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Y3(S) - General > Anorectal And Anaesthetics > Flashcards

Anorectal And Anaesthetics Flashcards

1
Q

What are some differentials:
-71y/o
-1/12 bleeding pr
-no abdominal pain

A

Colorectal cancer
Haemarrohoids
Diverticulits
UC
Crohns
Anal fissure (would be painful)

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2
Q

What investigations would you do on this patient:

-71y/o
-1/12 bleeding pr
-no abdominal pain

What are you suspecting?

A

FBC (WCC, Hb)
CRP
Ferritin
U+Es
Clotting
G+S
Urine dip
DRE

Colorectal cancer

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3
Q

What imaging would you request for:

-71y/o
-1/12 bleeding pr
-no abdominal pain

A

Colonoscopy with biopsy
CT CAP for staging witht IV contrast

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4
Q

What imaging would you request for:

-71y/o
-1/12 bleeding pr
-no abdominal pain

A

Colonoscopy with biopsy
CT CAP for staging witht IV contrast

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5
Q

What lymph nodes drain the descending + sigmoid colon?

A

Inferior mesenteric lymph nodes

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6
Q

What lymph nodes drain the ascending + transverse colon?

A

Superior mesenteric nodes

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7
Q

What procedure is done for a patient with a high rectal tumour? (>5cm above from anus)

A

Anterior resection

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8
Q

What occurs in an anterior resection for high rectal tumours?

A

Tumour removed
Rectal sphincter intact
Temporary loop ileostomy (allows for anastomosis to heal)

Then ileostomy can be reversed electively later down the line

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9
Q

What procedure is done for a low rectal tumour (<5cm from anus)?

A

AP resection (Abdominoperineal)

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10
Q

What iis done in an AP resection for low rectal tumours?

A

Distal colon, rectum and anal sphincters removed
Permanent colostomy

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11
Q

What is a complication of any bowel surgery?

A

Paralytic ileus
Anastomotic leak (if anastomosis made)

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12
Q

How does a paralytic ileus present?

A

3 days after surgery
Vomiting
Abdominal distension
No guarding or tenderness
Absent bowel sounds
Empty stoma

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13
Q

What investigations and imaging done for paralytic ileus?

A

CT AP IV contrast
Monitor U+Es

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14
Q

What is the management for paralytic ileus?

A

NG tube
IV fluids
Mobilise
Reduce opioid use

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15
Q

What are some anorectal pathologies?

A

Anal fistula
Anal fissure
Anal cancer
Perianal abscess
Anal ulcer
Pilonidal sinus
Haemorrhoids

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16
Q

What increases your risks of having anorectal pathologies?

A

Diabetic
Smoker
Crohn’s disease
Trauma history to anal region

17
Q

What investigation and imaging is important for investigating anorectal pathologies?

A

DRE

MRI pelvis

18
Q

What are the managements for ano fistula?

A

MRI pelvis to determine trajectory

Seton insertion

Fistulotomy

19
Q

What are the managements for ano fistula?

A

MRI pelvis to determine trajectory

Seton insertion

Fistulotomy

20
Q

When is a seton done for an ano fistula?

How does it work?

A

Deeper/higher tract disease

Knot keeps the tract open draining any existing abscess and prevent recurrent formation

Then glue or fibrin plugs can seal fistulae

21
Q

When is a fistulotomy used to treat an ano fistula?

A

Superficial fistulae

Cut open tract through skin and subcutaneous tissue letting it heal by secondary intent

22
Q

What is a complication of seton insertion?

A

Faecal incontinence

23
Q

What investigations are done for a Perianal abscess?

A

FBC
U+E
Clotting
Serum glucose or HbA1c (diabetic?)

May need MRI pelvis if atypical presentation

24
Q

What is the management of a Perianal abscess?

A

Antibiotics

Analgesia

Incision and drainage

25
Q

How is incision and drainage of a Perianal abscess done?

A

Clean area
Incise abscess
Clean out with swabs
Insert clean betadine swab so wound heals bottom up (secondary intention)

26
Q

What are the complications of incision and drainage of Perianal abscess?

A

Sphincter damage (?incontinence)
Infection
Bleeding risk
Scarring
Recurrence
Anaesthetic risk

27
Q

How do you manage a patient with diabetes surgically?

A

Prioritise their case first
Don’t miss more than 1 meal
Cease short acting insulin
Maintain long acting insulin

28
Q

What do you do if a patient is diabetic and they’re going to miss more than one meal before surgery?

A

Variable rate insulin
+
Bag of dextrose with K+

29
Q

What are the 3 situations when fixed rate insulin is used?

A

Hyperkalaemia
Hyperosmolar hyperglycaemic state
DKA

30
Q

What do you do if a patient is on steroids before surgery?

A

Double the dose and convert to IV hydrocortisone.

31
Q

How do you convert oral Prednisolone to IV hydrocortisone?

Why is it important to double a patients steroid dose before surgery?

A

5mg Prednisone = 20mg IV hydrocortisone

Prevents adrenal crisis since patients intrinsic prodcution of steroids will have ceased

Y3(S) - General (5 decks)

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