Colorectal Surgery

Question 1

What are the main types of surgeries for colorectal conditions?

Answer 1

Open surgery
Endoscopic treatment
Minimally invasive techniques - laparoscopic, robotics and NOTES

Question 2

What is the function of the colon?

Answer 2

Water and electrolyte absorption
Production and absorption of vitamins
Storage of faeces
Hosts gut microbiota

Question 3

Describe the arterial supply of the colon and the rectum

Answer 3

Superior and inferior mesenteric artery
Marginal artery is important
Superior, middle and inferior rectal artery

Question 4

What is the venous drainage of the colon and rectum

Answer 4

Superior and inferior mesenteric vein

Question 5

Describe the nerve supply of colon and rectum

Answer 5

Parasympathetic - vagus and C2,3,4
Sympathetic

Question 6

What are some important factors causing continuence?

Answer 6

Anatomy
Rectal compliance
Stool consistency
Central control
Anorectal sensation

Question 7

What is screening?

Answer 7

Identification of unrecognised disease in apparently healthy individual in asymptomatic population by means of tests

Question 8

What is the screening for colorectal cancer in Scotland?

Answer 8

Age 50-74
Every 2 years
Quantitative faecal immunochemical test (qFIT)

Question 9

What are ways to screen for colorectal cancer?

Answer 9

qFIT
Replaced faecal occult blood test (FOBT)
Once off flexible sigmoidoscopy

Question 10

What are some different types of polyps?

Answer 10

Pedunculated polyp
Flat, FAP, giant, multiple

Question 11

Describe a polypectomy

Answer 11

Removal of polyp with hot snare
Colonoscopy guided

Question 12

What are the symptoms of colorectal cancer?

Answer 12

Abdominal pain, rectal bleeding, change in bowel habits, weight loss, tenesmus, fatigue and vomiting

Question 13

What are some investigations used for colorectal cancer?

Answer 13

Colonoscopy and biopsy - gold standard
CT colonography, Plain CT abdo/pelvis
Pre-op MRI and PET

Question 14

What are the most common tumour locations in colorectal cancer?

Answer 14

Mostly proximal colon, then distal colon then rectum

Question 15

Describe pre-op management for colorectal cancer

Answer 15

MDT discussion
Anaesthetic assessment and stoma nurse appointment
Colon cancer usually straight to surgery if no metastases but rectum has neoadjuvant chemo or RT

Question 16

What are some rectal cancer basic surgical principles?

Answer 16

Rectum surrounded by fatty envelope called mesorectum which had lymph nodes
The rectum and mesorectum has to be excised

Question 17

Why is there pre-op MRI for rectal cancer?

Answer 17

Best for looking at CRM - circumferential resection margins
Restaging after 6-8 weeks following neoadjuvant treatment
Surgery 8-10 weeks after treatment

Question 18

When is neoadjuvant treatment needed for rectal cancer?

Answer 18

CRM threatened disease, extramural venous invasion (EMVI), nodal disease and very low rectal cancer

Question 19

What is the treatment for colorectal cancer?

Answer 19

Surgical or medical
Open or minimally invasive
Palliative if advanced metastatic disease

Question 20

What is a right hemicolectomy?

Answer 20

Cecum, ascending colon and part of transverse colon removed
Ileocolic artery removed

Question 21

What are the principles for bowel anastomosis?

Answer 21

Tension free, well perfused, well oxygenated, clean surgical site and acceptable systemic state

Question 22

What are the 2 stoma types?

Answer 22

Ileostomy and colostomy

Question 23

Describe an ileostomy

Answer 23

Usually RIF
Contents are liquid and looser stools
Appearance is spouted

Question 24

Describe a colostomy

Answer 24

Usually LIF
Contents are solid stools
Appearance is no spout and flush with skin

Question 25

What are the complications with with surgery?

Answer 25

Bleeding, infection, anastomotic leak and stoma problems - ischaemia, retraction, prolapse, hernia, high output

Question 26

What are some complications with low anterior resections?

Answer 26

Damage to pelvic nerves - bowel, urinary and sexual dysfunction
Possible impaired fecundity in younger women

Question 27

What is the pathological staging used for colorectal cancer?

Answer 27

TNM staging

Question 28

Describe the post-op management of rectal cancer

Answer 28

Dependant on pathological staging
Presence of high risk pathological features
Adjuvant chemo may be needed (FOLFOX)
Surveillance CT CAP, colonoscopy
USS liver and CT CAP

Question 29

What are the cardinal signs and symptoms of bowel obstruction?

Answer 29

Abdominal pain, vomiting, absolute constipation (flatus and solids) and abdominal distention

Question 30

What is the aetiology of large bowel obstruction?

Answer 30

Malignant or benign
Benign - structures, volvulus, faecal impaction, intussusception, pseudo-obstruction

Question 31

What is the aetiology of small bowel obstruction?

Answer 31

Adhesions and hernias

Question 32

What is the management of bowel obstruction?

Answer 32

ABC, fluid resus, nasogastric tube, analgesia and antiemetics, IV antibiotics
Bloods, blood gas and CT abdo/pelvis

Question 33

What is PEARLS?

Answer 33

If closed loop obstruction then needs urgent surgical review
Normal lactate does not exclude ischaemia
Pain out of proportion suggests ischaemia or perforation

Question 34

What are the treatment options for small or large bowel obstruction?

Answer 34

Sigmoid colectomy and primary anastomoses
Hartmanns procedure
Defentioning colostomy
Colonic stenting
Do nothing

Question 35

When should you not perform an anastomosis?

Answer 35

No reservoir, rectal compliance and previous traumatic birth
Better off with stoma