gen surg pm

Question 1

ileostomy usual location

Answer 1

rif

Question 2

colostomy

Answer 2

left side of abdomen

Question 3

AMi management

Answer 3

immediate laparotomy

Question 4

anal cancers are usually.

Answer 4

squamous cell carcinomas

Question 5

anal fissure

Answer 5

pain ful bleeding from rectum

Question 6

proctitis

Answer 6

crohns, UC, C diff

Question 7

ano rectal abscess

Answer 7

E.coli, staph aureus
Positions: Perianal, Ischiorectal, Pelvirectal, Intersphincteric

Question 8

most common type of rectal cancer

Answer 8

rectal then sigmoid

Question 9

describe the colon

Answer 9

Question 10

How do we manage a CAP cancer
Caecal, ascending colon, proximal tramsberse colon

Answer 10

right hemicolectomy ILEO COLIC anastomosis

Question 11

Distal transverse colon and descending colon

Answer 11

left hemicolectomy colo-colon

Question 12

sigmoid colon

Answer 12

high anterior resection colo rectal

Question 13

upper rectum

Answer 13

anterior resection (TME) colo rectal

Question 14

lower rectum

Answer 14

anterior resection lower TME colo - rectal

Question 15

analo verge

Answer 15

abdomino perineal excision

Question 16

what is a hartmanns procedure

Answer 16

resection of the sigmoid colon is performed and an end colostomy is fashioned

Question 17

colo rectal cancer referrak

Answer 17

NICE updated their referral guidelines in 2015. The following patients should be referred urgently (i.e. within 2 weeks) to colorectal services for investigation:
patients >= 40 years with unexplained weight loss AND abdominal pain
patients >= 50 years with unexplained rectal bleeding
patients >= 60 years with iron deficiency anaemia OR change in bowel habit
tests show occult blood in their faeces (see below)

An urgent referral (within 2 weeks) should be ‘considered’ if:
there is a rectal or abdominal mass
there is an unexplained anal mass or anal ulceration
patients < 50 years with rectal bleeding AND any of the following unexplained symptoms/findings:
abdominal pain
change in bowel habit
weight loss
iron deficiency anaemia

Question 18

what is a fit test

Answer 18

every 2 years to those 60- 74
everyone sent a post and antibodies against hb are checked to see amount of human blood in stool

can also be used in
patients >= 50 years with unexplained abdominal pain OR weight loss
patients < 60 years with changes in their bowel habit OR iron deficiency anaemia
patients >= 60 years who have anaemia even in the absence of iron deficiency

Question 19

what is the dukes classification for colorectal cancer

Answer 19

DUKE ABCD
A- confined to mucosa
B- spread to bowel
C- lymph note metastases
D- distant metastases

Question 20

what are haemorroids

Answer 20

enlarged vascular anal cushions
painless rectal bleeding is the most common symptom
pruritus
pain: usually not significant unless piles are thrombosed
soiling may occur with third or forth degree piles

Question 21

external vs internal haemorroid

Answer 21

External
originate below the dentate line
prone to thrombosis, may be painful

Internal
originate above the dentate line
do not generally cause pain

soften stools: increase dietary fibre and fluid intake
topical local anaesthetics and steroids may be used to help symptoms
outpatient treatments: rubber band ligation is superior to injection sclerotherapy
surgery is reserved for large symptomatic haemorrhoids which do not respond to outpatient treatments

Question 22

management of thrombosed haemorroids

Answer 22

typically present with significant pain
examination reveals a purplish, oedematous, tender subcutaneous perianal mass
if patient presents within 72 hours then referral should be considered for excision. Otherwise patients can usually be managed with stool softeners, ice packs and analgesia. Symptoms usually settle within 10 days

Question 23

what is a large bowel obstruction

Answer 23

In large bowel obstruction, the passage of food, fluids and gas, through the large intestines becomes blocked.

caused by tumour, volvulus and diverticular disease

Question 24

IX for large bowerl obstruction

Answer 24

first line abdo xray
gold= ct

Question 25

peri anal abscess

Answer 25

collection of pus within the subcutaneous tissue of the anus
e coli and staoph aureus
mri
drainage and incision

mainly caused by
Any anorectal abscess can be caused by an underlying inflammatory bowel disorder, especially Crohn’s;
Diabetes mellitus is a risk factor due to its ability to affect wound healing;
Underlying malignancy can cause these abscesses as well as other anorectal lesions due to the risk of bowel perforation.

Question 26

all patients with rectal bleeding need

Answer 26

All patients presenting with rectal bleeding require digital rectal examination and procto-sigmoidoscopy as a minimal baseline.

Question 27

fissure in anao treatment

Answer 27

GTN ointment 0.2% or diltiazem cream applied topically is the usual first line treatment

Question 28

management of volvulus’s

Answer 28

sigmoid volvulus: rigid sigmoidoscopy with rectal tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed

sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, often with air-fluid levels) + coffee bean sign
caecal volvulus: small bowel obstruction may be seen- baby sign