Colorectal Surgery Flashcards
Arterial supply of the ascending colon
Ileocolic arteries
Right colic arteries
Both from superior mesenteric artery
Arterial supply of transverse colon
Middle colic artery from the SMA
Arterial supply of the descending and sigmoid colon
Left colic artery and sigmoid arteries from the inferior mesenteric artery
Anastomose with marginal artery
Arterial supply of the rectum
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
Types of lymph nodes of the colon
Epicolic
Paracolic
Intermediate
Central
Innervation of the ascending colon
Superior mesenteric plexus
Innervation of transverse colon
Superior mesenteric plexus
Innervation of the descending, sigmoid and rectum
Superior hypogastric plexus
Inferior hypogastric plexus
Venous drainage of ascending colon
Ileocolic and right colic veins drain into the superior mesenteric vein
Venous drainage of the transverse colon
Middle colic vein drains into the SMV
Venous drainage of transverse colon
Middle colic vein drains into SMV
Venous drainage of descending, sigmoid colons and rectum
Left colic and sigmoid veins drain into the inferior mesenteric vein
The IMV joins with the splenic vein and becomes the portal vein
Anatomical relations of the right colon
R kidney
R ureter
R gonadal vessel
Anatomical relations of the transverse colon
Stomach
Pancreas
Duodenum
Anatomical relations of the left colon
Spleen
L Kidney
L ureter
L gonadal vessel
Common pathologies that may require surgical resection
Colorectal pathology Benign polyps Diverticular disease Perforation Ischaemic bowel IBD not responding to medical intervention
Features of laparoscopic surgery
Less scarring Less pain Faster recovery Shorter hospital stay Quicker return to normal activity
Disadvantages of laparoscopic surgery
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
Complications of colorectal resection
Early - infection - haemorrhage - DVT - Chest infection Anastomotic leak Intra abdominal abscess Damage to surrounding structures Late - tumour recurrence - hernia formation - adhesion formation causing obstruction
Surgical problems of the colon and rectum
Tumour; colorectal
Inflammation; UC, CD
Degeneration; diverticular disease
Abnormal function; constipation, incontinence, IBD
Congenital; atresia, hirschprung’s disease
What is teach back?
Asking patients to repeat in their own words what they need to do or know, in a non shaming way
Function of the colon and rectum
Fluid and electrolyte balance
Waste management
Continence
How is faecal continence maintained?
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
What contributes to continence?
Rectal compliance Stool composition Pelvic floor/puborectalis External anal sphincter Internal anal sphincter Anorectal sensation
