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ICSM Year 6 > Surgery - Colorectal > Flashcards

Surgery - Colorectal Flashcards

1
Q

What is the 1st line of management for peri-anal abscess?

A

Incision and drainage under local anaesthetic

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2
Q

How many weeks does an anal fissure have to last for to be classified as ‘chronic’?

A

> 6 weeks

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3
Q

What are the 1st and 2nd line management options for chronic anal fissure?

A 
1st line: topical GTN/ dilitiazem/ nifedipine
2nd line (after 8 weeks): sphincterectomy
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4
Q

Which colorectal surgical procedure would leave someone with a transverse muscle splitting scar?

A

Right hemicolectomy

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5
Q

Recall 2 colorectal procedures that will not leave someone with laparoscopic port scars

A

Hartmann’s

Abdomino-perineal resection

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6
Q

What does a Hartmann’s procedure involve?

A

Sigmoid colectomy
Proximal bowel exteriorised as an end colostomy
Distal bowel oversewn to form a rectal stump

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7
Q

If a Hartmann’s is reversed, how long after the initial surgery will this be attempted?

A

3-6 months

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8
Q

What are the indications for a Hartmann’s?

A

Obstruction or perforation secondary to sigmoid tumour or diverticulitis

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9
Q

What is the main risk of a high output stoma?

A

Metabolic acidosis and respiratory compensation

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10
Q

Recall 3 small bowel and 3 large bowel causes of obstruction

A

SBO: hernia, adhesions, tumour
LBO: cancer, volvulus, strictures

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11
Q

Recall the Duke stages of colorectal cancer

A

Duke’s A: tumour confined to mucosa
Duke’s B: tumour invading bowel wall
Duke’s C: LN mets
Duke’s D: distant mets

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12
Q

Which type of colorectal cancer is more likely to present with anaemia?

A

Right sided

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13
Q

What is the current protocol for bowel cancer screening in the UK?

A

Between ages 60 and 74, invited every 2 years to do faceal occult blood test

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14
Q

What needs to be done in addition to a sigmoid colectomy to make it a cancer operation?

A

Complete removal of inferior mesenteric artery as this supplies lymph

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15
Q

How should post-op ileus be managed?

A

NG and IV fluids

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16
Q

How does anastomotic dehiscence present, and how common is it?

A

Day 6 with fever and sepsis, typically

10% of colorectal anastomoses

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17
Q

How many colonic adenomas would you expect to see in FAP?

A

> 100

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18
Q

Which types of cancer does Peutz-Jegher’s syndrome predispose to?

A

Colorectal (20%)

Gastric (5%)

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19
Q

What is the schedule of colorectal cancer screening in people who have HNPCC?

A

Colonoscopy every 1-2y from 25y

20
Q

What is the typical sign on x ray for each of sigmoid and caecal volvulus?

A

Sigmoid: coffee bean sign
Caecal: embryo sign

21
Q

Which type of volvulus is strongly associated with malignancy?

A

Caecal

22
Q

What is the best way to treat sigmoid volvulus?

A

Sigmoidoscopy with air insufflation

23
Q

Recall 5 associations with sigmoid volvulus

A 
Age (older) 
Chagas disease
Schizophrenia
Chronic constipation 
Parkinson's
24
Q

Which sort of bowel obstruction is pregnancy associated with and why?

A

Small bowel obstruction

Due to caecal volvulus which is associated with pregnancy

25
Q

What are the most important imaging investigations to request in a suspected bowel obstruction?

A 
AXR+CXR
CT AP (can't go to theatre w/o this)
26
Q

In what % of bowel obstruction cases caused by adhesions is conservative management (drip and suck) successful?

A

65-85%

27
Q

What is Rigler’s sign, and what does it indicate?

A

Air seen on both sides of bowel wall

Indicative of pneumoperitoneum

28
Q

What are the 2 most likley causes of pneumoperitoneum?

A

Perforation of diverticulum or duodenal ulcer

29
Q

At how many cm is the colon pathologically dilated?

A

> 3cm = small bowel
6cm = large bowel
9cm = sigmoid/caecum

30
Q

Where is an inguinal hernia in relation to the pubic tubercle

A

Superior and medial

31
Q

Which types of hernia carry the highest risk of strangulation?

A

Femoral and paraumbilical

32
Q

What is a ‘mayo repair’?

A

Surgical reparation of paraumbilical hernia

33
Q

In which demographic group are epigastric hernias most common?

A

Men 20-30 years

34
Q

Following a surgery to the abdomen, if someone has reduced oxygen saturations and a fever, what complication is most likely to have occured?

A

Atelectasis

35
Q

What is the difference in appearance between a colostomy and ileostomy?

A

Colostomy: flush with skin, LIF
Ileostoy: sprouted from skin (due to presence of digestive enzymes), RIF

36
Q

If acute diverticulitis is not managed by oral abx, what is the next step in treatment?

A

IV ceftriaxone and metronidazole

37
Q

At what level of haemoglobin should men of any age be 2ww for an upper and lower GI endoscopy?

A

<110g/L

38
Q

What is the management of an acute anal fissure?

A
  • Analgesia (topical local anaesthetic if required)
  • Bulk-forming laxatives
  • Dietary fibre
39
Q

When is a left-hemicolectomy indicated?

A

Distal transverse or descending colon lesion

40
Q

When is a loop ileostomy used?

A

A loop ileostomy is performed to divert stool away from the healing portion post-anterior resection. They are typically used when the intention is to later reverse the stoma and restore bowel continuity.

41
Q

What is the typical presentation of solitary rectal ulcer syndrome (SRUS)?

A
  • Hx of IBS
  • Bright rectal bleeding
  • Fibromuscular obliteration and collagen deposits seen on flexible sigmoidoscopy
42
Q

What are the different grades of haemorrhoids?

A

Grade I - Do not prolapse out of the anal canal
Grade II - Prolapse on defecation but reduce spontaneously
Grade III - Can be manually reduced
Grade IV - Cannot be reduced

43
Q

How would a thrombosed haemorrhoid present?

A

Acute onset rectal pain with tender lump in anal region

44
Q

What surgery is typically performed for rectal cancers?

A

Anterior resection

45
Q
A

ICSM Year 6 (21 decks)

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