colorectal surgery Flashcards
function of the colon
water and electrolytes absorption
production and absorption of vitamins
storage of faeces
hosts the gut microbiota: role in immune function and disease
structures present in the foregut
esophagus stomach proximal duodenum liver gall bladder pancreas
structures of midgut
distal duodenum jejunum ileum cecum appendix ascending colon proximal 2/3 of transverse colon
structures of hindgut
distal 1/3 of transverse colon descending colon sigmoid colon rectum proximal anus
important factors of incontinence
anorectal sensation central control stool consistency renal compliance anatomy- sphincter complex, anal cushions
whats the 4th most common cancer?
colorectal cancer
whst id the overall 10 year survival rate?
59.9%
what is screening defined as?
defined as the presumptive identification of unrecognised disease in an apparently healthy, asymptomatic population by means if tests, examinations or other procedures that can be applied rapidly and easily to the target population
is colorectal preventable?
yes 54.4%
how do we screen patients for colorectal cancer?
Quantitative faecal immunochemical test (qFIT)
Replaced Faecal occult blood test (FOBT) in November 2017 in Scotland
Once off flexible sigmoidoscopy (In certain areas in England only >age 55)
symptoms of colorectal cancer
Abdominal pain - colicky
Rectal bleeding – anorectal pain?, colour?, mixed in stool?
Change in bowel habits (diarrhoea, constipation)
Weight loss
Tenesmus
Fatigue
Vomiting
investigations for rectal bleeding
Colonoscopy +/- biopsies (gold standard)
Radiological imaging
CT colonography
Plain CT abdo/pelvis with contrast
Staging CT if confirmed CRC (CT chest)
Pre-op MRI in confirmed rectal cancer
Others i.e PET scan
where is the tumour most likely to be in the colon
proximal
where is the tumour most likley not to be?
rectum
do you treat colorectal cancer and rectal cancer the same?
no
rectal cancer basic surgical principles
Rectum surrounded by fatty envelope called the mesorectum. This contains all the draining lymph nodes of the rectum.
To reduce local recurrence rate, the rectum and it’s surrounding mesorectum has to be excised en bloc. (TME)
If mesorectal fascia involved, surgery will be pointless unless we can downstage tumour and get clear circumferential resection margins (CRM).
why should you do MRI before operating om rectal cancer?
Best imaging modality for looking at CRM
Neoadjuvant treatment for circumferential resection margin (CRM) threatened disease, Extramural venous invasion (EMVI), nodal disease, Very low rectal cancer
Restaging 6-8 weeks later following neoadjuvant treatment
Surgery 8-10 weeks after treatment (Total Mesorectal Excision)
bowel anastomosis principles
Tension free Well perfused Well oxygenated Clean surgical site Acceptable systemic state
where is the site of a stoma for a ileostomy?
usually RIF
where is the site of a stoma for a colostomy
usually LIF
what are the contents of a stoma for a ileostomy?
liquid, looser stools
what are the contents of a stool of a colostomy?
solid stools
what is the appearance of an ileostomy stoma?
spouted
what is the appearnance of a colostomy stoma?
no spout, flush with skin
