SURG: Colorectal Flashcards
Management of acute mesenteric ischaemia?
Immediate laparotomy usually required, particularly if signs of advanced ischemia e.g. peritonitis or sepsis
Where is anal cancer found?
Exclusively in the anal canal, the borders of which are the anorectal junction and the anal margin (area of pigmented skin surrounding the anal orifice)
RFs for anal cancer?
- HPV
- MSM
- Immunosuppression
- Cervical cancer / CIN
Clinical features of anal cancer?
subacute onset of:
- Perianal pain, perianal bleeding
- A palpable lesion
- Faecal incontinence
- A neglected tumour in a female may present with a rectovaginal fistula.
Investigations for anal cancer?
- T stage assessment - examination, including DRE, anoscopic examination with biopsy, and palpation of inguinal nodes
- Imaging modalities - CT, MRI, endo-anal ultrasound and PET
- The patient should be tested for relevant infections, including HIV
Management of anal fissures?
Acute (< 1 week):
- > > soften stool
- dietary advice - high-fibre diet with high fluid intake
- bulk-forming laxatives first-line - if not tolerated then lactulose should be tried
- lubricants such as petroleum jelly may be tried before defecation
- topical anaesthetics
- analgesia
Chronic:
- above techniques should be continued
- topical GTN first-line
- if not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin
Clinical features of chronic mesenteric ischaemia?
- TRIAD - post-prandial abdominal pain, weight loss, food aversion
- N/V/D
- Bloating / abdominal distension
Screening for colorectal cancer?
> > Every 2 years to all men and women aged 60 to 74 years
- Sent Faecal Immunochemical Test (FIT) tests through the post
- Type of faecal occult blood (FOB) test which uses antibodies that specifically recognise human haemoglobin (Hb)
- Patients with abnormal results are offered a colonoscopy
Staging of colorectal cancer?
All patients with newly diagnosed colorectal cancer should have the following for staging:
- carcinoembryonic antigen (CEA)
- CT CAP
- entire colon should have been evaluated with colonoscopy or CT colonography
- patients whose tumours lie below the peritoneal reflection should have their mesorectum evaluated with MRI
> > TNM staging
Management of colorectal cancer?
Surgery:
- Resectional surgery is the only option for cure
- The operations are segmental resections based on blood supply and lymphatic drainage
Chemotherapy:
- Used in the neoadjuvant setting (particularly for rectal cancers), adjuvant setting, and for metastatic disease
- Common regimens include FOLFOX and FOLFIRI.
Radiation Therapy:
- Predominantly used for rectal cancers in the neoadjuvant or adjuvant setting.
Targeted Therapies:
- Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), particularly for metastatic disease
Investigations for diverticular disease?
- colonoscopy
- CT cologram
- barium enema
Investigations for acute diverticulitis?
- Plain abdominal films and an erect chest x-ray will identify perforation - pneumoperitoneum
- An abdominal CT scan (not a CT cologram) with oral and IV contrast will help identify whether acute inflammation is present but also the presence of local complications such as abscess formation
- Colonoscopy: should be avoided initially due to increased risk of perforation in diverticulitis
Management of diverticular disease?
- Increase dietary fibre intake
- Mild attacks of diverticulitis may be managed conservatively with oral antibiotics, liquid diet and analgesia
- if the symptoms don’t settle within 72 hours, or the patient intiially presents with more severe symptoms, the patient should be admitted to hospital for IV antibiotics - cef and met
- Peri colonic abscesses should be drained either surgically or radiologically.
- Recurrent episodes of acute diverticulitis requiring hospitalisation are a relative indication for a segmental resection.
- Hinchey IV perforations (generalised faecal peritonitis) will require a resection and usually a stoma
- Less severe perforations may be managed by laparoscopic washout and drain insertion.
Describe Dukes classification of colorectal cancer
Describe the types of haemorroids
External
originate below the dentate line
prone to thrombosis, may be painful
Internal
originate above the dentate line
do not generally cause pain
