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IBD surgical
WOCN program
| Question | Answer |
|---|---|
| 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
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