Colorectal Surgery Flashcards
What are some colorectal surgical specialties?
Colorectal cancers
Polyps
Inflammatory bowel disease
Functional bowel problems
Pelvic floor disorders
Benign (DD, piles, fissures, fistulas)
Advanced pelvic malignancies
Peritoneal malignancies
Anal cancers
Open surgery
Endoscopic treatment
Minimally invasive techniques
What are examples of minimally invasive colorectal surgery techniques?
Laparoscopic
Robotics
NOTES
What are functions of the colon and rectum?
Water and electrolyte abruption
Production and absorption of vitamins (K and B)
Storage of faeces (rectum)
Hosts the gut microbiota (role in immune function and disease)
What structures are derived from the foregut?
Oesophagus
Stomach
Proximal duodenum
Liver
Gallbladder
Pancreas
What structures are derived from the midgut?
Distal duodenum
Jejunum
Ileum
Caecum
Appendix
Ascending colon
Proximal 2/3 of transverse colon
What structures are derived from the hindgut?
Distal 1/3 of transverse colon
Descending colon
Sigmoid colon
Rectum
Proximal anus
What is continence?
When an individual has control of their bladder and bowel
What number of most common cancer is colorectal cancer?
4th most common cancer
Over the last decade, is the incidence of colorectal cancer increasing or decreasing?
Decreasing
What is screening?
Presumptive identification of unrecognised disease in an apparently healthy, asymptomatic population by means of tests, examination or other procedure that can be applied rapidly and easily to the target population
How are patients screened for colorectal cancer in Scotland?
Quantitative faecal immunochemical test (qFIT)
What is the adenoma-carcinoma sequence?
1) Normal colon
2) Mucosa at risk
3) Adenomas
4) Carcinoma
What are presenting symptoms of colorectal cancer?
Abdominal pain
Rectal bleeding
Change in bowel habits (diarrhoea, constipation)
Weight loss
Tenesmus
Fatigue
Vomiting
How many people experience rectal bleeding in their lifetime?
1 in 4
What investigations are done for colorectal cancer?
Colonoscopy with or without biopsies (gold standard)
Radiological imaging (CT colonoscopy, plain CT abdomen/pelvic contrast)
Staging CT if confirmed colorectal cancer (CT chest)
Pre-op MRI in confirmed rectal cancer
Where are most colorectal tumours located?
1) Proximal colon
2) Distal colon
3) Rectum
What should be remembered about colon and rectal cancer?
They are treated as 2 separate entities
What is the pre-op management of colorectal cancer?
MDT discussion
Anaesthetic assessment, stoma nurse appointment
MRI important in rectal cancer
Why is an MRI important before surgery in rectal cancer?
Could dictate if neoadjuvant chemotherapy, radiotherapy or both required following surgery
What are the basic surgery principles of rectal cancer?
Rectum surrounded by fatty envelope caled the mesorectum (contains all drianing lymph nodes)
To reduce local recurrence rate the rectum and surrounding mesorectum has to be excised
If mesorectal fascia is involved, surgery will be pointless unless tumour can be downsized and get clear circumferential resection margins (CRM)
What fatty stucture surrounds the rectum?
Mesorectum
What does the mesorectum contain?
All draining lymph nodes of the rectum
Why is a pre-operative MRI given for rectal cancer?
Best imaging modality for looking at circumferential resection margin (CRM)
What is the treatment for colorectal cancer?
Resection
Restoration intestinal continuity
Faecal diversion (stoma)
Preservation of function
Palliative if advanced metastatic disease
What is surgery for colorectal cancer guided by?
Pathology
Tumour location
Vascular anatomy
What are different kinds of colectomy?
What are some bowel anastomosis principles?
Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state
What are the different kinds of stoma?
Ileostomy
Colostomy
What is the location of ileostoma?
Right iliac fossa
What is the location of colostomy?
Left iliac fossa
What stools come out of ileostomy?
Liquid, looser stools
What stools come out of colostomy?
Solid stools
Which of ileostomy and colostomy has a spouted appearance?
Ileostomy
What are some complications of colectomy?
Bleeding
Infection
Anastomotic leak
Stoma problems (ischaemia, retraction, prolapse, hernia, high output)
In low anterior resection, damage to pelvic nerves (bowel, urinary, sexual dysfunction)
What are some possible stoma problems?
Ischaemia
Retraction
Prolapse
Hernia
High output
When is colorectal cancer considered to be stage one?
T1 or T2
When is colorectal cancer considered to be stage II?
T3
When is colorectal cancer considered to be stage III?
N1 or N2
When is colorectal cancer considered to be stage IV?
M1
What is T1 colorectal cancer?
No deeper than submucosa
What is T2 colorectal cancer?
Not through muscularis
What is T3 colorectal cancer?
Through muscularis
What is N1 colorectal cancer?
1-3 lymph node metastasis
What is N2 colorectal cancer?
More than or 4 lymph node metastasis
What is M1 colorectal cancer?
Distant metastasis
What is the post-operative management of colorectal cancer dependant on?
Pathological staging
What is the post operative management of colorectal cancer?
Adjuvant chemotherapy may be required (FOLFOX)
Post-operative complications might hinder or delay adjuvant treatment
Surveillance CT CAP, colonoscopy
What is the clinical presentation of bowel obstruction?
Abdominal pain
Vomiting
Absolute constipation
Abdominal distension
What is the golden rule to be remembered about bowel obstruction?
Never let a sun rise or set on a complete bowel obstruction
Explain the pathophysiology of bowel blockage?
What are the 2 different kinds of bowel obstruction?
Large bowel obstruction
Small bowel obstruction
What is the aetiology of large bowel obstruction?
Malignancy (60%)
Stirctures (diverticular, ischaemic)
Volvulus
Faecal impaction
Intussusception
Pseudo-obstruction
What is the aetiology of small bowel obstruction?
Adhesions
Hernias
What is the management of bowel obstruction?
Fluid resuscitation
Analgesia
Nasogastric tube if vomiting
Consider IV antibiotics
Bloods (FBC, U&E, G&S, coagulation screen)
Blood gas (lactate, pH, BE)
CT abdomen/pelvis
