colorectal Flashcards
dukes staging
Dukes' A Tumour confined to the mucosa 95% Dukes' B Tumour invading bowel wall 80% Dukes' C Lymph node metastases 65% Dukes' D Distant metastases 5% (20% if resectable)
Solitary rectal ulcers
associated with chronic constipation and straining. It will need to be biopsied to exclude malignancy (the histological appearances are characteristic). Diagnostic work up should include endoscopy and probably defecating proctogram and ano-rectal manometry studies.
biopsied and reported as showing ‘fibromuscular obliteration’.
IBD ops
toxic megacolon
perianal crohns, small bowel fine
UC not controlled when off steroids
sub total colectomy
proctectomy
panproctocolectomy + ileoanal pouch
tumour in rectum:
distal 8 cm
proximal
abdominoperoneal resection -the anus, rectum and distal sigmoid are removed and the remaining sigmoid is brought out to the surface as a permanent colostomy.
an anterior resection is performed and after removal of the tumour, the remaining sigmoid is anastomosed to the lower rectum.
colorectal cancer screening
FIT every 2 years to all men and women aged 60 to 74 years
this is being offered to people who are 55-years-old
Nocturnal diarrhoea and incontinence
IBD
hartmans procedure
pathology removed and defunctioning stoma brought out
joined later
volvulus mx
sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed
ix to check anastomosis leakage- non urgent
gastrografin enema
haemorrhoid grades
Grade I Do not prolapse out of the anal canal
Grade II Prolapse on defecation but reduce spontaneously
Grade III Can be manually reduced
Grade IV Cannot be reduced
cause of metabolic acidosis with stoma
high output loos of bicarb in ileostomy
hinchey classification
I Para-colonic abscess
II Pelvic abscess
III Purulent peritonitis
IV Faecal peritonitis
tx 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.
mx of anal fissure
Management of an acute anal fissure (< 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
analgesia
topical steroids do not provide significant relief
Management of a chronic anal fissure (> 6 weeks)
the above techniques should be continued
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
sigmoid volvulus associations
older patients
chronic constipation
Chagas disease
neurological conditions e.g. Parkinson’s disease, Duchenne muscular dystrophy
psychiatric conditions e.g. schizophrenia
