Colorectal Surgery

Question 1

What are the important factors of continence?

Answer 1

Rectal compliance, stool composition, pelvic floor muscles, anorectal sensation and anal sphincters

Question 2

What are pathologies of the colon and rectum may require surgery?

Answer 2

Tumour
Inflammation (ulcerative colitis & Crohn’s)
Degeneration (diverticular disease)
Abnormal Function (constipation, incontinence and IBD)
Congenital (atresia & Hirschsprung’s disease)

Question 3

What are the common presentations of colorectal problems?

Answer 3

Changes in bowel habit/continence, bleeding, pain and non-intestinal manifestations

Question 4

What is a typical feature of visceral pain?

Answer 4

It is poorly localised

Question 5

What are the low risk features of rectal bleeding?

Answer 5

Transient symptoms, anal symptoms and patient<40

Question 6

What are the high risk features of rectal bleeding?

Answer 6

Persistent change in bowel habit, no anal symptoms, right sided abdominal mass, palpable rectal mass, unexplained iron deficiency anaemia and patients in whom there is clinical doubt

Question 7

What are the investigations used in colorectal pathologies?

Answer 7

Endoscopy - colonoscopy and biopsy
Contrast Imaging - barium enema
Cross Sectional Imaging - CT/CT colonography
MRI

Question 8

What are the considerations when deciding treatment?

Answer 8

Resection, restoration of continuity, preservation of function and faecal diversion

Question 9

What features of a bowel anastomosis are necessary for good recovery?

Answer 9

Tension free, well perfused, well oxygenated, clean surgical site and acceptable systemic site

Question 10

What are the complications of faecal diversion?

Answer 10

Anaesthetic related, bleeding, sepsis, VTE, anastomotic breakdown, small bowel obstruction and wound hernia