Inflammatory Bowel Disease = Crohn’s disease and Ulcerative Colitis.
- Mouth to anus
- Skip areas
- Full thickness
- Anal involvement common (fistulas, abscess, fissures, ulcers)
- Cancer risk less than that of 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
Skin and Soft Tissue – Surgical Issues
- Various classification systems for necrotizing skin and soft tissue infections help in the study of the disease, doesn’t necessarily help in the care of the patient.
- Dish water exudates and grey necrotic tissue are macroscopic findings of necrotizing soft tissue infection.
- Along with early debridement, very broad spectrum IV antibiotics is the mainstay of necrotizing soft tissue infection.
- Hyperbaric oxygen is not a proven therapy of necrotizing soft tissue infection.
- Switching from castille soap to a once daily 2% chlorhexidine body wash reduces MRSA colonization rates of Surgical ICU patients.
- MRSA (Methicillin Resistant Staphylococcus Aureus) is currently the leading pathogen of surgical site infection
- Chloraprep (contains alcohol) use must be selective – beware of starting a fire on the surgical site.
- After fasciotomies, negative wound therapy could be helpful for getting rid of edema and keeping wound clean and dry.
- Negative pressure wound systems have been associated with complications of death and injuries.
- Measuring compartment pressures, position of the head and trunk relative to the extremities is important when zeroing the transducer
- When performing a Fasciiotomy – one approach anterolateral incision and then posteromedial incision
- Calciphylaxis is associated with high calcium phosphorus product (Ca x P).
- Infected Calciphylaxis lesions must be completely excised which is associated with a high mortality rate.
- Pressure sores is a “never” event.
- Smoking cessation is a mainstay of managing hidradenitis supperativa
- Carbon dioxide laser excision is now being tried to treat moderate infections of hidradenitis supperativa (not severe enough for hospitalization).
- Biopsy of complex skin lesions is important for diagnosis
- Pyoderma Gangrenosum – 50-70% will have systemic disease (like inflammatory bowel disease (UC / Crohn’s Disease).