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Medicine > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

Right iliac fossa mass differentials

A 
Appendix msss / abscess
Caecal carcinoma 
Pelic mass
Crohns disease
Intussusception 
Transplanted kidney
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2
Q

Causes of abdominal distension

A 
Flats 
Fat
Fluid 
Faeces
Fetus
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3
Q

Causes of ascites

A 
Malignancy 
Infection - TB
Decreased albumin 
Pancreatitis 
Myxoedema

Cirrhosis
Budd-chiari syndrome - a condition in which the hepatic veins (veins that drain the liver) are blocked or narrowed by a clot
Portal vein thrombosis

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4
Q

Presentation of appendicitis

A

Anorexia
Abdominal pain, vomiting
Abdo pain initially colicky, starts centrally then moves to RIF
RIF peritonism
Fever usually mild. If high = perforation or abscess

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5
Q

What is McBurneys point?

A

1/3 of the way from ASIS to umbilicus

If tenderness - suggestive of appendicitis

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6
Q

What is Rovsing’s sign?

A

RIF pain on pressing LIF

Suggestive of appendicitis

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7
Q

What is psoas sign?

A

Pain on extending the hip (if retrocaecal appendix)

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8
Q

What is cope sign?

A

Pain on flexion and internal rotation of the right hip - suggestive of appendicitis

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9
Q

How might appendicitis present in children?

A

Vague abdominal pain and child won’t eat

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10
Q

Investigations of appendicitis

A 
Diagnosis usually clinical 
Bloods - raised WCC and CRP
Urine - may contain WBCs
Abdo-pelvic CT goof but often not required 
US acceptable alternative
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11
Q

Managment of acute appendicitis

A

Surgery - appendectomy is definitive (laparoscopic ideal)

Abx - 1hr pre-op and 24hrs after (pip/taz)

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12
Q

AXR signs of SBO

A

Dilated bowel - lines going all the way across (valvulae conniventes)

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13
Q

AXR signs of LBO

A

Dilated bowel - lines don’t go all the way through

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14
Q

AXR signs of sigmoid volvulus

A

Coffee bean sign (As the closed loop of the sigmoid colon distends with gas, apposition of the medial walls of the dilated bowel form the cleft of the coffee bean, while the lateral walls of the dilated bowel form the outer walls of the bean). closed loop = two points blocked in a loop

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15
Q

What is rigler’s sign?

A

Can see both sides of the bowel wall on an AXR. Sign of free air in the abdomen

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16
Q

Clinical features of bowel obstruction

A

Vomiting
Nausea and anorexia
Colic occurs early
Constipation (may be absolute in distal obstruction)
Abdominal distension
Active tinkling bowel sounds (silent in ileus)

17
Q

What is an ileus?

A

Where bowel doesn’t contract

18
Q

Common causes of bowel obstruction

A

SBO - ADHESIONS, hernias

LBO - COLON Ca, diverticulitis disease, volvulus

19
Q

Management of bowel obstruction

A

Ileus and incomplete SBO can be managed conservatively
Drip and suck- IV fluids and NGT to empty stomach
Analgesia
Abc if perforation or surgery planned
DVT prophylaxis
Bloods - FBC, U+E, amylase
AXR, erect CXR

CT - FOR CAUSE

Surgery - strangulation, large BO,
Endoscopic stenting - LBO malignancy or in palliative

20
Q

Risk factors for colorectal cancer

A 
Polyps 
IBD
genetic predisposition 
Smoking 
Alcohol 
Previous cancer
Diet - low fibre and processed red meat
21
Q

First and last section of large bowel (before rectum)

A

Caecum

Sigmoid

22
Q

Presentation of colorectal cancer

A 
LEFT-SIDED:
Bleeding PR / mucus
Altered bowel habit
Obstruction
Mass on PR

RIGHT-SIDED:
decreased weight
Anaemia
Abdo pain

23
Q

Surgery for caecal, ascending or proximal transverse colorectal tumours

A

Right hemicolectomy

24
Q

Surgery for distal transverse and descending colon tumours

A

Left hemicolectomy

25
Q

Surgery for low sigmoid or high rectal tumours

A

Anterior resection - a surgical procedure to remove the diseased portion of your bowel and rectum (back passage). When possible, your surgeon will join the healthy ends of your bowel with stitches or staples.

26
Q

Surgery for tumours low in the rectum (<9cm from anus)

A

Abdomino-perineal resection - The end of the remaining sigmoid colon is brought out permanently as an opening, called a colostomy, on the surface of the abdomen. Can be done laparoscopically.

27
Q

AF with acute abdominal pain = suspect what?

A

Acute mesenteric ischaemia

28
Q

What is acute mesenteric ischaemia?

A

Syndrome caused by inadequate blood flow through mesenteric vessels.

Almost always involves small bowel
Follows SMA
Thrombus, embolism is cause or non-occlusive disease

29
Q

Presentation of acute mesenteric ischaemia

A

Classic triad - acute abdo pain, no/minimal abdo signs, rapid hypovolaemia

Pain constant, central or around RIF

30
Q

Management of acute mesenteric ischaemia

A 
Fluid resus
Abx (pip/taz)
Herparin/LMWH required 
Consider thrombolytics 
Surgery - dead bowel removed and revascularise viable bowel
31
Q

Anal fissure presentation

A

Risk factors - constipation, IBD, sexuallh transmitted infections

Features - painful bright red rectal bleeding
90% occur on the posterior midline

32
Q

Management of anal fissures

A

Acute (<1)
Soften stool
- dietary advice - fibre, high fluid intake
- bulk-forming laxatives - first line (lactulose)
- lubricants - petroleum jelly may be tried before defecation
- topical anaesthetics
- analgesia

Chronic

  • all of the above
  • topical GTN first line
  • if not effective after 8 weeks- consider surgery (sphincterotomy) or botulinin
33
Q

Complication of haemorrhoids

A

Thrombosed heamorrhoid

  • significant pain and a tender lump
  • purplish, oefematous tender subcutaneoud perinatal mass
  • if presents within 72 hours- referral for excision otherwise can be managed with stool softeners, ice packs and analgesia. Symtpoms usually settle within 10 days
34
Q

What is a harrmanns procedure?

A

Resection of the sigmoid colon, an end colostomy is fashioned

Often used in emergency situations

35
Q

Diverticulitis management

A

Abx - co-amoxiclav
observation
Analgesia (avoiding nsaids and opiates)
Fluids

36
Q

Management of sigmoid volvulus

A

Decompression via rigid sigmpidoscopy flats tube insertion

37
Q

Management of caecal volvus

A

Usually operative

Right hemicolextomy is often needed

Medicine (25 decks)

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