Colorectal Surgery

Question 1

How do you tell the difference between an ileostomy and a colostomy

Answer 1

Iliostomy is spouted to prevent the surrounding skin from coming into contact with the alkaline enzymes in the small intestine

Colostomies are flat

Question 2

What is the most common location in the bowel for diverticular disease

Answer 2

Sigmoid colon

Question 3

Risk factors for diverticular disease

Answer 3

Increasing age 
Lack of dietary fibre
Obesity 
Sedentary lifestyle 
Smoking 
NSAIDs

Question 4

Pathophysiology of diverticular disease

Answer 4

Intra colonic pressures occur

Weaker areas of the bowel wall become outpouched

Question 5

Symptoms of diverticulitis

Answer 5

LLQ pain
Nausea and vomiting
Change in bowel habit - either constipation or diarrhoea
Urinary symptoms e.g, frequency, urgency due to bladder irritation
PR bleeding
Low grade fever

Question 6

Management of diverticulitis

Answer 6

Mild - can be managed in community with oral abx

Severe - hospital for IV abx

Question 7

What is a volvulus

Answer 7

Torsion of the colon around its Mesenteric axis

This results in compromised blood flow and closed loop obstruction

Question 8

Types of volvulus

Answer 8

Sigmoid volvulus

Caecal volvulus

Question 9

X-ray findings in different types of Volvulus

Answer 9

Sigmoid volvulus - coffee bean sign + large bowel obstruction
Caecal volvulus - small bowel obstruction (can see valvulae conniventes all across)

Question 10

Management of sigmoid volvulus

Answer 10

Rigid sigmoidoscopy with rectal tube insertion

If there are symptoms of peritonitis - treat with urgent midline laparotomy

Question 11

Management of caecal volvulus

Answer 11

Right hemicolectomy

Question 12

Presentation of anal fissure

Answer 12

Painful, bright red rectal bleeding

Painful defecation

Question 13

Management of acute anal fissure (<6 weeks)

Answer 13

Increase fibre intake 
Bulk laxatives
Lubricants before defecation 
Topical anaesthetics 
Analgesia

Question 14

Management of chronic anal fissure (>6 weeks)

Answer 14

Topical GTN

Question 15

Clinical features of haemorrhoids

Answer 15

Painless rectal bleeding
Pruritis
Only have pain when haemorrhoids become thrombosed

Question 16

Management of haemorrhoids

Answer 16

Increase fibre
Topical local anaesthetics
Topical steroids
May be referred for rubber band ligation or surgery

Question 17

How does a thrombosed haemorrhoid usually present

Answer 17

Painful limp

Purple, oedema, perianal mass on exam inaction

Question 18

Management of thrombosed haemorrhoids

Answer 18

If patient present within 72 hours - considered for excision
If patient presents >72 hours - manage conservatively with stool softeners, ice packs and analgesia

Question 19

Most common type of colorectal cancer

Answer 19

Adenocarcinoma (90%)

Question 20

Most common location for colorectal cancer

Answer 20

Rectal (40%)

Sigmoid (30%)

Question 21

Referral criteria for suspected colorectal cancer

Answer 21

Patients >40 with rectal or abdominal mass
Patients >50 with unexplained rectal bleeding
Patients >60 with iron deficiency anaemia or change in bowel habit

If patients are FIT positive

Question 22

Classification for colorectal cancer

Answer 22

Dukes

Question 23

Screening programme for colorectal cancer

Answer 23

FIT test - every 2 years from age 60-74

One off sigmoidoscopy offered to patients who are aged 55 years old

Question 24

Main risk factor for anal cancer

Answer 24

HPV