Colorectal surgeryy

Question 1

Function of colon

Answer 1

Water and electolyte absorption
Produciton and absorption of vits K and B
Faeces storage
Gut microbiota

Question 2

What is the margional artery?

Answer 2

It is the artery that the colon and is a key point of anastomoses of the IMA and the SMA.

Question 3

S2,3,4, keeps the …. and other parasymp.

Answer 3

Bowel off the floor. Also the vagus is the other parasymp supply.

Question 4

WHat i the cut off for a colonoscopy following a qFIUT

Answer 4

80micrograms /ml

Question 5

If cancer is in pelvic/rectal area what additionsal scanis used alongside the CT abdo, pelvis and chest

Answer 5

MRI

Question 6

Colon vs rectal chaemo-radio therapy when

Answer 6

chaemo-radio therapy more commonly done prior to rectal cancer surger to shrink within good resectable margins, whereas more commonly done after the surger in colon surgery

Question 7

Join bowl together depends on what?

Answer 7

flexibility f the bowel,
faecal continance and control prior to the surgery,
fitness of the patient
And relies on it being:
-tension free
-well perfused
-well oxygenated
-clean surgical site
-acceptable systemic state

Question 8

Ileostomy vs colostomy

Answer 8

Ileostomy:
-Right iliac fossa region
-spout and bag
-more liquid
-more likely to become dehydrated easiliy

Colonoscopy:
-No Spout, can be flat on the skin
-solid faecal matter
-Left Iliac fossa region

Question 9

Soma complications, metastatic where?

Answer 9

Complications inc:
-leaks, bleeds and infections
-bags can be an issue
-may need further srgery too repair

metastases are often to the liver or lungs

Question 10

When would we give adjuvant chaemotherapy?

Answer 10

if there was nodal involvement

Question 11

what does the follow up look like after surgical resection? 1 year and 4 year?

Answer 11

1 and 4 years = colonoscopy

1-3 years annual chest, abdo, pelvis ct scan

Question 12

What are the cardinal signs and symptoms of bowel obsruction

Answer 12

Abdominal pain
Vomiting
Absolute constipation (flatus and solids)
Abdominal distension

Question 13

Benign causes of large bowel obstruction

Answer 13

Strictures (diverticular, ischaemic)
Volvulus
Faecal impaction
Intussusception
Pseudo-obstuction

Question 14

Small bowl obstruction aetiology

Answer 14

Adhesions
Hernias

Question 15

Management of bowel opstruction

Answer 15

1. Stabilise:
   ABC
   Fluid resuscitation
   NBM and consider nasogastric tube if vomiting
   Analgesia and antiemetics
   Consider IV antibiotics

Also run:
Bloods (FBC, U&Es, G&S, Coagulation screen)
Blood gas (Lactate, pH, BE)
CT abdo/pelvis

If closed loop obstruction, needs urgent surgical review

Normal lactate doesn’t exclude bowel ischaemia.

PAIN out of proportion suggests ischaemia or perforation

We frequently underestimate the amount of fluid resuscitation required