Colorectal Surgery

Question 1

What is the aim of population screening?

Answer 1

To detect pre-malignant adenomas/early cancers in the general population

Question 2

What two modalities of testing are most commonly used to screen populations for bowel cancer?

Answer 2

Faecal occult blood test (FOBT)

Faecal immunochemical test (FIT)

Question 3

Other than the general population, what groups would screening regularly take place in?

Answer 3

High risk groups

Question 4

Give an example of a group with a high risk of developing colorectal cancer

Answer 4

Heritable conditions e.g. FAP/HNPCC
Inflammatory bowel disease
Family history
Previous adenomas/colorectal cancer

Question 5

Give two types of colorectal problems which might require surgery

Answer 5

Tumour 
Inflammation 
Degeneration 
Abnormal function 
Congenital

Question 6

Give an example of an inflammatory colorectal condition which might require surgical treatment

Answer 6

Ulcerative colitis

Crohn’s disease

Question 7

Give an example of a degenerative colorectal condition which might require surgical treatment

Answer 7

Diverticular disease

Question 8

Give an example of a colorectal condition causing abnormal function which might require surgical treatment

Answer 8

Constipation
Incontinence
IBD

Question 9

Give an example of a congenital colorectal condition which might require surgical treatment

Answer 9

Atresia

Hirschsprung’s disease

Question 10

What investigations would you do if suspecting a colorectal condition?

Answer 10

Endoscopy
Colonoscopy and biopsy
Cross sectional imaging - CT/CT colonography
MRI

Question 11

What should be considered before surgery is carried out to correct a colorectal condition?

Answer 11

Resection
Restoration of continuity
Preservation of function
Faecal diversion

Question 12

What peri-operative care should be given to a patient undergoing colorectal surgery?

Answer 12

Informed consent
DVT prophylaxis
Antibiotics prophylaxis
Possible bowel preparation

Question 13

What properties doe the bowel anastomosis need to have in order for surgery to be successful?

Answer 13

Tension free 
Well perfused 
Well oxygenated 
Clean surgical site 
Acceptable systemic state

Question 14

What are the surgical options for colorectal conditions?

Answer 14

Faecal diversion

Ileal pouch

Question 15

What is involved in a faecal diversion surgery?

Answer 15

Colostomy/ileostomy - stoma created

Question 16

What is involved in ileal pouch surgery?

Answer 16

Creation of a pouch of small intestine, following surgical removal of colon and rectum, to recreate the removed rectum - 2 or more loops of small intestine sutured or stapled together to form a reservoir for stool which is then attached to the anus.

Question 17

What are the possible complications of colorectal surgery?

Answer 17

Anaesthetic related 
Bleeding 
Sepsis 
Venous thromboembolism 
Anastomotic breakdown 
Small bowel obstruction 
Wound hernia