Category Archives: Topics

Inflammatory Bowel Disease – Topics in General Surgery

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

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

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

  • 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