Colorectal Surgery

Question 1

Explain the blood supply of the colon?

Answer 1

Sup. Mesenteric Art
–> Ileocolic/Right Colic/Middle Colic arteries
–> Caecum/Asc. Colon/proximal 2/3rds of transverse colon

Inf. Mesenteric Art
–> Left Colic/Sigmoid/Rectal
–> Distal 1/3 of transverse colon/Desc. Colon/Sigmoid Colon/Rectum

Question 2

How do we maintain continence?

Answer 2

• Internal anal sphincter contracts at rest
• Rectal wall is distended by blood at rest
• Anything that increases intra-abdominal pressure or predicts it (E.g. lifting or fight/flight) will cause the external anal sphincter to contract
• Pelvic floor muscles contract to maintain continence

Question 3

What are the most common surgical problems of the colon?

Answer 3

Tumour - Colorectal Cancer

Inflammation - Ulcerative colitis, Crohn’s disease

Degeneration - Diverticular disease

Abnormal functions - Constipation, incontinence, IBD

Congenital - Atresia, Hirschsprung’s disease

Question 4

What are the common complaints of patients with a colon issue?

Answer 4

• Changes in bowel habit
• Changes in continence
• Bleeding
• Pain
• Non-intestinal manifestations

Question 5

How common is rectal bleeding?

Answer 5

Actually very common, a large proportion of people have it at some point.
Around 1 in 30 who attend the GP with it turn out to have bowel cancer

Question 6

What are non-intestinal manifestations?

Answer 6

Some bowel disorders can cause symptoms elsewhere

E.g. Crohn’s can cause eye problems and joint pain which can be more noticeable than the intestinal symptoms (which can sometimes be very minor)

Question 7

What is the most common cause of visceral pain?

Answer 7

The gut distending and the smooth muscle trying to contract against it.
Pain receptors in the smooth muscles have afferent sympathetic fibres accompanyin the major segmental vessels

Question 8

What kind of investigations are there for colorectal issues?

Answer 8

Endoscopy - Colonoscopy & biopsy
Contrast Imaging - Barium Enema
Cross Sectional Imaging - CT or CT colonography
MRI

Question 9

What are the considerations when deciding on treatment for a colorectal disordeR?

Answer 9

Medical vs surgical?
Endoscopic vs Invasive?
Laparoscopy vs laparotomy?

Consider consequences of resection and faecal diversion (stoma)

Remember you want to restore continuity and function while minimizing the effect on their lives

Question 10

What are the factors in an informed consent?

Answer 10

• Information provided by the medical team
• Patient’s capacity to understand & make a decision
• A meaningful discussion in which we learn what the patient wants and what important to them
• Time and help to reflect on their options

Question 11

How should you ensure your patient can comply with treatment and understands?

Answer 11

Take into account many people dont have the literacy to understand your language or meds instructions.
Try to explain in detail and laymans terms, maybe record your instructions for them to take home and listen to.
Ask for Teach back

Question 12

What is a bowel anastomosis?

Answer 12

Reconnective two sections of bowel after resection of a diseased section

Question 13

What factors are required for a bowel anatomosis to be carried out?

Answer 13

• Tension free
• Well perfused
• Well Oxygenated
• Clean surgical site
• Patient in an acceptable systemic state

Question 14

What is a faecal diversion?

Answer 14

Connecting small intestine (Ileostomy) or colon (colostomy) to the skin thorugh an opening called a stoma

Question 15

What are the common complciations of colorectal surgery?

Answer 15

• Anesthetic related
• Bleeding
• Sepsis
• VTE
• Anastomotic Breakdown
• Small Bowel Obstruction
• Wound Hernia