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Surgery > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

All different types of stomas:

A
  • gastrostomy
  • loop jejunostomy
  • percutaneous jejunostomy
  • loop ileostomy
  • end ileostomy
  • end colostomy
  • caecostomy
  • mucous fistula
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2
Q

Use of gastrostomy:

A
  • gastric decompression or fixation

- feeding

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3
Q

Common site of gastrostomy:

A

epigastrium

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4
Q

Use of loop jejunostomy:

A
  • not used much as very high output

- following emergency laparotomy with planned early closure

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5
Q

Common site of loop jejunostomy:

A

any location according to need

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6
Q

Use of percutaneous jejunostomy:

A

for feeding purposes and site in proximal bowel

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7
Q

Location of percutaneous jejunostomy:

A

left upper quadrant

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8
Q

Use of loop ileostomy:

A
  • defunctioning colon e.g. following rectal cancer surgery

- does not decompress colon (if ileocaecal valve competent)

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9
Q

Location of loop ileostomy:

A

right iliac fossa

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10
Q

Use of end ileostomy:

A
  • usually after complete excision of colon or where ileocolic anastomosis not planned
  • to defunction colon but reversal more difficult
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11
Q

Location of end ileostomy:

A

right iliac fossa

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12
Q

Use of end colostomy:

A
  • colon diverted or resected

- anastomosis not primarily achievable or desirable

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13
Q

Location of end colostomy:

A

left or right iliac fossa

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14
Q

Use of loop colostomy:

A
  • defunction a distal segment of colon

- both lumens present so distal lumen acts as vent

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15
Q

Location of loop colostomy:

A

any region depending on colonic segment used

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16
Q

Use of caecostomy:

A

stoma of last resort where loop colostomy not possible

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17
Q

Location of caecostomy:

A

right iliac fossa

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18
Q

Mucous fistula use:

A
  • decompress distal segment of bowel following colonic division or resection
  • where closure of distal resection margin not safe or achievable
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19
Q

Location of mucous fistula:

A

any region of abdomen

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20
Q

What are the borders of anal cancer?

A
  • anorectal junction

- anal margin (area of pigmented skin around anal orifice)

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21
Q

What type of cancer are most anal cancers?

A

80% squamous cell carcinoma

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22
Q

Type of anal cancers:

A
  • squamous cell
  • melanomas
  • lymphomas
  • adenocarcinomas
23
Q

Which lymph nodes do anal cancers spread to?

A
  • anal margin tumours - inguinal lymph nodes

- more proximal tumours - pelvic lymph nodes

24
Q

In which people are anal cancers more common?

A
  • mwhswm - HPV
  • females (1:2 ratio)
  • older
25
Q

Risk factors of anal cancer:

A
  • HPV infection causes 80-85% of SCCs of anus
  • anal intercourse
  • mwhswm
  • HIV or taking immunosuppressive medication
  • women with Hx of cervical cancer or cervical intraepithelial neoplasia
  • smoking
26
Q

Symptoms of anal cancer:

A
  • perianal pain
  • bleeding
  • palpable lesion
  • faecal incontinence
  • neglected tumour in female may present with rectovaginal fistula
27
Q

Investigations used for anal cancer:

A
  • T stage assessment: examination, anoscopic examination with biopsy and palpation of inguinal nodes
  • imaging: CT, MRI, endo-anal US, PET
  • test patients with HIV
28
Q

Staging of anal cancer:

A 
Tx - primary tumour cannot be assessed
T0 - no evidence
 of primary tumour
Tis - carcinoma in situ
T1 - tumour <=2cm in greatest dimension
T2 - tumour 2-5cm
T3 - >= 5cm in greatest dimension
T4 - any size but invades adjacent organs (vagina, urethra, bladder) rectal wall perirectal skin, subcutaneous tissue, sphincter NOT classified as T4
29
Q

What is an anal fissure and when is it chronic vs acute?

A
  • longitudinal or elliptical tear of squamous lining

- acute <6 weeks

30
Q

Risk factors for anal fissures:

A
  • constipation
  • IBD
  • STI e.g. HIV, syphilis, herpes
31
Q

Features of anal fissures:

A
  • painful, bright red, rectal bleeding

- 90% posterior midline (other locations in e.g. Crohn’s)

32
Q

Management acute anal fissure <1 week:

A
  • soften stool: dietary advice, bulk forming laxatives (lactulose if not tolerated)
  • lubricants e.g. petroleum jelly before defecation
  • topical anaesthetics
  • analgesia
33
Q

Management chronic anal fissure:

A
  • acute techniques
  • topical GTN first line
  • if not effective after 8 weeks - consider surgery (sphincterotomy)
  • botulinum toxin
34
Q

Locations of colorectal cancers in order of prevalence:

A
  • rectal
  • sigmoid
  • descending colon
  • transverse colon
  • ascending colon and caecum
35
Q

Type of resection and anastomosis used in caecal, ascending or proximal transverse colon cancer:

A
  • right hemicolectomy

- ileo-colic

36
Q

Type of resection and anastomosis used in distal transverse and descending colon cancer:

A
  • left hemicolectomy

- colo-colon

37
Q

Type of resection and anastomosis used in sigmoid colon cancer:

A
  • high anterior resection

- colo-rectal

38
Q

Type of resection and anastomosis used in upper rectum cancer:

A
  • anterior resection

- colo-rectal

39
Q

Type of resection and anastomosis used in low rectum cancer:

A
  • anterior resection

- colo-rectal (defunctioning stoma)

40
Q

Type of resection and anastomosis used in anal verge:

A
  • abdomino-perineal excision or rectum

- no anastomosis

41
Q

Management when colonic cancer presents with obstructing lesion:

A
  • stent or resect
  • following resection, patients with risk factors for recurrence are offered chemotherapy, combination of 5FU and oxaliplatin common
42
Q

How are rectal cancers resected?

A
  • anterior resection or abdomen-preineal excision of rectum (APER)
  • 2cm distal clearance margin
  • also mesolectal fat and lypmh nodes
  • can irradiate because exztraperitoneal unlike colonic
  • obstructing rectal cancer: defunctioning loop colostomy instead because of high rate of anastomotic leak
43
Q

Management of emergency perforation of bowel:

A
  • increased risk of anastomosis especially colon-colon

- end colostomy safer and can be reversed later

44
Q

Hartmans procedure:

A
  • sigmoid resection

- end colostomy

45
Q

Urgent referral guidelines for colorectal cancer (within 2 weeks):

A
  • patients >=40yo with unexplained weight loss AND abdominal pain
  • patients >=50yo with unexplained rectal bleeding
  • patients >=60yo with iron deficiency anaemia OR change in bowel habit
  • test shows occult blood in faeces
  • consider if: anal mass/ulceration, 50yo with rectal bleeding AND pain, change in bowel habit, weight loss, iron deficiency anaemia
46
Q

Who should be offered faecal occult blood testing?

A
  • patients >=50yo with unexplained abdominal pain OR blood loss
  • patients <60yo with changes in bowel habit OR iron deficiency anaemia
  • patients >=60yo with anaemia or absence of iron def
47
Q

When is CRC screening carried out?

A

every 2 years to all men and women 60-74 years (request over 74yo)

48
Q

How is CRC screening carried out?

A
  • faecal immunochemical test through post
  • faecal occult blood test uses antibodies which recognises human haemoglobin
  • quantifies amount of human blood in single stool sample
  • abnormal results offered colonoscopy
  • also flexible sigmoidoscopy screening
49
Q

Why is flexible sigmoidoscopy used in CRC screening?

A
  • to detect and treat polyps and reduce further risk

- offered to 55yo

50
Q

Usual site of diverticular disease:

A

between taenia coli where vessels pierce muscle to supply mucosa
-rectum spared

51
Q

Diagnosis of diverticular disease:

A
  • colonoscopy
  • CT cologram
  • barium enema
  • critically unwell: plain abdominal films, erect CXR for perforation, abdominal CT with oral and IV contrast
52
Q

Hinchey classification of diverticular disease severity:

A

I - para-colonic abscess
II - pelvic abscess
III - purulent peritonitis
IV - faecal peritonitis

53
Q

Treatment of diverticular disease:

A
  • dietary fibre
  • mild: Abx
  • abscess can be drained
  • Hinchey IV perforations - resection and stoma

Surgery (10 decks)

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