Colorectal Surgery

Question 1

What are 4 functions of the colon and rectum?

Answer 1

Fluid and electrolyte balance
Waste management
Continence
Microbe related

Question 2

What is the basic anatomy going along the colon to the rectum?

Answer 2

Caecum 
Ascending colon 
Transverse colon 
Descending colon 
Sigmoid colon 
Rectum

Question 3

What is the superior rectal artery a continuation of?

Answer 3

IMA

Question 4

Is the parasympathetic or sympathetic division of NS stimulatory to the colon?

Answer 4

Parasympathetic

Question 5

Which division of the NS is inhibitory to the colon?

Answer 5

Sympathetic

Question 6

What are 5 categories of colorectal problems which indicate surgery?

Answer 6

Tumour (colorectal cancer)
Inflammation (ulcerative colitis, Crohn’s)
Degeneration (diverticular disease)
Abnormal function (constipation, incontinence, IBD)
Congenital (atresia, Hirschprung’s)

Question 7

Protocol for rectal bleeding: low risk features?

Answer 7

TRANSIENT (>6 weeks)
Rectal bleeding with anal symptoms
Patient < 40 yrs

Question 8

Protocol for rectal bleeding: next step with low risk features?

Answer 8

‘watch and wait’ - symptoms persist = refer/recur or deteriorate

Question 9

Protocol for rectal bleeding: high risk features?

Answer 9

PERSISTENT change in bowel habit (>6 weeks)
PERSISTENT rectal bleeding without anal symptoms
R side abdo mass
Palpable rectal mass
Unexplained anaemia

Question 10

Protocol for rectal bleeding: next step for high risk features?

Answer 10

refer

Question 11

Protocol for rectal bleeding: what happens when patients are referred?

Answer 11

Colonoscopy
Flexible/rigid sigmoidoscopy +/- barium enema
CT colonography

Question 12

What are 4 methods of investigation for colorectal cancer?

Answer 12

Endoscopy (colonoscopy + biopsy)
Contrast imaging (barium enema)
Cross-sectional imaging (CT/CT colonography)
MRI

Question 13

Things to consider with surgery of colorectal cancer?

Answer 13

Resection
Restoration of continuity
Preservation of function
Faecal diversion

Question 14

Is there prophylaxis involved with colorectal perioperative care?

Answer 14

YES - DVT + abx

Question 15

Classification for staging of colorectal cancer?

Answer 15

TNM

Duke classification

Question 16

What colon pre-screening tests are available for 50 and over?

Answer 16

FOBT bi-annually

Question 17

Name some possible complications of colorectal surgery

Answer 17

Anaesthetic related 
Bleeding
Sepsis
VTE
Anastomotic breakdown
Small bowel obstruction 
Wound hernia 
Others...