Colorectal Surgery Flashcards by Sophie Pitcairn

What are the main types of surgeries for colorectal conditions?

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

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What is the function of the colon?

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

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Describe the arterial supply of the colon and the rectum

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

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What is the venous drainage of the colon and rectum

Superior and inferior mesenteric vein

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Describe the nerve supply of colon and rectum

Parasympathetic - vagus and C2,3,4
Sympathetic

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What are some important factors causing continuence?

Anatomy
Rectal compliance
Stool consistency
Central control
Anorectal sensation

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What is screening?

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

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What is the screening for colorectal cancer in Scotland?

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

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What are ways to screen for colorectal cancer?

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

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What are some different types of polyps?

Pedunculated polyp
Flat, FAP, giant, multiple

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Describe a polypectomy

Removal of polyp with hot snare
Colonoscopy guided

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What are the symptoms of colorectal cancer?

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

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What are some investigations used for colorectal cancer?

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

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What are the most common tumour locations in colorectal cancer?

Mostly proximal colon, then distal colon then rectum

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Describe pre-op management for colorectal cancer

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

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What are some rectal cancer basic surgical principles?

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

Why is there pre-op MRI for rectal cancer?

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

When is neoadjuvant treatment needed for rectal cancer?

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

What is the treatment for colorectal cancer?

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

What is a right hemicolectomy?

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

What are the principles for bowel anastomosis?

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

What are the 2 stoma types?

Ileostomy and colostomy

Describe an ileostomy

Usually RIF
Contents are liquid and looser stools
Appearance is spouted

Describe a colostomy

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

What are the complications with with surgery?

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

What are some complications with low anterior resections?

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

What is the pathological staging used for colorectal cancer?

TNM staging

Describe the post-op management of rectal cancer

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

What are the cardinal signs and symptoms of bowel obstruction?

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

What is the aetiology of large bowel obstruction?

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

What is the aetiology of small bowel obstruction?

Adhesions and hernias

What is the management of bowel obstruction?

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

What is PEARLS?

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

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

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

When should you not perform an anastomosis?

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