Colorectal Surgery Flashcards
Who gets screened for colorectal cancer in scotland? How often?
Adults age 50-74 - FOBT every 2 years
HNPCC - colonoscopy every 2 years after age 25
FAP - annual colonoscopy from age 10-12
Main tests for colorectal cancer screening?
Faecal immunochemical test (FIT)
Faecal occult blood test (FOBT)
Once off sigmoidoscopy (certain areas of England only)
What is the normal procedure with a patient complaining of rectal bleeding?
Watch and wait for 6 weeks - see if there is improvement
If so - discharge
If not - review & investigations
If presence of additional warning signs other courses of action may be taken
What is the approximate location distribution of colorectal cancers in the bowel?
Proximal colon - 43%
Distal colon - 30%
Rectum - 27%
Normal course of treatment for colon and rectal cancer?
Colon cancer is almost always straight to surgery if no metastases and patient is fit
Rectal depends more on MRI - to decide whether neoadjuvant radio/chemotherapy is required
What is the mesorectum? Is it removed during a TME?
It is a fatty envelop that covers the rectum - contains all the draining lymph nodes of the rectum
Yes it is excised during a total mesorectal excision - to prevent local recurrence
Why is the pre-operative MRI important in rectal cancer?
To decide on whether neoadjuvant therapy is needed before surgery
What is the circumferential resection margin in colorectal cancer?
Good question - research bc cba rn
What is a right hemicolectomy?
Remove (approximately) the right half of the colon (caecum, ascending colon and a portion of the transverse colon)
Often also involves resection of the terminal ileum
What is often performed along with a right hemicolectomy?
A bowel anastomosis between the ileum and the colon along the TV colon
Two types of stoma and differences between the two?
- Stoma after ileostomy - Usually at right iliac fossa, liquid stool and spouted (protruding) appearance
- Stoma after colostomy - Usually LIF, solid stool, no protruding appearance
Complications of colorectal surgery?
Bleeding
Infection
Anastomotic leak
Stoma problems (ischaemia/retraction/prolapse/hernia)
Complications of colorectal surgery in low anterior resections?
Damage to pelvic nerves (bowel/urinary/sexual dysfunction)
Impaired fecundity in younger women
Causes of small bowel obstruction?
Adhesions
Hernias
Malignancy
Causes of large bowel obstruction?
Malignancy
Strictures (diverticular/ischaemic)
Faecal impaction
Volvulus (loop of intestine and mesentery twists around itself causing obstruction)
Intussusception (one segment of intestine slides inside of another section)
