Category Archives: Topics

Inflammatory Bowel Disease – Topics in General Surgery

Colon Cancer, Crohn's Disease, Inflammatory Bowel disease, Topics, Ulcerative Colitis

Inflammatory Bowel Disease = Crohn’s disease and Ulcerative Colitis.

Crohn’s Disease

  • Mouth to anus
  • Skip areas
  • Full thickness
  • Anal involvement common (fistulas, abscess, fissures, ulcers)
  • Cancer risk less than that of ulcerative colitis

Ulcerative Colitis

  • Bloody diarrhea
  • Colon only
  • Anal involvement is rare
  • Always involves the rectum and spreads proximally (no skips)
  • mucosa, submucosa (not full thickness)
  • 20% risk of colon cancer after 20 years of disease

 

Normal Lab Values – Topics in General Surgery

Topics

To help remember these numbers I’ve simplified the ranges.  Please look up these actual values in other sources, these numbers are just easier to remember without a written reference.  These are just crude numbers within the normal range.  The units have also been left off.  So this really is not a reliable source of info.

Amylase = 100

BUN (Urea Nitrogen) = 15

Bilirubin Total = 1

Calcium = 10

Creatinine = 1

Sodium = 140

Chloride = 100

Potassium = 4

Bicarbonate = 25

Magnesium = 2

WBC = 10

Phosphorus = 4

Upper GI Bleeding – Topics in General Surgery

Topics, Upper GI Bleeding

Upper GI (gastrointestinal) Bleeding

  • bleeding proximal to the ligament of Trietz
  • Most common cause of UGI bleeding is Duodenal Ulcer (25%), Gastric ulcer (20%), Acute Gastritis (15%)
  • EGD is the diagnostic test of choice with UGI bleeding

Peptic Ulcer Disease

  • Both gastric and duodenal ulcers

Duodenal Ulcers

  • Caused by increased gastric acid production
  • ZE syndrome (zollinger ellison) is a risk factor

Surgeries for duodenal ulcers

  • Graham patch
  • Truncal Vagotomy and pyloroplasty
  • Truncal Vagotomy and antrectomy with Billroth I (one limb off the stomach remnant)
  • Truncal Vagotomy and antrectomy with Billroth II (2 limbs off stomach remnant)
  • Proximal gastric vagotomy (Highly selective)
  • Truncal Vagotomy – removal of a segment of vagal trunk on the distal esophagus, this decreases gastric acid secretion
  • Drainage procedure is needed with Truncal Vagotomy

Gastric Ulcers

  • Due to decreased cytoprotection, gastric acid is usually normal or low.
  • Most of  the gastric ulcers (70%) are on the lesser curvature.  5% is on the greater curvature.
  • With all gastric ulcers, must rule out gastric cancer  – need biopsy

Mallory Weiss Syndrome

  • Postemesis longitudinal tear
  • Do not use sengstaken-blakemore balloon

Esophageal Variceal Bleeding

  • Need to verify bleeding with EGD.  Only 50% of UGI bleeding in patients with known Esophageal Varices are bleeding from varices.
  • Treatment:  sengstaken-blakemore balloon, Liver transplant, shunts (ie. Warren)

Lower GI Bleeding – Topics in General Surgery

Lower GI Bleeding, Topics

Lower GI Bleeding

  • Distal to ligament of Treitz
  • Most common causes of lower GI bleeding:  1. Diverticulosis (usually right sided), 2. Vascular ectasia
  • Must rule out upper GI bleeding with lower GI bleeding.  Use NGT aspiration and/or EGD.
  • If massive bleeding – consider angiogram
  • If slow bleeding – consider colonoscopy
  • If colonoscopy is negative consider tagged RBC study
  • tagged RBC scan (radiolabeled) can detect bleeding at a rate of 0.1 ml/Min
  • Angiogram detects 1ml/Min