Colon and Rectum Flashcards
Tx of diverticulosis
Mebeverine (antispasmodic)
Tx of divertiulitis
Mild – uncomplicated + low grade fever
Bowel rest at home
Fluids only
Oral co-amoxiclav +/- metronidazole
Severe (complicated, high grade fever)
Admit if pain uncontrolled/oral fluids not tolerated
Give analgesia, IV fluids, IV cefuroxime + metronidazole and keep NBM
Order an erect CXR, supine AXR + contrast CT of the abdomen to assess for complications
Do not scope in acute attacks
What are complications of diverticulae
Perforation
Abscess formation
Bleeding
Obstruction
Fistula formation
strictures
Tx of asymptomatic diverticulae
Dietary advice
Increased unprocessed food and dietary fibre as part of a balanced diet
Surgical options for colon cancer
wide tumour resection + lymph node clearance
right hemicolectomy - caecal/ascending colon/proximal transverse colon
Left hemicolectomy - distal transverse, descending colon tumours
high anterior resection - sigmoid tumour
anterior resection - low sigmoid/high rectal tumours
Abdomino-peritoneal (AP) resection - low rectal tumours
hartmans procedure - if there is emergency bowel obstruction
endoscopic stenting - palliative
chemotherapy/radiotherapy regimes for cancer
Radiotherapy
Used pre-op in rectal cancer to reduce recurrence and increase survival
Higher risks of post-op complications
Post-op radiotherapy is only used if there is a high risk for local recurrence
Chemotherapy
Adjuvent 5-FU and folic acid can reduce mortality in higher stage tumours
may be used in palliation of metastatic disease
Tx of an obstructing bowel cancer
A-E resus
Analgesia + NG tube decompression
AXR + erect CXR – confirm obstruction and assess for perforation
Ct to determine level of obstrution
Gastrogaffin (contrast enema) may also show level of obstruction whilst providing some symptomatic relief for more symptomatic obstruction
Surgery is the definitive management when the patient is adequately hydrated, or stenting can be done palliatively
when should you manage haemorrhoids
only if symptomatic
conservative management of haemorrhoids
plenty of fluids + no straining
topical analgesia
Bulk-forming laxatives (psyllium)
when is sclerotherapy indicated in haemorrhoids and how is it done
stage 1 and 2 haemorrhoids not managed by conservative management (1st degree – still in anal canal, bleed but do not prolapse , 2nd degree – prolapse on defacation, then reduce spontaneously)
5% phenol in almond oil injected as a sclerosing agent
painless as they are above the dentate line
1+ injections may be required monthly
when should haemorrhoids be banded
stage 3 haemorrhoids - 3rd degree – prolapse outside the anal margin on decafaction, can be reduced manually
when is surgery indicated for haemorrhoids and what surgery is done
3rd degree – (prolapse outside the anal margin on decafaction, can be reduced manually) - if banding not indicated/unsuccessful
or
4th degree – (remain prolapsed outside the anal margin at all times)
Stapled haemorrhoidoplexy or hemorrhoidal artery ligation are the main methods
Hemorrhoidectomy used to be used but it is less common
Tx of thrombosed external haemorrhoid
Untreated they will fibrose in a few days to a skin tag, or rupture to discharge clotted blood
In the acute phase they can be incised and drained under local
If they are already discharging/have resolved by the time the patient has been seen, hot baths and reassurance is all that is necessary
Tx of an anorectal abscess
incision and drainage under anaesthetic to prevent rupture/possible formation of a fistula
Tx of pilonidal sinus
excision of sinus tract and primary closure with preoperative antibiotics
