Download - Nir Hus Q 29 30 iv
![Page 1: Nir Hus Q 29 30 iv](https://reader033.vdocuments.site/reader033/viewer/2022061203/546d7651af795997388b6b22/html5/thumbnails/1.jpg)
Q: 29 - 30
![Page 2: Nir Hus Q 29 30 iv](https://reader033.vdocuments.site/reader033/viewer/2022061203/546d7651af795997388b6b22/html5/thumbnails/2.jpg)
Q29: Rx Ulcerative Colitis
Surgical indications: Hemorrhage Toxic megacolon Acute fulminant UC (occures in 15%) Obstruction Any dysplasia Cancer Intractability Failure to thrive LONG standing disease > 10 years – proph. for
CA
![Page 3: Nir Hus Q 29 30 iv](https://reader033.vdocuments.site/reader033/viewer/2022061203/546d7651af795997388b6b22/html5/thumbnails/3.jpg)
Emergent / Urgent resections – Total proctocolectomy and bring up ileostomy with takedown later.
Elective: Ileoanal (Low rectal) anastomosis -- rectal
mucosectomy, J-pouch. **Infectious pouchitis – Tx Flagyl
NEED lifetime surveillance of resaidual rectum. If bad rectoanal disease – APR
![Page 4: Nir Hus Q 29 30 iv](https://reader033.vdocuments.site/reader033/viewer/2022061203/546d7651af795997388b6b22/html5/thumbnails/4.jpg)
Cancer risk is 1% - 2% per year starting 10 years from initial diagnosis.
Require yearly colonoscopy starting 8-10 yrs post diagnosis.
** primary sclerosing cholangitis & ankylosing spondylitis DO NOT Improve w/ resection.
Ocular problems, arthritis, anemia – Most get better w/ resection.
Pyoderma gangrenosum – upto 50% get better.
![Page 5: Nir Hus Q 29 30 iv](https://reader033.vdocuments.site/reader033/viewer/2022061203/546d7651af795997388b6b22/html5/thumbnails/5.jpg)
Q30: Colovesical FistulaSymptoms – fecaluria, pneumonuria.More common in Mem. Vs. colovaginal fistula.Use CYSTOSCOPY for diag.TX –
close opening in bladder Resect involved colon segment Primary colon anastemosis w/wout diverting
ileostomy.