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CP3 Management > Colon and Rectum > Flashcards

Flashcards in Colon and Rectum Deck (20)
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1
Q

Tx of diverticulosis

A

Mebeverine (antispasmodic)

2
Q

Tx of divertiulitis

A

Mild – uncomplicated + low grade fever
Bowel rest at home
Fluids only
Oral co-amoxiclav +/- metronidazole

Severe (complicated, high grade fever)
Admit if pain uncontrolled/oral fluids not tolerated
Give analgesia, IV fluids, IV cefuroxime + metronidazole and keep NBM
Order an erect CXR, supine AXR + contrast CT of the abdomen to assess for complications
Do not scope in acute attacks

3
Q

What are complications of diverticulae

A

Perforation

Abscess formation

Bleeding

Obstruction

Fistula formation

strictures

4
Q

Tx of asymptomatic diverticulae

A

Dietary advice

Increased unprocessed food and dietary fibre as part of a balanced diet

5
Q

Surgical options for colon cancer

A

wide tumour resection + lymph node clearance

right hemicolectomy - caecal/ascending colon/proximal transverse colon

Left hemicolectomy - distal transverse, descending colon tumours

high anterior resection - sigmoid tumour

anterior resection - low sigmoid/high rectal tumours

Abdomino-peritoneal (AP) resection - low rectal tumours

hartmans procedure - if there is emergency bowel obstruction

endoscopic stenting - palliative

6
Q

chemotherapy/radiotherapy regimes for cancer

A

Radiotherapy
Used pre-op in rectal cancer to reduce recurrence and increase survival
Higher risks of post-op complications
Post-op radiotherapy is only used if there is a high risk for local recurrence

Chemotherapy
Adjuvent 5-FU and folic acid can reduce mortality in higher stage tumours
may be used in palliation of metastatic disease

7
Q

Tx of an obstructing bowel cancer

A

A-E resus

Analgesia + NG tube decompression

AXR + erect CXR – confirm obstruction and assess for perforation

Ct to determine level of obstrution

Gastrogaffin (contrast enema) may also show level of obstruction whilst providing some symptomatic relief for more symptomatic obstruction

Surgery is the definitive management when the patient is adequately hydrated, or stenting can be done palliatively

8
Q

when should you manage haemorrhoids

A

only if symptomatic

9
Q

conservative management of haemorrhoids

A

plenty of fluids + no straining

topical analgesia

Bulk-forming laxatives (psyllium)

10
Q

when is sclerotherapy indicated in haemorrhoids and how is it done

A

stage 1 and 2 haemorrhoids not managed by conservative management (1st degree – still in anal canal, bleed but do not prolapse , 2nd degree – prolapse on defacation, then reduce spontaneously)

5% phenol in almond oil injected as a sclerosing agent
painless as they are above the dentate line
1+ injections may be required monthly

11
Q

when should haemorrhoids be banded

A

stage 3 haemorrhoids - 3rd degree – prolapse outside the anal margin on decafaction, can be reduced manually

12
Q

when is surgery indicated for haemorrhoids and what surgery is done

A

3rd degree – (prolapse outside the anal margin on decafaction, can be reduced manually) - if banding not indicated/unsuccessful
or
4th degree – (remain prolapsed outside the anal margin at all times)

Stapled haemorrhoidoplexy or hemorrhoidal artery ligation are the main methods

Hemorrhoidectomy used to be used but it is less common

13
Q

Tx of thrombosed external haemorrhoid

A

Untreated they will fibrose in a few days to a skin tag, or rupture to discharge clotted blood

In the acute phase they can be incised and drained under local

If they are already discharging/have resolved by the time the patient has been seen, hot baths and reassurance is all that is necessary

14
Q

Tx of an anorectal abscess

A

incision and drainage under anaesthetic to prevent rupture/possible formation of a fistula

15
Q

Tx of pilonidal sinus

A

excision of sinus tract and primary closure with preoperative antibiotics

16
Q

Tx of perianal wart

A

Tx = podophyllin, cryotherapy or surgical excision

if secondary to syphillis - penicillin

17
Q

Tx of anal fistula

A

Superficial and low level fistula are laid open to heal from secondary intention healing (fistulotomy)

High fistula, that involve the continence muscles of the anus may be injected with a fibrin glue or a ‘fistula plug’

If these methods fail a seton suture gradually tightened over time can be used to ensure continence (the tract getting fixed with scar tissue)

Recurrent crohns related fistulae may respond to metronidazole

18
Q

management of acute (<6weeks) anal fissure

A

conservative

Local anaethetic ointments
Lubricant laxative
Dietary advice (high fibre/water)
Bulk forming laxative (ispaghula)

19
Q

Chronic anal fissure (>6 weeks) management

A

0.4% GTN cream is used to relax the spincter and allow the epithelium to heal, although this can give headaches

Botox injection may also work and lasts for 8 weeks

Small incidence of incontinence afterwards

20
Q

Tx for intractable/recurrent haemorrhoids

A

sphincterectomy