nir hus q 29 30 iv
DESCRIPTION
Slides with topics that are covered and were tested in the recent Absite exams.Nir Hus MD., PhD.http://www.nirhus.comTRANSCRIPT
Q: 29 - 30
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
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
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.
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.