Colorectal Surgery Flashcards
What is the most common type of anal cancer and from where does it arise
Squamous cell carcinoma
They arise inferior to the dentate line
What is the biggest risk factor for anal cancer?
HPV 16
What are the first line and second line treatments to anal cancer?
First line: chemoradiotherapy
Second line: salvage radical abdominoperineal excision of the anus and rectum
Diseases associated with anal fissures?
Crohns disease
TB
Internal rectal prolapse
Treatment options for anal fissures?
Diltiazem paste or topical GTN
How would you define a simple uncomplicated fistulae?
They are low down and do not involve more than 30% of the external anal sphincter
How would you define a complicated fistula?
They involve the sphincter, they have multiple branches or they are not cryptoglandular in origin
What are the best investigations for ano-rectal fistulas?
-endoanal US with instillation of hydrogen peroxide
-MRI rectum is very sensitive and can show you the tracking of the fistula
What is the management options for ano-rectal fissures?
- seton sutures
- fistulotomy
- anal fistula plugs and fibrin glue
- anorectal advancement flaps
- ligation of intersphincteric tract procedures
- fistulotomy at the time of abscess drainage
What are the different types of seton sutures?
simple setons: lie within the fistula tract to encourage both drainage and fibrosis
cutting seton: seton is inserted and the skin is incised to form scar tissue around the seton
Most common position of haemorrhoids?
3, 7 and 11 o clock position
What are some common causes of proctitis?
Crohns disease, UC and Clostridium difficile
What are the different positions of anorectal abscess?
perianal
ischiorectal
pelvirectal
intersphincteric
Most common cause of anal fistula?
Likely due to anorectal abscess
Most common cause of a solitary rectal ulcer?
Associated with chronic straining and constipation
What are the treatments for anorectal prolapse?
- covering with sugar in the acute setting may reduce swelling
- Delormes procedure for external prolapse - but high recurrence rate
- Altmeirs procedure: resects the colon via the perineal route, lower recurrence rates but higher risks of anastomotic leak
- Rectopexy
What are the symptoms of appendicitis?
pyrexia
vomiting once or twice, but persistent vomiting would be unusual
periumbilical pain that migrates to the right iliac fossa
anorexia is very common
diarrhoea is rare
What are the indications in appendicitis to operate?
Raised inflammatory markers accompanied with a fitting clinical history
What is the follow up protocol for colorectal cancer?
A colonoscopy 12 months post resection
Large non pedunculated colorectal polyps follow up?
R0 = One off scope at 3 years
R1 = Site check at 2-6 months with a further scope at 12 months
What is the follow up for high risk findings on initial colonoscopy?
A further colonoscopy arranged in 3 years (one off)
What would be defined as high risk findings in colonoscopy?
More than 2 premalignant polyps including 1 or more advanced colorectal polyps or more than 5 premalignant polyps
What are the criteria where segmental resection or complete colectomy can be considered?
Incomplete excision of a malignant polyp
Malignant sessile polyp
Malignant pedunculated polyp with submucosal invasion
polyps with poorly differentiated carcinoma
familial polyposis coli
What radiological evaluation should be taken in patients diagnosed with a colorectal cancer?
- CT CAP for staging
- Entire colon evaluation with colonoscopy or CT colonography
- Tumours below the peritoneal reflection should be evaluated via mesorectum MRI
