Surgery For IBD Flashcards
(17 cards)
What are the elective indications for surgery in UC?
Disease requiring maximal therapy or prolonged courses of steroids
Elective surgery is considered when medical management is insufficient.
What is the risk associated with longstanding UC?
Malignant transformation
Dysplastic transformation of colonic epithelium is linked to cancer risk.
What is an absolute indication for proctocolectomy?
Dysplastic transformation of the colonic epithelium with associated mass lesions
This indicates severe changes in the tissue that may lead to cancer.
How should emergency presentations of poorly controlled colitis be managed?
Subtotal colectomy
This approach is taken when medical therapy fails.
What is the typical procedure for the rectum during subtotal colectomy?
Subtotal colectomy removes most of he colon and leaves the rectum and mainly intact. The rectum is Stapled off and left in situ or brought to the surface as a mucous fistula
The method depends on the condition of the bowel.
What is the incidence of DVT in patients with IBD?
High incidence
This necessitates appropriate thromboprophylaxis.
What is a restorative option in UC?
Ileoanal pouch a J pouch replacing the rectum after its removal, allowing for the storage of stool until it can be passed through the anus
This can only be performed while the rectum is in situ.
What are some complications associated with ileoanal pouch?
- Anastomotic dehiscence
- Pouchitis
- Poor physiological function with seepage and soiling
These complications can significantly affect patient quality of life.
Does surgical resection of Crohn’s disease equate with a cure?
No
Surgery may provide symptomatic improvement but is not a definitive cure.
What are the indications for surgery in Crohn’s disease?
- Complications such as fistulae
- Abscess formation
- Strictures
Surgical intervention is typically reserved for these severe complications.
What can extensive small bowel resections lead to?
Short bowel syndrome
This condition results from the loss of significant bowel length.
What is the preferred method for managing complex perianal fistulae?
Long term draining seton sutures
Attempting closure may lead to complications.
What may severe perianal and/or rectal Crohn’s require?
Proctectomy
This is a more drastic surgical option when other treatments fail.
What is the risk associated with ileoanal pouch reconstruction in Crohn’s disease?
High risk of fistula formation and pouch failure
This is why it is not recommended in Crohn’s cases.
What is the commonest disease site in Crohn’s disease?
Terminal ileum
Limited ileocaecal resections can be performed for treatment.
How does terminal ileal Crohn’s affect bile salt recycling?
It may affect enterohepatic bile salt recycling and increase the risk of gallstones
This can lead to additional complications.
