Colorectal Surgery Flashcards
Which artery supplies the caecum, ascending colon and proximal 2/3/ or transverse colon?
SMA
Which artery supplies the distal 1/3 of the transverse colon, descending colon, sigmoid colon and rectum and anus?
IMA
How can colorectal cancer be screened?
qFIT test- quantitive faecal immunochemical test
What is involved in qFIT?
50-74yrs of age send a sample of faeces to be tested every two years
What can be removed to reduce risks of cancer?
Polpys
If patients have black faeces, where are they more likely to be bleeding from?
Upper GIT
If patients have red faeces, where are they more likely to be bleeding from?
Lower GIT
List some symptoms of rectal cancer.
-Abdominal pain- colicky (patients often have abdominal pain is they are further on in the manifestation of the cancer, not always present).
-Rectal bleeding
-Weight loss
-Tenesmus (feeling like you still need a poo after having a poo).
-Fatigue
-Vomiting
Which investigations are the gold-standard for diagnosing colon cancer?
Colonoscopy +/- biopsies
Which investigation can be used for staging of colon cancer?
CT
What is the surgical management of colon cancer?
If patient fit and does not have any metastatic disease, they are taken straight to surgery
What is the surgical management of rectal cancer?
MRI required to see if patient should have neoadjuvant chemo/radiotherapy before surgery
Describe the removal of the rectum in rectal cancer.
Rectum and surrounding mesorectum are removed to reduce reoccurrence rate.
Mesorectum is the fatty envelope containing all the lymph nodes of the rectum, hence why is it removed to reduce spread and reoccurrence.
If the cancer is in the caecum, why is the whole ascending colon removed?
The blood supply would be at risk
What is meant be a bowel anastomoses?
Join two parts if the bowel together if middle part has been removed
What are the principles for bowel anastomoses?
Must be:
-tension free
-good blood supply
-well oxygenated
-free of abnormalities
What is the difference in stoma appearance between an ileostomy and colostomy?
Ileostomy- sprouted appearance, almost as if the colon is coming out the body a bit.
Colostomy- end is flushed with skin
What would be in the contents of a ileostomy bag?
Loose stool, has not had water absorped
(Liz!)
What would be in the contents of a colostomy bag?
Solid stool
Where is the usual site of an ileostomy?
Right iliac fossa
What is the usual site of a colostomy?
Left iliac fossa
What are some complications of colorectal surgery?
Similar to most surgery- bleeding, infection
Also, anastomotic leak, stoma problems
What is meant by TNM in terms of staging?
T-local growth
N-lymph node involvement
M- metastatic deposits
What does post-op bowel management depend on?
Results from the lab as bowel will be send to the lab
What are the cardinal signs/symptoms of bowel obstruction?
Abdominal pain
Vomiting
Absolute constipation
Abdominal distention
What is the difference in terms of presentation in someone with a competent ileocecal valve and someone without?
Functional valve- might not vomit as contents will not go back up. Will be abdominal pain, constipation and distention.
Malfunctional valve- will vomit, have distention and constipation
What happens if a bowel obstruction is not operated on immediatly?
May perforate- large bowel obstruction is a medical emergency
What might be the cause of a large bowel obstruction?
Malignant cause i.e. tumours
Benign i.e. strictures, faecal impaction etc.
What might be the cause of a small bowel obstruction?
Hernia
Adhesion
Describe the management for a patient with a bowel obstruction.
-ABC
-Fluid resuscitation- dehydrated as have lost a lot of fluid
-Nasogastric tube to remove fluid
-IV antibiotics and pain meds as won’t be able to take anything orally
-Blood tests
-Blood gas
-CT scan
