Colorectal Flashcards
Main types of stomas, and their positions?
Loop ileostomy
- Defunctioning of colon (e.g. after colon ca.)
- RIF
End Ileostomy
- Usually after pancolectomy
- RIF
End colostomy
- LIF (or RIF)
Loop colostomy
- Defunction a distal segment of bowel
- Any region
Most common type of anal cancer?
SCC
What lymph nodes do the anal cancers spread to?
Anal margin - to the pelvic lymph nodes
Proximal tumours - inguinal
What is the most common cause of SCC cancer of the anus?
HPV infection.
Anal cancer presentation?
Perianal pain, perianal bleeding
A palpable lesion
Faecal incontinence
A neglected tumour in a female may present with a rectovaginal fistula.
What staging do you use for anal cancer?
T staging
Management of an anal fissure?
Acute (<6 weeks):
- Dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first line - if not tolerated then lactulose should be tried - Lubricants such as petroleum jelly may be tried before defecation
- Topical anaesthetics
Chronic (>6 weeks)
- GTN first line
- Botox through referral is second
Types of haemorrhoids, management?
Location: 3, 7, 11 o’clock position
Internal or external
Treatment:
- Conservative
- Rubber band ligation
- Haemorrhoidectomy
Different causative organisms in ano-rectal abscesses?
E.coli, staph aureus
How do you stage a colorectal cancer?
CT chest abdo/pelvis
Should also have had colonoscopy/CT colonoscopy
Treatment of colonic cancer options?
Surgical resection (unless palliative)
If HNPCC consider panproctocolectomy
Either then anastomosed or end stoma
What are the key factors influencing the choice for anastomosis or end stoma?
Adequate blood supply
Mucosal apposition
No tissue tension
Management of rectal cancer?
Anterior resection if the tumour is high up.
Adominoperineal excision of the rectum if it is low lying or involves the sphincter
Adjuvant radiotherapy should be offered
What are the definite referral 2ww guidelines for colorectal Ca.?
patients >= 40 years with unexplained weight loss AND abdominal pain.
patients >= 50 years with unexplained rectal bleeding.
patients >= 60 years with iron deficiency anaemia OR change in bowel habit.
tests show occult blood in their faeces (see below).
Colorectal cancer screening programme details?
Screening every 2 years to all men and women aged 60 to 74 years. Faecal occult blood test
Symptoms of diverticulitis?
Altered bowel habit
Bleeding
Abdominal pain
Diverticular disease complications?
Diverticulitis
Haemorrhage
Development of fistula
Perforation and faecal peritonitis
Perforation and development of abscess
Development of diverticular phlegmon
Treatment of diverticular disease?
Increase dietary fibre intake.
Mild attacks of diverticulitis may be managed conservatively with antibiotics.
Peri colonic abscesses should be drained either surgically or radiologically.
Recurrent episodes of acute diverticulitis requiring hospitalisation are a relative indication for a segmental resection.
Hinchey IV perforations (generalised faecal peritonitis) will require a resection and usually a stoma. This group have a very high risk of post operative complications and usually require HDU admission. Less severe perforations may be managed by laparoscopic washout and drain insertion.
Diverticulitis presentation?
Symptoms
Severe abdominal pain in the left lower quadrant: this may be in the right lower quadrant in some Asian patients
Nausea and vomiting (20-60%)
Change in bowel habit: constipation is more common (seen in 50%)
Urinary frequency, urgency or dysuria (10-15%): this is due to irritation of the bladder by the inflamed bowel.
PR bleeding (in some cases).
Signs
- Low grade pyrexia
- Tachycardia
- Tender LIF: in 20% there will be a tender palpable mass due to inflammation or an abscess
Dukes classification for colorectal cancer?
Dukes’ A
- Tumour confined to the mucosa
- 95% survival
Dukes’ B
- invading bowel wall
- 80% survival
Dukes’ C
- Lymph node metastases
- 65% survival
Dukes’ D
- Distant metastases
- 5% survival (20% if resectable)
Presentation of haemorrhoids?
Painless rectal bleeding is the most common symptom
Pruritus
Pain
Types of haemorrhoids?
External:
- originate below the dentate line
prone to thrombosis, may be painful
Internal:
- originate above the dentate line
do not generally cause pain
Ano-rectal abscess presentation?
Patients may describe pain around the anus, which may be worse on sitting
They may have also discovered some hardened tissue in the anal region
There may be pus-like discharge from the anus
If the abscess is longstanding, the patient may have features of systemic infection.
Presentation and management of volvulus?
Presentation:
- Constipation
- Abdominal bloating
- Abdominal pain
- Nausea/vomiting
Management
- Sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
- If peritonism then just do laparotomy
- Caecal volvulus: management is usually operative. Right hemicolectomy is often needed
