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icsm year 6 + edits > Surgery - Colorectal + General > Flashcards

Surgery - Colorectal + General 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

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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

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21
Q

Which type of volvulus is strongly associated with malignancy?

A

Caecal

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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

> 6cm

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, 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

A syndrome consisting of a PTEN mutation and intestinal hamartomas

A

Cowden disease

multiple intestinal hamartomas - increased breast cancer risk

39
Q

A syndrome which may be present in a patient with multiple intestinal hamartomas and pigmentation spots around the mouth

A

Peutz-Jeghers syndrome

STK11

Multiple benign intestinal hamartomas
Episodic obstruction and intussusception
Increased risk of GI cancers

annual pan intestinal endoscopy each 2-3 yrs

40
Q

A syndrome likely to be present in a 28-year-old man who presents with a locally advanced mucinous carcinoma of the caecum. There are scanty polyps in the remaining colon. His father died from colorectal cancer aged 34.

A

Lynch syndrome (HNPCC)

Scanty polps associated with coloreactal and endometrial cancer

Mainly right sided cancer

colonoscopy every 2-3 yrs, consider removal

41
Q

What is Pilonidal disease

A

sinuses and cysts form near the upper part of the natal cleft of the buttocks

men around 20 - hair debris collects in pores

42
Q

Clinical features of pilonidal disease

A

pain (may be severe)
purulent discharge
fluctuant swelling at the site

can be cyclical

43
Q

Management of Pilonidal disease

A

asymp - conservative with hygeine

symp - acute - incision and drainage, wound to close
chronic - excision of pits and removal of underlying cavity

44
Q

What are femoral hernias

A

section of the bowel or any other part of the abdominal viscera pass into the femoral canal

via the femoral ring

45
Q

Features of a femoral hernia

A

inferolateral to pubic tubercle
non - reducible
cough impulse absence
more common in women e.g. pregnancy

46
Q

Complications of femoral hernia

A

Incaration - cannot be reduced
Strangulation - surgical emergency, tender, non-reducible (more likely in femoral)
bowel obstruction
bowel ischaemia

47
Q

Mx of a femoral hernia

A

surgical repair - laparoscopic/tomy
no support belts due to herniation

48
Q

Risk factors for Anal fissure

A

constipation
inflammatory bowel disease
sexually transmitted infections e.g. HIV, syphilis, herpes

49
Q

Features anal fissure

A

painful, bright red, rectal bleeding
around 90% of anal fissures occur on the posterior midline.
if the fissures are found in alternative locations then other underlying causes should be considered e.g. Crohn’s disease

50
Q

Mx for acute and chronic anal fissure

A

acute less than 1 week
soften stool
high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia

chronic

the above techniques should be continued
topical glyceryl trinitrate (GTN) is first-line treatment for a chronic anal fissure
if topical GTN is not effective after 8 weeks then secondary care referral should be considered for surgery (sphincterotomy) or botulinum toxin

51
Q

Main cause of neurogenic shock

A

Spinal cord transection

massive vasodilation due to either decreased sympathetic or increased parasympathetic tone

decreased preload hence cardiac output

treat with vasoconstrictors

52
Q

If unfit for lap chole

A

percutaneous cholecystostomy

calot triangle: avoid right hep artery

53
Q

empyema vs abscess

A

empyema in own body cavity
abscess creates its own

54
Q
A

icsm year 6 + edits (28 decks)

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