colorectal surgery Flashcards

1
Q

function of the colon

A

water and electrolytes absorption

production and absorption of vitamins

storage of faeces

hosts the gut microbiota: role in immune function and disease

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2
Q

structures present in the foregut

A
esophagus
stomach
proximal duodenum
liver
gall bladder
pancreas
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3
Q

structures of midgut

A
distal duodenum
jejunum
ileum
cecum
appendix
ascending colon 
proximal 2/3 of transverse colon
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4
Q

structures of hindgut

A
distal 1/3 of transverse colon
descending colon
sigmoid colon
rectum
proximal anus
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5
Q

important factors of incontinence

A
anorectal sensation
central control
stool consistency
renal compliance
anatomy- sphincter complex, anal cushions
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6
Q

whats the 4th most common cancer?

A

colorectal cancer

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7
Q

whst id the overall 10 year survival rate?

A

59.9%

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8
Q

what is screening defined as?

A

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

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9
Q

is colorectal preventable?

A

yes 54.4%

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10
Q

how do we screen patients for colorectal cancer?

A

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)

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11
Q

symptoms of colorectal cancer

A

Abdominal pain - colicky
Rectal bleeding – anorectal pain?, colour?, mixed in stool?
Change in bowel habits (diarrhoea, constipation)
Weight loss
Tenesmus
Fatigue
Vomiting

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12
Q

investigations for rectal bleeding

A

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

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13
Q

where is the tumour most likely to be in the colon

A

proximal

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14
Q

where is the tumour most likley not to be?

A

rectum

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15
Q

do you treat colorectal cancer and rectal cancer the same?

A

no

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16
Q

rectal cancer basic surgical principles

A

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).

17
Q

why should you do MRI before operating om rectal cancer?

A

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)

18
Q

bowel anastomosis principles

A
Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state
19
Q

where is the site of a stoma for a ileostomy?

A

usually RIF

20
Q

where is the site of a stoma for a colostomy

A

usually LIF

21
Q

what are the contents of a stoma for a ileostomy?

A

liquid, looser stools

22
Q

what are the contents of a stool of a colostomy?

A

solid stools

23
Q

what is the appearance of an ileostomy stoma?

A

spouted

24
Q

what is the appearnance of a colostomy stoma?

A

no spout, flush with skin

25
Q

what are the complications of a stoma?

A

bleeding
infection
anastomotic leak
stoma problems- ischaemia, retraction, prolapse, hernia, high output

26
Q

post op management

A

Adjuvant chemotherapy may be required (FOLFOX)
Post-operative complications might hinder or delay adjuvant treatment
Surveillance CT CAP, colonoscopy.
In NHSG alternate USS liver + CT CAP every 6 months

27
Q

aetiology of large bowel obstruction

A
Malignant (60%)
Benign
Strictures (diverticular, ischaemic)
Volvulus
Faecal impaction
Intussusception
Pseudo-obstuction
28
Q

aetiology of small bowel obstruction

A

adhesions

hernias

29
Q

management of bowel obstruction?

A

Fluid resuscitation
NBM and consider nasogastric tube if vomiting
Analgesia and antiemetics
Consider IV antibiotics
Bloods (FBC, U&Es, G&S, Coagulation screen)
Blood gas (Lactate, pH, BE)
CT abdo/pelvis