Colorectal Surgery Flashcards
What is the structure of the colon and rectum?
- Smooth muscle tube
- Lined by specialised epithelium
- Enteric nerve supply
What is the function of the colon and rectum?
- Fluid and electrolyte balance
- Waste management
- Continence
What are the 5 parts of the large intestine?
- Cecum
- Ascending colon
- Transverse colon
- Descending colon
- Sigmoid colon
What important factors are there relating to continence?
- Rectal compliance
- Stool composition
- Pelvic floor/puborectalis
- External anal sphincter
- Internal anal sphincter
- Anorectal sensation
What can tumours in the colon and rectum indicate?
Colorectal cancer
What could inflammation in the colon and rectum indicate?
- Ulcerative colitis
- Crohn’s disease
What could degeneration in the colon and rectum be?
Diverticular disease
What could abnormal function in the colon and rectum be due to?
- Constipation
- Incontinence
- IBD
What congenital conditions can affect the rectum and colon?
- Atresia
- Hirschsprung’s disease
What doe patients with problems in their colon and rectum complain of?
- Change in bowel habit/ continence
- Bleeding
- Pain
- Non-intestinal manifestations
How is visceral pain “formed”?
- Pain receptors in smooth muscle
- Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
- Poorly localised
What are low risk features associated with rectal bleeding?
Transient symptoms <6 weeks
- Rectal bleeding with anal symptoms
- Patient <40
What are high risk features with rectal bleeding?
- 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
What is the pathway for CRC management?
- Presentation
- Investigation
- Diagnosis
- Staging
- MDT
- Treatment
- Follow up
- MDT
What are the key points in CRC management?
-Equality of access across network
-Common service structure and approach
-Electronic communication + co-ordination
-Information available for patients throughout
Certainty and choice for patients
What are the investigations for CRC?
- Endoscopy (colposcopy and biopsy)
- Contrast imaging (barium enema)
- Cross-sectional imaging (CT/CT colonography)
- MRI
- Other
What are the 3 treatment decisions for CRC?
- Medical vs surgical
- Endoscopic vs invasive
- Laparoscopy vs laparotomy
What should be considered when thinking of treatment?
- Resection
- Restoration of continuity
- Preservation of function
- Faecal diversion
What are the factors relating to informed consent by shared/supported decision making?
- Information
- Capacity
- Meaningful discussion
- Time and reflection
How do literacy levels differ across adults in Scotland?
- 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
What is teach-back?
- 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
What peri-operative care should the patient receive?
- Shared decision making and informed consent
- Pre-admission assessment
- Admission on the same day as surgery
- DVD prophylaxis
- Antibiotic prophylaxis
- Enhanced recovery
What is surgery guided by?
Pathology and arterial supply
What is important for successful bowel anastomosis?
- Tension free
- Well perfused
- Well oxygenated
- Clean surgical site
- Acceptable systemic state
What possible complications are there?
- Anasethetic related
- Bleeding
- Sepsis
- VTE
- Anastomotic breakdown
- Small bowel obstruction
- Wound hernia
- Other
What are the domains which are thought to reflect quality of care?
- Safety
- Effectiveness
- Patient-experience
- Leadership
- Governance
- Workforce
- Quality improvement
