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Systems: Alimentary AB > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

What is the structure of the colon and rectum?

A
  • Smooth muscle tube
  • Lined by specialised epithelium
  • Enteric nerve supply
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2
Q

What is the function of the colon and rectum?

A
  • Fluid and electrolyte balance
  • Waste management
  • Continence
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3
Q

What are the 5 parts of the large intestine?

A
  • Cecum
  • Ascending colon
  • Transverse colon
  • Descending colon
  • Sigmoid colon
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4
Q

What important factors are there relating to continence?

A
  • Rectal compliance
  • Stool composition
  • Pelvic floor/puborectalis
  • External anal sphincter
  • Internal anal sphincter
  • Anorectal sensation
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5
Q

What can tumours in the colon and rectum indicate?

A

Colorectal cancer

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6
Q

What could inflammation in the colon and rectum indicate?

A
  • Ulcerative colitis

- Crohn’s disease

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7
Q

What could degeneration in the colon and rectum be?

A

Diverticular disease

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8
Q

What could abnormal function in the colon and rectum be due to?

A
  • Constipation
  • Incontinence
  • IBD
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9
Q

What congenital conditions can affect the rectum and colon?

A
  • Atresia

- Hirschsprung’s disease

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10
Q

What doe patients with problems in their colon and rectum complain of?

A
  • Change in bowel habit/ continence
  • Bleeding
  • Pain
  • Non-intestinal manifestations
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11
Q

How is visceral pain “formed”?

A
  • Pain receptors in smooth muscle
  • Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
  • Poorly localised
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12
Q

What are low risk features associated with rectal bleeding?

A

Transient symptoms <6 weeks

  • Rectal bleeding with anal symptoms
  • Patient <40
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13
Q

What are high risk features with rectal bleeding?

A
  • Persistent change in bowel habit >6 weeks
  • Persistent rectal bleeding without anal symptoms
  • Right sided abdominal mass
  • Palpable rectal mass
  • Unexplained iron deficiency anaemia
  • Patients in whom there is clinical doubt
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14
Q

What is the pathway for CRC management?

A
  • Presentation
  • Investigation
  • Diagnosis
  • Staging
  • MDT
  • Treatment
  • Follow up
  • MDT
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15
Q

What are the key points in CRC management?

A

-Equality of access across network
-Common service structure and approach
-Electronic communication + co-ordination
-Information available for patients throughout
Certainty and choice for patients

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16
Q

What are the investigations for CRC?

A
  • Endoscopy (colposcopy and biopsy)
  • Contrast imaging (barium enema)
  • Cross-sectional imaging (CT/CT colonography)
  • MRI
  • Other
17
Q

What are the 3 treatment decisions for CRC?

A
  • Medical vs surgical
  • Endoscopic vs invasive
  • Laparoscopy vs laparotomy
18
Q

What should be considered when thinking of treatment?

A
  • Resection
  • Restoration of continuity
  • Preservation of function
  • Faecal diversion
19
Q

What are the factors relating to informed consent by shared/supported decision making?

A
  • Information
  • Capacity
  • Meaningful discussion
  • Time and reflection
20
Q

How do literacy levels differ across adults in Scotland?

A
  • Very poor skills. May not be able to determine the amount of medicine to take
  • Weak skills. Can only deal with well laid out simple material and tasks that are not complex
  • Skills at or above level required for copying with demands of everyday life
21
Q

What is teach-back?

A
  • Asking patients to repeat in their own words what they need to know or do in a non-shaming way
  • Not a test of the patient, but of how well you explained the concept
  • A chance to check for understanding and if necessary, re-teach the information
22
Q

What peri-operative care should the patient receive?

A
  • Shared decision making and informed consent
  • Pre-admission assessment
  • Admission on the same day as surgery
  • DVD prophylaxis
  • Antibiotic prophylaxis
  • Enhanced recovery
23
Q

What is surgery guided by?

A

Pathology and arterial supply

24
Q

What is important for successful bowel anastomosis?

A
  • Tension free
  • Well perfused
  • Well oxygenated
  • Clean surgical site
  • Acceptable systemic state
25
Q

What possible complications are there?

A
  • Anasethetic related
  • Bleeding
  • Sepsis
  • VTE
  • Anastomotic breakdown
  • Small bowel obstruction
  • Wound hernia
  • Other
26
Q

What are the domains which are thought to reflect quality of care?

A
  • Safety
  • Effectiveness
  • Patient-experience
  • Leadership
  • Governance
  • Workforce
  • Quality improvement

Systems: Alimentary AB (37 decks)

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