Colorectal surgery Flashcards
what is the structure of the colon
- smooth muscle tube
- lined by specialised
epithelium - enteric nerve supply
what is the function of the colon
- fluid and electrolyte balance
- waste management
- continence
what causes anorectal sensation
stretch, volume and discrimination
what are the groups of surgical problems of the colon and rectum
tumour inflammation degeneration abnormal function congential
give examples of these surgical problems of the colon and the rectum
Tumour- colorectal cancer
Inflammation- ulcerative colitis, Crohn’s disease
Degeneration- diverticular disease
Abnormal function- constipation, incontinence, IBD
Congenital- atresia, Hirschsprung’s disease
what common symptoms do patients complain of
Change in bowel habit/ continence
Bleeding
Pain
Non-intestinal manifestations
why is it usually visceral pain experienced
Pain receptors in smooth muscle
Afferent impulses run with sympathetic fibres accompanying segmental vessels (CP, SMA, IMA)
so poorly localised
what investigations can be done to help diagnose a problem
Endoscopy
- colonoscopy and biopsy
Contrast imaging
- barium enema
Cross sectional imaging
- CT/ CT colonography
MRI
what kind of treatments are available for patients with colon and rectum disorders
Medical vs. surgical
Endoscopic vs. invasive
Laparoscopy vs. laparotomy
Consider: resection restoration of continuity preservation of function faecal diversion
what is involved in peri-operative care for colon and rectum surgeries
informed consent
DVT prophylaxis
Antibiotic prophylaxis
what guides the surgery used
pathology and arterial supply
what allows for successful bowel anastomoses
Tension free Well perfused Well oxygenated Clean surgical site Acceptable systemic state
what are complications of colorectal surgery
Anaesthetic related Bleeding Sepsis VTE Anastomotic breakdown Small bowel obstruction Wound hernia
