Colorectal

Question 1

Large Bowel Surgery Complications

Early

1. Local
2. Regional
3. Systemic

Answer 1

1. Damage to nearby structures
   Haemorrhage
   Wound breakdown/infection
   Intra-abdominal sepsis

2. Anastomotic leak/breakdown
    Stoma problems (sloughing/retraction)
    (Compartment syndrome of legs due to prolonged elevation)

3. New AF/flutter, usually indicates anastomotic breakdown
   Systemic sepsis

Question 2

Late complications of large bowel surgery

Answer 2

Diarrhoea (short gut syndrome)
Division of pelvic parasympathetic nerves (causes sexual/bladder dysfunction)
SBO (ie. adhesions from surgery of RTx)

Question 3

Early stoma complications

Answer 3

Mucosal sloughing
Necrosis of terminal bowel
Obstruction (oedema, faecal impaction)
Skin erosion (inappropriate location of stoma, bag attachment, persistent leaking over skin)

Stoma nurse. Resite stoma, suppositories for obstruction and DSE (digital stoma examination)

Question 4

Late complications of stoma

Answer 4

Hernia - resite stoma
Bowel prolapse - refashion stoma
Parastomal fistula - refashion
Retraction of the ileostomy spout - reopen and refashion
Stenosis - refashion
Perforation after colonic irrigation
Psychological and psychosexual dysfunction

Question 5

Factors to affect anastomotic healing

Answer 5

Sepsis
Diabetes
Poor nutrition
Poor surgical technique 
Steroid use
Jaundice 
Heavy local contamination
Haemodynamic instability

Question 6

Appendicitis:

1. Common obstructive agents
2. Common scoring systems

Answer 6

1. Faecolith, intestinal worm, lymphoid tissue, tumours, foreign body
2. ALVARADO
   AIR

Question 7

Follow up of colorectal cancer

Answer 7

Surveillance CT and CEA monitoring

Question 8

Liver segments in

1. Right hepatectomy
2. Left hepatectomy

Answer 8

1. 5,6,7,8
2. 3,4,5

(Segment 1 is very middle of the liver)

Question 9

Duke staging and 5 year survival

A:
B
C
D

Answer 9

A: within mucosal, 90%
B: beyond mucosa, 60(-70%)
C: LN involvement, 30%
D: distant mets, 10%

Question 10

CRC screening

Answer 10

60-75y/o, every 2years
Faecal occult blood, 3separate samples
Colonoscopy

Question 11

How does C. Diff cause pseudomembranous colitis

Answer 11

Toxin A secreted.

Fibropurulent debris and mucus adheres to damaged mucosa, appears like a membrane