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GI Surgery 1


Appendicitis: Pathophys: hyperplasia (kids); fecalith (adults); also neoplasm, parasite
Appendicitis prevalence 7% genl (mostly teens); 20% mort in elderly
Appendicitis: most common (first) sx anorexia
Appendicitis: complications Wound infxn; Dehiscence; Bowel obstruction; Peritoneal abscess; Stump appendicitis
Appendicitis: pt mgmt Laparoscopic appendectomy; after 24-48 hr (prob ruptured): percutaneous drainage & Abx; interval appy after 4 wks
Gold standard for dx appendicitis CT (>7 mm & >2mm thick = appy)
Imaging used for appy in kids: US
Cholecystectomy: performed for: cholelithiasis, cholecystitis, gallstone pancreatitis, GB cancer
Gall stones: Etiology related to: increasing conc of cholesterol (chol stones: 80%) or bile salts (pigments stones: 15%)
Gall stones: 4 Fs female, fertile, fat, forty
Cholecystectomy: prevalence US: 10-20% of popn develop gallstones; 60-80% of pts w/ gallstones never develop sx
Gall stones: sx Abd pain, jaundice, fever
Gall stones: dx imaging US best; plain films only 15%; CT; HIDA (dye)
Cholecystitis = stone in neck (cystic duct); GB cannot drain
Cholangitis = obstr GB as well as fr L/R ducts (common bile duct cannot drain)
Gall stone Pancreatitis = obstr ampulla; have obstruction of pancreas: both Panc duct and common bile duct (can be surg emergency)
Procedure of choice for GB dz Laparoscopic Cholecystectomy
Cholecystectomy: complications Common bile duct injury (often w/ lap); retained stones (ERCP); Bile leak; Hemorrhage; abscess, bowel injury, wound infection
Abd hernia defn protrusion of extraperitoneal fat, peritoneum, omentum, bowel, or other viscera thru a defect in transversalis fascia
Abd wall anatomy (in order): Skin; SubQ Tissue; Ext Oblique Fascia; Cremasteric Fibers; Spermatic Cord; Transversus Abdominus Aponeurosis; Transversalis Fascia; Preperitoneal Tissue; Peritoneum
Hesselbach triangle rectus sheath, Inf epigastric vessels, Inguinal lig
Direct inguinal hernia: directly thru inguinal triangle (do not occur in infants)
Indirect inguinal hernia: abd viscera pass thru internal ring within a patent processus vaginalis
Femoral hernia: more common in elderly women; can become incarc / strangulated (repair early); medial to vessels, inferior to inguinal lig
Epigastric hernia: occur thru midline defects in fascia in upper abdomen
Sliding hernia: a viscus forms an integral part of the wall
Incisional hernia: recurrent by definition
Spigelian hernia: lateral to rectus sheath
Grynfeltt’s/Petit’s hernia: posterior hernias (lumbosacral area)
Internal hernia: Rare; typically occurs thru openings in mesentery or ligaments within the peritoneum; usu strangulated (repair early)
Umbilical hernia: usu congenital; or PG, obese, ascites;
Hernia: imaging useful in obese pt CT
Hernia: Incarceration inability to reduce hernia contents
Hernia: Strangulation compromise of intestinal vascular supply; secondary to incarceration
Open hernia repair: most common complications wound related / infxn; testicular; urinary
Hernia post-op recurrence by type: recurrent (5-35%); direct (4-10%); indirect, femoral (each 1-7%)
Purpose of onlay prosthetic mesh when repair causes undue tension; bridges gap btw margins of hernia aperture
Laparoscopic vs open hernia repair More expensive; longer op time; higher risk of rare serious comp; dec postop pain / numbness; quicker time back to work; equivalent recurrence
Bassini surg for: direct / indirect inguinal
Coopers surg for: direct, lg indirect, recurrent
Surg: femoral hernia inguinal canal approach; open preperitoneal; or lap
Surg: incisional hernia usu open
Created by: Adam Barnard Adam Barnard