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Finals > Colorectal surgery > Flashcards

Colorectal surgery Flashcards

1
Q

Most common anal cancer

A

SSC

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2
Q

Borders of anal canal

A

Anorectal junction
Anal margin

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3
Q

Where do anal margin tumours spread

A

inguinal lymph nodes

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4
Q

Where to more proximal anal tumours spread

A

Pelvic lymph nodes

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5
Q

RF for anal cancer

A

HPV
Anal intercourse
MM sex
HIV

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6
Q

Presentation of anal cancer

A

Perianal pain
Perianal bleeding
A palpable lesion
Faecal incontinence

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7
Q

Presentation of anal fissure

A

painful, bright red, rectal bleeding

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8
Q

Where do 90% of anal fissures occur

A

Posterior midline
Alternative location ? consider underlying cause (e.g. crohns)

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9
Q

RF for anal fissures

A
  • constipation
  • inflammatory bowel disease
  • sexually transmitted infections e.g. HIV, syphilis, herpes
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10
Q

Acute fissure management (<1wk)

A
  • Dietary advice: high-fibre diet with high fluid intake
  • Bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
  • Lubricants such as petroleum jelly may be tried before defecation
  • Topical anaesthetics
  • Analgesia
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11
Q

Chronic fissure management

A

topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure

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12
Q

How are haemorrhoids classified ?

A
  • 1st degree: no prolapse
  • 2nd degree: prolapse when straining and return on relaxing
  • 3rd degree: prolapse when straining, do not return on relaxing, but can be pushed back
  • 4th degree: prolapsed permanently
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13
Q

Common presentation of haemorrhoids

A

-> Painless, bright red bleeding. Typically on the toilet tissue.
-> Sore / itchy
-> Feeling a lump around or inside the anus

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14
Q

Treatment for haemorrhoids

A
  • Increase fibre and fluids
  • Topical : anusol
  • Non surgical : rubber band ligation, injection sclerotherapy
  • Surgical : haemorrhoidal artery ligation, haemorrhoidectoimy
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15
Q

How can haemorrhoids be prevented

A
  • Increasing the amount of fibre in the diet
  • Maintaining a good fluid intake
  • Using laxatives where required
  • Consciously avoiding straining when opening their bowels
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16
Q

Screening for colorectal cancer

A
  • Faecal immunochemical test testing every 2 yrs for anyone aged 60-74
  • Detects and quantifies amount of human blood in single stool sample
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17
Q

Presentation of colorectal cancer

A
  • Rectal bleeding
  • Chnage in bowel habit
  • Abdo pain and discomfort
  • Unexplained weight loss
  • Anaemia
  • Bowel obstruction
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18
Q

tumour marker for colorectal cancer

A

Carcinoembryonic antigen

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19
Q

Colorectal cancer of caecal, ascending or proximal transverse colon

A

Right hemicolectomy with ileo-colic anastomosos

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20
Q

cancer of Distal transverse, descending colon

A

Left hemicolectomy with Colo-colon anastomosis

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21
Q

Cancer of sigmoid colon

A

High anterior resection with colo-rectal anastomosis

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22
Q

Cancer of upper rectum

A

Anterior resection with colo-rectal anastomosis

23
Q

Cancer of low rectum

A

Anterior resection with colo-rectal anastomosis (+/- defunctionin stoma)

24
Q

RF for colon cancer

A
  • FHx
  • Familial adenomatous polyposis (AD)
  • Hereditary nonpolyposis colorectal cancer (AD)
  • IBD
  • Obesity
  • Smoking
  • Alcohol
25
Q

What is diverticular disease

A

herniation of colonic mucosa through muscular wall of colon

26
Q

Risk factors for diverticulosis

A
  • Increased age
  • Low fibre diet
  • Obesity
  • Use of NSAIDs
27
Q

Presentation of diverticulosis

A
  • Lower left abdominal pain
  • Constipation
  • Rectal bleeding
28
Q

Management of diverticulosis

A
  • Increased fibre diet
  • Bulk forming laxatives
29
Q

Presentation of acute diverticulitis (7)

A
  • Pain and tenderness in the left iliac fossa / lower left abdomen
  • Fever
  • Diarrhoea
  • Nausea and vomiting
  • Rectal bleeding
  • Palpable abdominal mass (if an abscess has formed)
  • Raised inflammatory markers (e.g., CRP) and white blood cells
30
Q

Management of uncomplicated acute diverticulitis in primary care (4)

A
  • Oral co-amoxiclav (at least 5 days)
  • Analgesia (avoiding NSAIDs and opiates, if possible)
  • Only taking clear liquids (avoiding solid food) until symptoms improve (usually 2-3 days)
  • Follow-up within 2 days to review symptoms
31
Q

Complications of diverticulitis

A
  • Perforation
  • Peritonitis
  • Peridiverticular abscess
  • Large haemorrhage requiring blood transfusions
  • Fistula (e.g., between the colon and the bladder or vagina)
  • Ileus / obstruction
32
Q

Explain Duke’s classification for colorectal cancer

A

A : confined to mucosa
B : invades bowel wall
C : lymph node mets
D : distant mets

33
Q

Define ischaemic colitis

A

transient comprimise of blood flow to large bowel

34
Q

define acute mesenteric ischaemia

A

Embolism occluding artery suplying small bowel (e.g. superior mesenteric)

35
Q

Presentatio of acute mesenteric ischaemia

A

often AF Hx
Abdo pain severe, sudden and out of keeping with physical exam findings

36
Q

Mx of acute mesenteric ischaemia

A

Immediate laparotomy

37
Q

3 causes of large bowel obstruction

A
  1. tumour
  2. volvulus
  3. Diverticular diease
38
Q

Large bowel obstruction present ?

A
  • Absence of passing flatus or stool
  • Abdominal pain
  • Abdominal distention
  • Nausea and vomiting are late symptoms that may suggest a more proximal lesion
39
Q

Diagnosis and key finding of bowel obstruction

A
  • X ray = distended loops of bowel
40
Q

what will be seen on bloods in bowel obstruction and why ?

A
  • Electrolyte imbalances
  • Metabolic alkalosis due to vomiting (VBG)
  • Raised lactate (bowel ischaemia)
41
Q

Initial management of bowel obstruction

A

” Drip and suck “

  • Nil by mouth (don’t put food or fluids in if there is a blockage)
  • IV fluids to hydrate the patient and correct electrolyte imbalances
  • NG tube with free drainage to allow stomach contents to freely drain and reduce the risk of vomiting and aspiration
42
Q

RF for volvulous

A

Neuropsychiatric disorders (e.g., Parkinson’s)
Nursing home residents
Chronic constipation
High fibre diet
Pregnancy
Adhesions

43
Q

Investigation of choice for volvulus

A

Contrast CT

44
Q

Finding on abdominal x-ray in sigmoid volvulus

A

” Coffee bean “

45
Q

Features of perianal abscess

A
  • Pain around the anus, which may be worse on sitting;
  • Hardened tissue in the anal region;
  • There may be pus-like discharge from the anus;
  • If the abscess is longstanding, the patient may have features of systemic infection.
46
Q

Tx of perianal abscess

A
  • Incision and drainage
47
Q

What operation is done for colorectal cancer if they present with perforation

A

Hartmann’s -> resection of sigmpid colon and end colostomy fashioned

48
Q

Most common histiological subtype of colorectal cancer

A

Adenocarcinoma

49
Q

Surgery for anal verge cancer (tumour of low rectum with a projection inferior to within 1cm of dentate line)

A

abdomino-perineal excision of rectum

50
Q

Location, appearance and ouput of ileostomy

A
  • RIF
  • Spouted
  • Liquid contents
51
Q

Location, appearance and output of colostomy

A
  • Varies, often left side
  • Flush with skin
  • Solid
52
Q

why are small bowel stomas often spouted and colonic ones are not ?

A
  • Small bowel is spouted as the content is more irritant and so does not want to be in contact with skin
  • Colonic content is more alkaline and so can be flush with skin
53
Q
A

Finals (92 decks)

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