Colorectal surgery Flashcards
What is the presentation of bowel obstruciton?
*Constipation, failure to pass flatus or stool
*Cramping, intermittent abdominal pain
*vomiting, may be bilious
*Abdominal distension/tenderness/mass
*Peritonitis
*Tinkling bowel sounds may be heard in early obstruction
What are the causes of bowel obstruction?
*Adhesions (small) due to surgery, endometriosis, peritonitis, infection
*Hernia (small)
*Malignancy (large)
*Volvulus
*Diverticular disease
What are the normal limits on CT for bowel
*Small = 3cm
*colon = 6cm
*Caecum= 9cm
How can you tell what is small bowel/what is large bowel on CT/Xray
Small bowel has valvulae conniventes which extend the full width of the bowel, large bowel has haustra which do not extend the full width
What is the management of bowel obstruction?
*ABCDE
*FBC
*UEs
*VBG
*Drip and suck: nill by mouth, IV fluids and NG tube with free drainage
*Consider surgery to fix underlying cause
What is the most common types of colonic carcinoma?
Adenocarcinoma
What are the risk factors of colonic cancer?
*APC mutation
*Lynch syndrome
*IBD
*Obesity
*Older age
What is the presentation of colon cancer?
*Rectal bleeding
*Change in bowel habit
*Mass (abdominal or rectal)
*Anaemia (iron deficiency)
*Unexplained weight loss
When would you urgently refer someone in the context of colon cancer
*>40 with abdominal pain and unexplained weight loss
*>50 with unexplained rectal bleeding
*>60 with a change in bowel habit/iron deficiency anaemia
What investigations would you carry out in suspected colon cancer?
*FBC: anaemia
*UEs and LFTs to check baseline function
*Colonoscopy
Once colon cancer has been confirmed what investigations should you carry out?
*Carcinoembryonic antigen (CEA)
*Genetic testing for lynch syndrome
*Staging CT of chest, abdo, pelvis
What is the management of colon cancer?
*Surgical resection, post operative chemotherapy
What is Hartmann’s procedure?
Emergency procedure if there is an acute obstruction or significant diverticular disease: removal of the rectosigmoid colon and colostomy
What is the colon cancer screening programme?
*50-74
*Once every two years
*FIT - faecal immunochemical test
*If positive then colonscopy
What is diverticulosis?
Herniation of the mucosa and the submucosa through the muscular layer of the abdominal wall
What is the presentation of diverticular disease?
In uncomplicated disease:
- Mild left lower quadrant pain
- Bloating
- Constipation with episodes of diarrhoea
What is the management of diverticular disease?
- Bulk forming laxatives if constipated
- healthy, balanced diet, increase fibre intake
- consider an anti-spasmodic to treat abdominal cramping
- paracetamol for abdominal pain
What are the complications of diverticular disease?
*Fistula
*Colorectal neoplasm
*Abscess
*Perforation
*Strictures, obstruction
What is the presentation of ano-rectal abscess?
- perianal pain
- perianal/rectal induration or swelling
- low grade fever
- tachycardia
What are colonic polyps?
Adenomas
What are the risk factors for colonic polyps?
- age
- family history or polyps or colorectal cancer
- previous history of polyps
- male
- acromegaly
What is the management of colonic polyps?
- polypectomy
- consider familial syndrome if >10 and follow up in 3 years
- if 1-2 low grade adenomas, repeat colonoscopy in 5-10 years
What gene is associated with familial adenomatous polyposis syndrome?
APC gene
What is the site of a gastrostomy?
Epigastrium
What is the site of a loop ileostomy?
Right iliac fossa
What is the location of a loop colostomy?
Any region of the abdomen
What is the difference between an ileostomy and colostomy?
- ileostomy spouted, colostomy is flush to skin
- ileostomy output is liquid, colostomy output is solid
What is a low anterior resection?
Removal of the rectum
What is a high anterior resection?
Sigmoid colon removed
What is a left hemicolectomy?
Removal of the distal transverse and descending colon
What is a right hemicolecotmy?
Removal of the caecum, ascending colon and proximal transverse colon
What is the treatment for chronic anal fissure?
Topical glyceryl trinitrate
What is the management of an anal fissure
Bulk forming laxative, dietary advice: increase fibre and liquid intake
What stoma is formed from a subtotal colectomy?
End ileostomy
What is the management of sigmoid volvulus causing bowel obstruction with signs of peritonism?
urgent midline laparotomy
When should you refer a patient presenting with an anal fissure?
If it is lateral - if not anterior or posterior it is likely a secondary cause
What are the signs of a gastric volvulus?
- vomiting
- pain
- failed attempts to pass a NG tube
