Colorectal surgery Flashcards

1
Q

what are the features of acute mesenteric ischaemia?

A

history of atrial fibrillation
severe, sudden onset abdominal pain out of keeping with physical exam findings
nausea and vomiting
metabolic acidosis
PR bleeding with advanced ischaemia

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2
Q

what is the management for acute mesenteric ischaemia?

A

immediate laparotomy

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3
Q

how is acute mesenteric ischaemia diagnosed?

A

CT angiography - most commonly occlusion of superior mesenteric artery

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4
Q

what are the risk factors for anal cancer?

A

HPV infection
anal intercourse
HIV, immunosuppressive medication
history of cervical cancer
smoking

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5
Q

what are the features of anal cancer?

A

perianal pain and bleeding
palpable lesion
faecal incontinence
may have rectovaginal fistula

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6
Q

where is the most common site for colorectal cancer?

A
  1. rectum
  2. sigmoid colon
  3. descending colon
  4. transverse colon
  5. ascending colon and caecum
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7
Q

what are the risk factors for colorectal cancer?

A

increasing age
FAP, HNPCC, juvenile polyposis, Peutz-Jeghers syndrome
alcohol, smoking
processed meat
obesity
IBD
FHx

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8
Q

what are the features of right-sided colon cancers?

A

abdominal pain
iron deficiency anaemia
palpable mass in RIF
often presents late

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9
Q

what are the features of left-sided colon cancers?

A

rectal bleeding
change in bowel habit
tenesmus
palpable mass in LIF or on rectal exam

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10
Q

when should patients be urgently referred on 2 week pathway for colorectal cancer?

A

≥40yrs with unexplained weight loss and abdominal pain
≥50yrs with unexplained rectal bleeding
≥60yrs with iron‑deficiency anaemia or change in bowel habit
Positive occult blood screening test

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11
Q

what are the features of volvulus?

A

constipation
abdominal bloating
abdominal pain
nausea/vomiting

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12
Q

how is volvulus investigated?

A

CT with contrast: whirl sign
abdominal X-ray
sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, with air-fluid levels) and coffee bean sign
caecal volvulus: small bowel obstruction

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13
Q

how is volvulus managed?

A

sigmoid volvulus: decompression via rigid sigmoidoscopy with rectal tube insertion, flatus tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed

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14
Q

where is the most common site for diverticula to form?

A

sigmoid colon

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15
Q

what are the features of haemorrhoids?

A

painless rectal bleeding
pruritis
pain: usually not significant unless piles are thrombosed

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16
Q

what are the features of thrombosed haemorrhoid?

A

significant pain and tender lump
purplish, oedematous, tender subcutaneous perianal mass