Surgery - Colorectal Flashcards
What is the 1st line of management for peri-anal abscess?
Incision and drainage under local anaesthetic
How many weeks does an anal fissure have to last for to be classified as ‘chronic’?
> 6 weeks
What are the 1st and 2nd line management options for chronic anal fissure?
1st line: topical GTN/ dilitiazem/ nifedipine
2nd line (after 8 weeks): sphincterectomy
Which colorectal surgical procedure would leave someone with a transverse muscle splitting scar?
Right hemicolectomy
Recall 2 colorectal procedures that will not leave someone with laparoscopic port scars
Hartmann’s
Abdomino-perineal resection
What does a Hartmann’s procedure involve?
Sigmoid colectomy
Proximal bowel exteriorised as an end colostomy
Distal bowel oversewn to form a rectal stump
If a Hartmann’s is reversed, how long after the initial surgery will this be attempted?
3-6 months
What are the indications for a Hartmann’s?
Obstruction or perforation secondary to sigmoid tumour or diverticulitis
What is the main risk of a high output stoma?
Metabolic acidosis and respiratory compensation
Recall 3 small bowel and 3 large bowel causes of obstruction
SBO: hernia, adhesions, tumour
LBO: cancer, volvulus, strictures
Recall the Duke stages of colorectal cancer
Duke’s A: tumour confined to mucosa
Duke’s B: tumour invading bowel wall
Duke’s C: LN mets
Duke’s D: distant mets
Which type of colorectal cancer is more likely to present with anaemia?
Right sided
What is the current protocol for bowel cancer screening in the UK?
Between ages 60 and 74, invited every 2 years to do faceal occult blood test
What needs to be done in addition to a sigmoid colectomy to make it a cancer operation?
Complete removal of inferior mesenteric artery as this supplies lymph
How should post-op ileus be managed?
NG and IV fluids
How does anastomotic dehiscence present, and how common is it?
Day 6 with fever and sepsis, typically
10% of colorectal anastomoses
How many colonic adenomas would you expect to see in FAP?
> 100
Which types of cancer does Peutz-Jegher’s syndrome predispose to?
Colorectal (20%)
Gastric (5%)
What is the schedule of colorectal cancer screening in people who have HNPCC?
Colonoscopy every 1-2y from 25y
What is the typical sign on x ray for each of sigmoid and caecal volvulus?
Sigmoid: coffee bean sign
Caecal: embryo sign
Which type of volvulus is strongly associated with malignancy?
Caecal
What is the best way to treat sigmoid volvulus?
Sigmoidoscopy with air insufflation
Recall 5 associations with sigmoid volvulus
Age (older)
Chagas disease
Schizophrenia
Chronic constipation
Parkinson’s
Which sort of bowel obstruction is pregnancy associated with and why?
Small bowel obstruction
Due to caecal volvulus which is associated with pregnancy
