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Flashcards in Surgery for IBD Deck (22):
1

What is a fistula

An abnormal communication between two epithelial surfaces

2

What is an anastomosis

The reconnection of two streams that previously branhced out, such as blood vessels

3

What 5 reasons might elective surgery be required in Ulcerative colitis

Medically unresponsive disease (cant't get off steroids)
Intolerability
Dysplasia / malginancy
Growth retardation in children
Attempted resolution of extra-intestinal disease

4

What are the operation types for UC

Elective proctocolectomy
with end ileostomy
With a pouch
Ileorectal anastomosis

5

What is the appearance of a colostomy

Usually on the left side
Usually flush with the skin
Stool usually comes out of it

6

What is the appearance of an ileostomy

Usually on the right
Usually spouted
Usually effluent

7

Why would a patient have pouch

Instead of having a stoma
usually for younger patients who are more likely to be self conscious

8

What are the 3 different types of pouches that can be created

W pouch
J pouch
S pouch

9

What are the functional outcomes of a pouch

6 bowel movements a day
some minor incontinence
20% nocturnal incontinence
50% nocturnal leakage and spotting for the first 6 months
Pouch failure 10% at 10 years to be reversed to an ileostomy

10

What are some long term complications of a proctocolectomy

Impotence
Infertility
Pouchitis

11

What does the Truelove and Witt Criteria Assess

The severity of IBD

12

What is assessed in the Trulove and Witt criteria

ESR
Haemoglobin
Bloody stools
temperature
heart rate

13

What is a subtotal colectomy

First aid operation that can be done lap or open depending on the expertise

14

How often do patients have a colonoscopy in IBD and why?

every 10 years post diagnosis because there is an increased risk of colorectal cancer

15

What is Rigler's sign

Gas on the outside of the bowel wall

16

What are the symptoms of toxic megacolon

Sepsis
Pain
Distension

17

What are the complications of toxic megacolon

May perforate
Can be fatal
requires urgent decompression

18

How successful is surgery for UC

Generally the patient is cured and does not need further surgery

19

How successful is surgery for Crohn's

Not very - most require further surgery in the future

20

What makes surgery more difficult in Crohn's disease

Immunosuppressive therapy
Biologicals cause increased sepsis
Steroids impact on healing

21

What is one of the largest dilemmas in Crohn's disease surgery

Whether the appendix is removed or left in place

22

Slide

31

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