Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 6 > Colorectal surgery > Flashcards

Colorectal surgery Flashcards

1
Q

Small bowel obstruction causes

A

Hernia
Adhesions
Tumour

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Large bowel obstruction causes

A

Cancer
Volvulus
Strictures (diverticular disease > IBD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Obstruction Ix

A

AXR

Definitive: CT abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Colorectal cancer S+S

A 
Change in bowel habit 
PR bleeding
WL
Fatigue
Anaemia - more likely a R sided colorectal cancer if this is found (more indolent bleeding)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Colorectal Ca Ix

A

Sigmoidoscopy –> colonoscopy

Screening
55y = flexi sig –> colonoscopy if +
- Once
- Male and female

60-74 = faecal immunochemical test

  • every 2 years
  • male and female
  • if +ve, colonoscopy is offered
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Colorectal Ca Mx

A
  • Resection (sigmoid colectomy is not a cancer operation – need to take the entire IMA for all lymph supply)
  • Heparin SC enoxaparin for 28d

± pre-operative (neoadjuvant) chemoradiotherapy if pelvic LN spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Colorectal Ca post-op complications

A

Ileus - peristalsis halted - fluids stop moving in intestine - electrolytes diffuse into lumen –> low electrolytes in blood and dehydrated pictures despite positive fluid balance

Anasamotic dehiscence – day 6, fever, septic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Ileus Mx

A

NG + IV fluids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Blood supply to the large bowel

A

IMA splits into Left colic artery

SMA splits into R colic artery –> ileocolic and middle colic arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

3 areas of bowel with poor perfusion

A

R colon - vulernable in systemic low flow states as marginal artery of Drummond is poorly develop in 50% of population

Splenic flexure - marginal artery of Drummond is tenuous here/ absent in 5%

Rectosigmoid junction - distal to last collateral connection with proximal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Syndromes associated with colorectal cancer

A

Familial adenomatous polyposis

MYH associated polyposis

Peutz Jegher’s syndrome

Cowden disease

HNPCC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

FAP inheritance pattern

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

FAP features

A

> 100 colonic adenomas

Cancer risk of 100%

20% are new mutations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

FAP screening and Mx

A

Risk –> predictive genetic testing as teenager

Annual flexi-sig from 15 years

No polyps found –> 5 yearly colonoscopies from 20yo

Polyps found = resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

FAP associated disorders

A

Gastric fundal polyps (50%)

Duodenal polyps 90%

If severe duodenal polyposis cancer risk of 30% at 10y

Abdominal desmoid tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

MYH associated polyposis inheritance pattern

A

AR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

MYH associated polyposis features

A

Multiple colonic polyps

Later onset right sided cancers more common than in FAP

100% cancer risk by age 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

MYH associated polyposis Mx

A

Resection and ileoanal pouch

Attenuated phenotype –> regular colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

MYH associated polyposis associations

A

Duodenal polyposis in 30%

Associated with increased risk of breast cancer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Peutz-Jegher’s syndrome inheritance pattern

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Peutz-Jegher’s syndrome features

A

Multiple benign intestinal hamartomas

Episodic obstruction / intussusception

Risk GI cancers (CRC 20%, gastric 5%)

Increased risk of breast, ovarian, cervical pancreatic and testicular cancers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Peutz-Jegher’s syndrome Ix Mx

A

Annual examination

Pan intestinal endoscopy every 2-3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Peutz-Jegher’s syndrome associations

A

Malignancies at other sites

Pigmentation pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Cowden disease inheritance pattern

A

AD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Cowden disease features
Macrocephaly Multiple intestinal hamartomas Multiple trichilemmomas 89% risk of cancer at any site 16% risk of colorectal cancer
26
Cowden disease screening and Mx
Targeted individualised screening
27
Cowden disease associated disorders
Breast cancer (81% risk) Thyroid ca, non-toxic goitre Uterine cancer
28
HNPCC (Lynch syndrome) features
CRC 30-70% Endometrial cancer 30-70% Gastric cancer 5-10% Scanty colonic polyps may be present Colonic tumours likely to be right sided and mucinous
29
HNPCC (Lynch syndrome) Screening and Mx
Colonoscopy every 1-2 years from 25yo Prophylactic surgery Extra colonic surveillance recommended
30
HNPCC (Lynch syndrome) associated disorders
Extra colonic cancers
31
Volvulus - what % many sigmoid and caecal
80% sigmoid | 20% caecal
32
what is a sigmoid volvulus
large bowel obstruction caused by sigmoid colon twisting on the sigmoid mesocolon
33
What is a caecal volvulus
small bowel obstruction caused from a proximal LBO cause of a congenital abnormality
34
Sigmoid volvulus associations
``` older chagas disease chronic constipation pyschiatric condiiton (schizo) neuro condiiton (PD) ```
35
Caecal volvulus associatoins
all ages adhesions pregnancy
36
volvulus S+S
constipation abdo pain abdo bloating N/V
37
volvulus Ix
AXR sigmoid - LBO coffee bean sign --haustra, large dilated loops of colon, often with air-fluid levels Caecal - SBO valvule conniventes, mucosal folds that cross entire width of bowel wall
38
Volvulus Mx
Sigmoid - therapeutic sigmoidoscopy with rectal tube insertion (if peritonism -- laparotomy) Caecal volvulus -- laparotomy (R hemicolectomy often needed)
39
Bowel obstruction Mx
1st - drip and suck - + conservative 2nd - adhesiolysis
40
Position of inguinal hernia
Above and medial to pubic tubercle
41
Femoral hernia position
Below and lateral to pubic tubercle
42
Is inguinal or femoral more common in women
Femoral
43
Inguinal hernia - strangulation risk
rare
44
Femoral hernia - strangulation risk
high risk of obstruction and strangulation
45
Femoral hernia Mx
surgical repair needed
46
Difference between umbilical and paraumbilical hernia
Umbilical = symmetrical bulge under umbilicus Paraumbilical = asymmetrical bulge - half the sac is covered by skin of abdomen directly above or below the umbilicus Paraumbilical = high risk of strangulation
47
Paraumbilical hernia Mx
Mayo repair
48
Epigastric hernia location Most common in
Lump in midline between umbilicus and xiphisternum men aged 20-30
49
Spigelian hernia also known as
lateral ventral hernia
50
Spigelian hernia location | seen in
A hernia through the spigelian fascia (aponeurotic layer between rectus abdominis muscle and semilunar line) Rare and seen in older patients
51
Obturator hernia location | F or M?
hernia which passes through obturator foramen | F>M
52
Obturator hernia presentation
obstruction
53
Richter hernia location and presentation
A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect (i.e. only ONE of the intestinal walls herniates through the bowel wall) Richter's hernia can present with strangulation without symptoms of obstruction
54
Types of hernia surgery
herniotomy - ligation and excision of hernial sac herniorrhaphy - repair of abdominal wall defect hernioplasty - mesh implant
55
Hernia RF
obesity, ascites, increasing age, surgical wounds
56
Hernia Mx
Strangulated/ incarcerated - emergency surgery Not strangulated/ incarcerated Adult - inguinal - repeat femoral - urgent repair ``` Child inguinal <6w - operate within 2 days <6m - operate within 2 weeks <6y - operate within 2 months ``` umbilical - most resolve by 4-5y
57
Femoral hernia repair approaches | elective vs emergency
eLective = Lockwood Low approach (low incision over hernia with herniotomy/herniorrhaphy) eMergency = McEvedy high approach (via inguinal region to inspect and resect non-viable bowel)
58
Hernia repair incision and risk of damage to
McBurney's - oblique Lanz - transverse incision to Iliohypogastric and ilioinguinal nerves
59
Hernia post-op advice
 Must pass urine before discharge  Mobilise early (work in 1-2 weeks; ≥6 weeks if work involves heavy lifting)  Adequate analgesia and avoid constipation (lactulose prescription)  Keep area clean and dry  Can bathe immediately
60
Complications of gastrectomy
Physical: - Gastric cancer risk - Reflux / bilious vomiting - Abdominal fullness - Stricture - Stump leakage Metabolic: - Dumping syndrome (abdominal distension, flushing, fainting, sweating) - Blind loop syndrome (malabsorption, diarrhoea) - Malnutrition: • Vitamin deficiency • Weight loss

Year 6 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions