptoms, weight loss, recurrent stricture and barrets esophagus.
- Conservative management of GERD
Medical therapy is indicated for all patients initially, and those unfit/refusing surgery.
Life style changes: avoid alcohol and smoking, weigh loss, some drugs osv.
Meds: PPIs, antacids, H2 blockers.
Propulsive agents(cisapride, metoclopramide)
Improve LES tone(bethanectol)
- Principles of surgical management of GERD
Indication: Complications despite proper conservative management, younger patients, symptoms other than heart burn, hernia.
Goal: restore high pressure zones
NISSEN fundoplication! (5-10% recurrence)
- Complications of anti reflux surgery
- Perforation
- Bleeding
- Pneumothorax and pneumomediastinum,
- Splenic injury
- Mechanical failure
- Recurrence of symptoms
- Dysphagia/inability to belch or vomit
- Fundal wrap displaced upwards or downwards (acute pain)
- Symptoms of gastroduodenal disorders and their clinical association
- Epigastric pain, fullness, discomfort: peptic ulcer
- Loss of appetite, early satiety, anorexia: cancer, gastroparesis
- Heart burn, regurgitation: GERD, Zolinger-Ellison syndrome
- Bleeding and anemia: peptic ulcer, cancer
- Weight loss: cancer
- Indications for surgical treatment of peptic ulcer disease
- Complications
- Failure to respond to medical treatment/recurrent ulcer disease
- Causes of jaundice in surgical patients
- Hemolysis
- Hepatitis
- Mechanical
- Damage to biliary duct
- Complications of biliary stones
- Cholesystitis
- Empyema
- Hydrops
- Perforation -> peritonitis
- Acute pancreatitis
- CBD lithiasis
- Biliary-enteric fistula and gallstone ileus
- Necrosis
- Cancer
- Indications and methods of treatment of cholelitiasis
Indications for surgery: - Symptoms (biliary colic) Exceptions to perform surgery: - Other abd. operation - Planning pregnancy or travelling - Before cardiac surgery (anticoagulation will make surgery difficult) - Immunosupression - Calcified or porcelain gallbladder Treatment: (surgery should be done within 72hr or after 4-6 weeks) - Cholecystectomy (lapraroscopic>>open) - Lithotrypsy - Cholic acids - Chemical dissolution
- Detection and management of CBD lithiasis
Diagnosis: - History of jaundice - Suspicion from US(dilation of ducts, stones in GB) - Elevated bilirubin, AP, GGT Treatment: 1. ERCP, then: - Cholecystectomy - Choledochotomy (opening the duct) - T-tube placement
- Complications of biliary sugery
- Biliary tree injury
- Would infection
- Wound dehiscence
- Incisional hernia
- Intraabdominal abcess
- Intestinal fistula
- Intestinal obstruction (adhesions, abscess)
- Complications of inflammatory bowel disease
Crohns: - Fistula - Obstruction/stricture UC: - Toxic megacolon - Perforation Both/unspecific colitis: - Perforation - Urologic complications (due to fistula) - Hemorrhage and anemia - Growth retardation - Cancer Extraintestinal manifestations: - Osteoporosis - Ankylosing spondylitis - Erythema nodosum - Sclerosing cholangitis (UC>Crohns) - Colorectal cancer (UC>Crohns)
- Indications for surgery in patients with inflammatory bowel disease
- Complications (perforation, toxic megacolon, bleeding, fistula)
- No response to medical therapy
- Large bowel diverticula; types, symptoms, complications, treatment
Types: True, false (left sided - acquired, right sided - congenital.
Symptoms: Cramping, bloating, constipation. If infected: pain(LLQ), N/V, fever, rectal bleeding
Complications: Bleeding, diverticulitis (–> fistula, abscess, peritonitis osv)
Treatment: Emergency bleeding: -left hemicolectomy
Diverticulitis: Conservative (AB), CT/US guided drainage if abscess, bowel resection (hartmans procedure) if perforation/peritonitis.
- Methods of assesment of the bowel; pros and cons
Endoscopy: Pros: - Method of choice for large bowel - Biopsy possible - High accuracy in detection of small mucosal lesions (sometimes therapeutic - f.ex removal of polyps) Cons: - Not good for small bowel - Sometimes difficult to assess right colon - No assessment distally to stricture - Complication - Discomfort - Cost X-ray: Pros: - Method of choice for small bowel - Well tolerated - Good assessment of anatomic relations - Visualization of whole organ, even distally to stricture - Minimal risk of complications Cons: - No biopsy possible - Low accuracy for small mucosal lesions - Barium should not be used in emergency (if perf. present can cause peritonitis) CT: - Good for diverticulitis
- Indications for diagnostic evaluation of the large bowel
Endoscopy:
- Abnormality noted on barium enema
- Inflammatory bowel disease (evaluation and surveillance)
- Diverticular disease
- Cancer + screening for cancer
- GI symptoms: change in bowel habits, bleeding, pain, iron deficiency anemia, abnormalities found in stools
- Reduction of sigmoid volvulus
- Clinical and pathological features of Crohns disease
Pathology: - Transmural inflammation - Skip lesions - Anal/perianal disease - Fistulas/abscesses - Granuloma Clinical: - Cramping abd. pain (due to strictures) - Diarrhea - Malaise, fever, weight loss, leukocytosis - Obstruction from bowel stricture
- Clinical and pathological features of UC
Pathology: - Mucosal inflammation (continuous, not transmural, rectum always included) - No anal/perianal disease - No small bowel involvement - Crypt abscesses and pseudopollyps Clinical: - Diarrhea w/ blood and or mucus - Cramping abd. pain - Malaise, fever, weight loss, anemia - Toxic megacolon
- Surgical treatment of inflammatory bowel disease
Crohns:
- Indications: Complications, no response to medical therapy, fistula
- Smallest resection possible (no chance of curing the disease)
- Severe rectal disease: total proctocolectomy with ileostomy
- Stricturoplasty
UC:
- Indications: complications, no response to medical therapy
- Proctocolectomy with anal sphincter preservation and ileal J-pouch (needs temporary ileostomy which is closed after 10 weeks)
- Total proctocolectomy with ileostomy
- Treatment of perianal abscess
- Incision and drainage (AB is inappropriate! Only given to immunocompromised patients)
- 50% will be cured, 50% will develop anorectal fistula
- Perianal fistulas; etiology, management
- Communication between an anal crypt and the perianal skin
- Classification: supra-/inter-/trans-/extrasphincteric
Etiology: - Obstruction of anal gland which leads to stasis and infection with abscess and fistula formation (most common)
- Iatrogenic (hemorrhoidal surgery)
- IBD (crohns >UC)
- Infections
- Malignancy
Treatment: - Identify both openings and open the tract by fistulotomy, leave open –>granulation
- Colorectal cancer - epidemiology and symptoms
Epidemiology:
- Increasing in incidence (slight more males)
- 3rd most lethal cancer in both sexes
- Onset usually >50years, incidence increase with age
- Frequent multiple foci
Symptoms:
- Blood in stools
- Changes in bowel habits
- Pain, distention
- Acute abdomen (perforation, bleeding, obstruction)
Right sided:
- Melanotic stools
- Iron deficiency anemia
- Right-sided mass
Left sided:
- Change in bowel habits (diarrhea, constipation, consistency, shape)
- Fresh blood in stools
- Cramping pain due to partial obstruction
