Colorectal Flashcards
What is rectal prolapse?
Associated with childbirth and rectal intussceception. May be internal or external
Features of an anal fissure?
Typically presents with painful rectal bleeding
Location: midline 6 (posterior midline 90%) & 12 o’clock position. Distal to the dentate line
Chronic fissure > 6/52: triad: Ulcer, sentinel pile, enlarged anal papillae
Dukes classifciation for the spread of colorectal cancer?
A- Confined to mucosa
B- Invafing bowel wall
C- Lymph node metastases
D- Distant metastases
Most common type of colorectal cancer?
Adenocarcinoma
Management of chronic anal fissures?
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
What is a Hartmann’s procedure?
type of colectomy that removes part of the colon and sometimes rectum
What is volvulus?
occurs when a loop of intestine twists around itself and the mesentery that supports it, causing bowel obstruction. Symptoms include abdominal distension, pain, vomiting, constipation, and bloody stools
What are diverticula?
medical term used to describe the small bulges that stick out of the side of the large intestine (colon). Diverticula are common and associated with ageing.
What is diverticulitis?
infection of a diverticulum, an out-pouching of the intestinal mucosa.
What are anal fissures?
longitudinal or elliptical tears of the squamous lining of the distal anal canal
Management of sigmoid volvulus?
rigid sigmoidoscopy with rectal tube insertion
What is a perianal abscess?
collection of pus within the subcutaneous tissue of the anus that has tracked from the tissue surrounding the anal sphincter.
Presentation of thronbosed haemorrhoids?
significant pain and a tender lump
Examination findings in thrombosed haemorrhoids?
purplish, oedematous, tender subcutaneous perianal mas
What is an anal fistula?
a small tunnel that develops between the end of the bowel and the skin near the opening of the bottom (anus)
caused by an infection near the anus, which results in a collection of pus (abscess) in the nearby tissue. When the pus drains away, it can leave a small channel behind.
What is an anal fissure?
tear or open sore (ulcer) that develops in the lining of the large intestine, near the anus.
What is CEA used to monitor?
Response to treatment of colon cancer
What is AFP used as a tumour marker for?
Hepatocellular carcinoma
Emergency presentations of poorly controlled colitis that fails to respond to medical therapy should usually be managed with what?
Sub total colectomy
Excision of the rectum is a procedure with a higher morbidity and is not generally performed in the emergency setting
What is the most commonly performed operation for rectal tumours, except in lower rectal tumours
Anterior resection
When is a loop ileosotomy done?
Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)
Colonic tumour resection pitcure
Management of acute mesenteric ischaemia?
immediate laparotomy is usually required, particularly if signs of advanced ischemia e.g. peritonitis or sepsis
poor prognosis, especially if surgery delayed
Faecal occult blood is used to screen for what?
bowel cancer but is not used for diagnosis in patients presenting with symptoms or signs of bowel cancer.
What is anterior resection in colorectal cancer?
remove a tumour in the upper or middle part of the rectum (back passage)
Frimann Dahl’s sign
diagnostic sign demonstrated when three dense lines, representing the sigmoid walls, are seen converging to the site of obstruction in sigmoid volvulus and associated with empty rectal gas
Grading of internal haemorrhoids?
Where are diverticula most commonly found?
Sigmoid colon
Where do most anal fissures occur?
Posterior midline
What is an end colostomy?
end of the colon is brought through the abdominal wall, where it may be turned under, like a cuff. The edges of the colon are then stitched to the skin of the abdominal wall to form an opening called a stoma
Antibiotics in hospital for diverticulitis if oral doesnt work- Which ones?
IV ceftriaxone and metronidazole
Management of thrombosed haemorrhoids?
stool softeners, ice packs and analgesia.
Most common cause of large bowel obstruction?
Bowel cancer
Perfered diagnostic test for chronic pancreatits?
CT pancreas
