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IBD surgical

WOCN program

QuestionAnswer
List the conditions that require immediate surgery for UC and CD obstruction, hemorrhage, toxic megacolon, perforation, fulminant attack that doesn't respond to medical treatment, sepsis
Identify indications for surgery for person with CD intolerance or failure to respond to medical therapy, EIM's that don't respond, failure to thrive, improve QOL, cancer, abscess, fistula, perianal disease, and emergent reasons
What is the most common indication for surgery for person with CD bowel obstruction or obstructive uropathy
Explain the surgical procedure for obstruction caused by CD in the small intestine stricturoplasty
What is the surgical procedure for the patient with extensive CD involving anorectal disease that will provide long term results proctocolectomy with ileostomy
Discuss when a subtotal colectomy may be performed critically ill pt, toxic megacolon, less severe colitis, severe colonic hemorrhage
What is the preferred treatment for ileocolitis segmental resection
What is IPAA ileal pouch anal anastomosis
Discuss the controversy over the surgical procedure IPAA for the person with CD high failure rate in CD, recurrence in sm bowel or pouch
What is the gold standard treatment for UC IPAA/restorative proctocolectomy
What are the advantages of laparoscopic procedure shorter hospital stay, faster recovery, fewer infections or complications (adhesions, hernias) , decreased incidence of SBO, better QOL, pt's more satisfied
Describe the indications and surgical procedure for stage 1, 2, and stage 3, and IPAA subtotal colectomy w/hartmann's pouch left, temp ilostomy, creation of ileal pouch & loop ileostomy, restore continuity
What is the average stool frequency one month postop IPAA procedure 7.5 stools a day with some night time leakage
What complications can develop following IPAA pouchitis, cuffitis, fistulas, perianal dermatitis, dehydration, rectal cancer
What is the importance of performing a mucosectomy with the IPAA to reduce the risk of cancer
What type of teaching will the patient with a Kock procedure require medina tube will be in place to drainage for 24 days, will flush TID, start clamping at 14 days, stoma intubation, problem solve for flushing and intubation
What is an indication for the continent ileostomy (Kock procedure) failed IPAA, poor sphincter tone, low rectal cancer, pt preference, complications with end ileostomy
What operation for CD of colon has the lowest recurrence rate proctolectomy with end ileostomy
What are two procedures that are controversial in the treatment of crohn’s colitis due to high recurrence rate IPAA and continent ileostomy
Why is strictureplasty particularly useful in patients with multiple strictures preserves bowel length
Where does recurrence most commonly occur after total proctocolectomy with ileostomy stoma site (terminal ileum)
Why is a cautious surgical approach taken in obese patients with UC need to have enough mesenteric length to have no tension, obesity increases tension on anastomosis
Why is the assessment and management of high output from the loop ileostomy following IPAA critical can become dehydrated easily, could have pouch failure
What is the most common complication following IPAA pouchitis
What is the drug of choice for the treatment of pouchitis in ileoanal anastomosis patient metronidazole
What is a continent ileostomy Kock pouch, nipple/valve that is accessed via catheter for drainage periodically during the day
What are advantages of stapled IPAA less nighttime incontinence right away, easier to perform, fewer complications, muscle cuff removed so there is less risk for infection in that area
Which type of IPAA leaves the ATZ intact stapled
what is the primary site of CD ileocecal ileocolic
what is the procedure of choice for CD of small intestine stricturoplasty
what is stricturoplasty not indicated for colonic strictures, perforation, fistulas multiple strictures within a small segment
which patient would be the most likely candidate for surgery for CD involving a proctocolectomy with permanent end ileostomy pt with pancolitis or extensive colorectal CD.
when explaining the procedure for laparoscopic ileocolic resection for CD what should be stated as an advantage/disadvantage over open surgery faster recovery, shorter hospital stay, fewer complications, better cosmesis
what is the guiding principle for surgical management of CD goal is to preserve length and function
what surgical procedures can be done for UC Proctocolectomy with end ileostomy, IPAA/Restorative proctocolectomy, Continent ileostomy “Kock pouch”
what treatment is definitive therapy for UC total proctocolectomy and end ileostomy
when is colonoscopic surveillance for adenocarcinoma is recommended for a pt with UC 8-10 years after diagnosis
what intervention would be one of the recommendations from the nurse for a pt who has a nonhealing perineal wound pressure redistribution seating, very warm sitz baths
what post surgical complication would be possible after creation of an ileal anal pouch anastomosis using stapled technique cuffitis
if a pt with CD develops severe perianal disease and sepsis of the rectum and anus, what procedure would be expected to done subtotal colectomy
if a pt recovering from IPAA (post stoma closure) says she has been having cramping and large amt watery stools, what complication of surgery would be suspected pouchitis
what surgical procedure is recommended to correct a 12 cm stricture in a pt with CD Finney
what are symptoms of pouchitis flu like symptoms, fever malaise, fatigue, watery stools,
which postsurgical complciation is the major cause of failure in continent ileostomy nipple valve sliding
what surgical procedures can be done for CD Resection, Subtotal colectomy, Segmental resection,Stricturoplasty Total proctocolectomy and ileostomy Restorative proctocolectomy and continent ileostomy
Created by: Beth Perry