Anorectal And Anaesthetics Flashcards
What are some differentials:
-71y/o
-1/12 bleeding pr
-no abdominal pain
Colorectal cancer
Haemarrohoids
Diverticulits
UC
Crohns
Anal fissure (would be painful)
What investigations would you do on this patient:
-71y/o
-1/12 bleeding pr
-no abdominal pain
What are you suspecting?
FBC (WCC, Hb)
CRP
Ferritin
U+Es
Clotting
G+S
Urine dip
DRE
Colorectal cancer
What imaging would you request for:
-71y/o
-1/12 bleeding pr
-no abdominal pain
Colonoscopy with biopsy
CT CAP for staging witht IV contrast
What imaging would you request for:
-71y/o
-1/12 bleeding pr
-no abdominal pain
Colonoscopy with biopsy
CT CAP for staging witht IV contrast
What lymph nodes drain the descending + sigmoid colon?
Inferior mesenteric lymph nodes
What lymph nodes drain the ascending + transverse colon?
Superior mesenteric nodes
What procedure is done for a patient with a high rectal tumour? (>5cm above from anus)
Anterior resection
What occurs in an anterior resection for high rectal tumours?
Tumour removed
Rectal sphincter intact
Temporary loop ileostomy (allows for anastomosis to heal)
Then ileostomy can be reversed electively later down the line
What procedure is done for a low rectal tumour (<5cm from anus)?
AP resection (Abdominoperineal)
What iis done in an AP resection for low rectal tumours?
Distal colon, rectum and anal sphincters removed
Permanent colostomy
What is a complication of any bowel surgery?
Paralytic ileus
Anastomotic leak (if anastomosis made)
How does a paralytic ileus present?
3 days after surgery
Vomiting
Abdominal distension
No guarding or tenderness
Absent bowel sounds
Empty stoma
What investigations and imaging done for paralytic ileus?
CT AP IV contrast
Monitor U+Es
What is the management for paralytic ileus?
NG tube
IV fluids
Mobilise
Reduce opioid use
What are some anorectal pathologies?
Anal fistula
Anal fissure
Anal cancer
Perianal abscess
Anal ulcer
Pilonidal sinus
Haemorrhoids
What increases your risks of having anorectal pathologies?
Diabetic
Smoker
Crohn’s disease
Trauma history to anal region
What investigation and imaging is important for investigating anorectal pathologies?
DRE
MRI pelvis
What are the managements for ano fistula?
MRI pelvis to determine trajectory
Seton insertion
Fistulotomy
What are the managements for ano fistula?
MRI pelvis to determine trajectory
Seton insertion
Fistulotomy
When is a seton done for an ano fistula?
How does it work?
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
When is a fistulotomy used to treat an ano fistula?
Superficial fistulae
Cut open tract through skin and subcutaneous tissue letting it heal by secondary intent
What is a complication of seton insertion?
Faecal incontinence
What investigations are done for a Perianal abscess?
FBC
U+E
Clotting
Serum glucose or HbA1c (diabetic?)
May need MRI pelvis if atypical presentation
What is the management of a Perianal abscess?
Antibiotics
Analgesia
Incision and drainage
