Colorectal Flashcards
CEA ranges
The normal range for CEA is 0 to 2.5 nanograms per milliliter of blood (ng/mL). If CEA levels remain elevated during treatment, the treatment may not have been as successful as hoped. Anything greater than 10 ng/mL suggests extensive disease, and levels greater than 20 ng/mL suggest the cancer may be spreading.
Bowel cancer surgery options
Loop vs end colostomy
A loop colostomy is used to defunction and decompress the distal colon in obstructing cancers.
An end colostomy is often formed at the sigmoid colon and positioned at the left iliac fossa
Easier to reverse a loop stoma
Loop vs end ileostomy
End ileostomy : This is performed in the permanent removal of entire colon
Loop ileostomy is performed in similar situations as a loop colostomy. However, it is only appropriate in cases where the ileocaecal valve is incompetent.
Volvulus x ray findings
Coffee bean sign - sigmoid volvulus
(note the valvulae conniventes, mucosal folds, that cross the full width of the bowel) secondary to caecal volvulus.
What is sclerotherapy
Sclerotherapy is a management option for haemorrhoids but is not of use in anal fissures.
What is sphincterectomy
sphincterotomy is a ‘last resort’ option in the management of anal fissures (correct answer). It releases the painful spasm of the torn sphincter with a clean incision and accelerates healing
What is a seton
The placement of a seton would not be of benefit in an anal fissure. They are used in anal fistulae to keep them open and allow proper drainage before definitive repair.
Would you do a colonoscopy in suspected chronic anal fissures in a 25 year old
An endoscopy to rule out malignancy as a cause of his bleed is unnecessary as the patient is <50 with a clear cause for his bleeding and no other unexplained symptoms (as per NICE guidance: NG12). This may be important however if bleeding persists after definitive management.
Where are diverticula most commonly found
Diverticula are most commonly found in the sigmoid colon
Which anal fissure requires further investigation
Primary anal fissures are typically caused by constipation, with approximately 90% occurring posteriorly, and 10% anteriorly. A lateral anal fissure suggests a secondary cause and requires further investigation.
What type of colostomy is formed in an emergency Hartmans procedure
End
An emergency Hartmann’s procedure involves resection of their rectosigmoid colon. An end colostomy is formed and rectal stump sewn. It is indicated by perforation of the rectosigmoid bowel, and subsequent peritonitis. Causes of perforation include colon cancer, diverticulitis, and trauma. Colostomies are brought out on the left side of the abdomen, and sewn flush with the skin.
This patient with an ascending colon resection will likely have what type of loop/end/colostomy/ileostomy
This patient with an ascending colon resection will likely have a loop ileostomy created to de-function the distal ascending colon.
Internal haemmarhoid stageing
1 - dont prolapse, 2 - go back in spontaneously, 3- have to manually reduce, 4- permanent prolapse
Why is an ileostomy spouted
An ileostomy is spouted to prevent the skin from coming into contact with the enzymes in the small intestine
