Colorectal Surgery

Question 1

Arterial supply of the ascending colon

Answer 1

Ileocolic arteries
Right colic arteries
Both from superior mesenteric artery

Question 2

Arterial supply of transverse colon

Answer 2

Middle colic artery from the SMA

Question 3

Arterial supply of the descending and sigmoid colon

Answer 3

Left colic artery and sigmoid arteries from the inferior mesenteric artery
Anastomose with marginal artery

Question 4

Arterial supply of the rectum

Answer 4

Superior rectal from the Inferior mesenteric artery provides proximal rectal supply
Middle rectal artery from the internal liac artery and the inferior rectal artery from the internal pudendal artery - supply the midpart and distal part of the rectum respectively

Question 5

Types of lymph nodes of the colon

Answer 5

Epicolic
Paracolic
Intermediate
Central

Question 6

Innervation of the ascending colon

Answer 6

Superior mesenteric plexus

Question 7

Innervation of transverse colon

Answer 7

Superior mesenteric plexus

Question 8

Innervation of the descending, sigmoid and rectum

Answer 8

Superior hypogastric plexus

Inferior hypogastric plexus

Question 9

Venous drainage of ascending colon

Answer 9

Ileocolic and right colic veins drain into the superior mesenteric vein

Question 10

Venous drainage of the transverse colon

Answer 10

Middle colic vein drains into the SMV

Question 11

Venous drainage of transverse colon

Answer 11

Middle colic vein drains into SMV

Question 12

Venous drainage of descending, sigmoid colons and rectum

Answer 12

Left colic and sigmoid veins drain into the inferior mesenteric vein
The IMV joins with the splenic vein and becomes the portal vein

Question 13

Anatomical relations of the right colon

Answer 13

R kidney
R ureter
R gonadal vessel

Question 14

Anatomical relations of the transverse colon

Answer 14

Stomach
Pancreas
Duodenum

Question 15

Anatomical relations of the left colon

Answer 15

Spleen
L Kidney
L ureter
L gonadal vessel

Question 16

Common pathologies that may require surgical resection

Answer 16

Colorectal pathology 
Benign polyps
Diverticular disease
Perforation 
Ischaemic bowel 
IBD not responding to medical intervention

Question 17

Features of laparoscopic surgery

Answer 17

Less scarring
Less pain 
Faster recovery 
Shorter hospital stay 
Quicker return to normal activity

Question 18

Disadvantages of laparoscopic surgery

Answer 18

Longer operative time
Difficult visualisation of anatomy and safe borders for tumour clearance
Previous abdominal surgery causes adhesions which complicates surgery and open may be the only option
Must be consented

Question 19

Complications of colorectal resection

Answer 19

Early
- infection 
- haemorrhage
- DVT
- Chest infection 
Anastomotic leak 
Intra abdominal abscess
Damage to surrounding structures
Late
- tumour recurrence
- hernia formation 
- adhesion formation causing obstruction

Question 20

Surgical problems of the colon and rectum

Answer 20

Tumour; colorectal
Inflammation; UC, CD
Degeneration; diverticular disease
Abnormal function; constipation, incontinence, IBD
Congenital; atresia, hirschprung’s disease

Question 21

What is teach back?

Answer 21

Asking patients to repeat in their own words what they need to do or know, in a non shaming way

Question 22

Function of the colon and rectum

Answer 22

Fluid and electrolyte balance
Waste management
Continence

Question 23

How is faecal continence maintained?

Answer 23

Internal anal sphincter is contracted at rest
Anything that increases the intra-abdominal pressure, the external anal sphincter contracts
The internal anal sphincter produces nitric oxide which causes relaxation
Can let out gas without letting anything else out

Question 24

What contributes to continence?

Answer 24

Rectal compliance
Stool composition 
Pelvic floor/puborectalis
External anal sphincter
Internal anal sphincter 
Anorectal sensation

Question 25

Is visceral pain poorly or well localised?

Answer 25

Poorly