Colorectal Surgery Flashcards
What is the structure of the colon?
Smooth muscle tube lined by specialised epithelium with an enteric nerve supply
What determines colon function?
Fluid and electrolyte balance
Waste management
Continence
What does Nitric Oxide do?
Mediates inhibitory relfexes
What are causes for surgical procedures?
Tumours - Colorectal cancer
Inflammation - UC & Crohn’s disease
Degeneration - Diverticular disease
Abnormal function - Constipation, Incontinence & IBD
Congenital - Atresia & Hirschsprung’s disease
What do patients complain about in reference to their bowel?
Change in bowel habit/continence
Bleeding
Non-intestinal bleeding
Pain
How is somatic pain usually localised?
Accurately but it can be referred
What may be caused by colorectal cancer?
Rectal bleeding
What should be considered before surgery?
Benefit vs Harm
Psychological morbidity, Labelling, Physical harm & Cost: Financial/Opportunity
How are anal cushions fed?
By arterioles (Not capillaries) and when haemorrhoids are removed surgically not too much of one wants to be removed as there is a risk you may make the patient incontinent
What are the investigations before surgery?
Endoscopy - Colonoscopy & Biopsy
Contrast Imaging - Barium enema
Cross sectional imaging - CT/CT Colonography
MRI
What should be considered for treatment?
Medical & Endoscopic vs Invasive
Laparoscopy vs Laparotomy
What types of surgery should be considered?
Resection
Restoration of continuity
Preservation of function
Faecal diversion
What four actions should be consider for planning surgery?
Plan
Do
Study
Act
What should be done for peri-operative care?
DVD Prophylaxis
Antibiotics prophylaxis
For bowel anastamosis to succeed the bowel must be?
Tension free Well perfused Well oxygenated Clean surgical site Acceptable systemic state
