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07. Year 2: Alimentary System > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

What are some colorectal surgical specialties?

A

Colorectal cancers

Polyps

Inflammatory bowel disease

Functional bowel problems

Pelvic floor disorders

Benign (DD, piles, fissures, fistulas)

Advanced pelvic malignancies

Peritoneal malignancies

Anal cancers

Open surgery

Endoscopic treatment

Minimally invasive techniques

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2
Q

What are examples of minimally invasive colorectal surgery techniques?

A

Laparoscopic

Robotics

NOTES

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3
Q

What are functions of the colon and rectum?

A

Water and electrolyte abruption

Production and absorption of vitamins (K and B)

Storage of faeces (rectum)

Hosts the gut microbiota (role in immune function and disease)

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4
Q

What structures are derived from the foregut?

A

Oesophagus

Stomach

Proximal duodenum

Liver

Gallbladder

Pancreas

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5
Q

What structures are derived from the midgut?

A

Distal duodenum

Jejunum

Ileum

Caecum

Appendix

Ascending colon

Proximal 2/3 of transverse colon

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6
Q

What structures are derived from the hindgut?

A

Distal 1/3 of transverse colon

Descending colon

Sigmoid colon

Rectum

Proximal anus

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7
Q

What is continence?

A

When an individual has control of their bladder and bowel

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8
Q

What number of most common cancer is colorectal cancer?

A

4th most common cancer

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9
Q

Over the last decade, is the incidence of colorectal cancer increasing or decreasing?

A

Decreasing

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10
Q

What is screening?

A

Presumptive identification of unrecognised disease in an apparently healthy, asymptomatic population by means of tests, examination or other procedure that can be applied rapidly and easily to the target population

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11
Q

How are patients screened for colorectal cancer in Scotland?

A

Quantitative faecal immunochemical test (qFIT)

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12
Q

What is the adenoma-carcinoma sequence?

A

1) Normal colon
2) Mucosa at risk
3) Adenomas
4) Carcinoma

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13
Q

What are presenting symptoms of colorectal cancer?

A

Abdominal pain

Rectal bleeding

Change in bowel habits (diarrhoea, constipation)

Weight loss

Tenesmus

Fatigue

Vomiting

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14
Q

How many people experience rectal bleeding in their lifetime?

A

1 in 4

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15
Q

What investigations are done for colorectal cancer?

A

Colonoscopy with or without biopsies (gold standard)

Radiological imaging (CT colonoscopy, plain CT abdomen/pelvic contrast)

Staging CT if confirmed colorectal cancer (CT chest)

Pre-op MRI in confirmed rectal cancer

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16
Q

Where are most colorectal tumours located?

A

1) Proximal colon
2) Distal colon
3) Rectum

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17
Q

What should be remembered about colon and rectal cancer?

A

They are treated as 2 separate entities

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18
Q

What is the pre-op management of colorectal cancer?

A

MDT discussion

Anaesthetic assessment, stoma nurse appointment

MRI important in rectal cancer

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19
Q

Why is an MRI important before surgery in rectal cancer?

A

Could dictate if neoadjuvant chemotherapy, radiotherapy or both required following surgery

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20
Q

What are the basic surgery principles of rectal cancer?

A

Rectum surrounded by fatty envelope caled the mesorectum (contains all drianing lymph nodes)

To reduce local recurrence rate the rectum and surrounding mesorectum has to be excised

If mesorectal fascia is involved, surgery will be pointless unless tumour can be downsized and get clear circumferential resection margins (CRM)

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21
Q

What fatty stucture surrounds the rectum?

A

Mesorectum

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22
Q

What does the mesorectum contain?

A

All draining lymph nodes of the rectum

23
Q

Why is a pre-operative MRI given for rectal cancer?

A

Best imaging modality for looking at circumferential resection margin (CRM)

24
Q

What is the treatment for colorectal cancer?

A

Resection

Restoration intestinal continuity

Faecal diversion (stoma)

Preservation of function

Palliative if advanced metastatic disease

25
Q

What is surgery for colorectal cancer guided by?

A

Pathology

Tumour location

Vascular anatomy

26
Q

What are different kinds of colectomy?

A
27
Q

What are some bowel anastomosis principles?

A

Tension free

Well perfused

Well oxygenated

Clean surgical site

Acceptable systemic state

28
Q

What are the different kinds of stoma?

A

Ileostomy

Colostomy

29
Q

What is the location of ileostoma?

A

Right iliac fossa

30
Q

What is the location of colostomy?

A

Left iliac fossa

31
Q

What stools come out of ileostomy?

A

Liquid, looser stools

32
Q

What stools come out of colostomy?

A

Solid stools

33
Q

Which of ileostomy and colostomy has a spouted appearance?

A

Ileostomy

34
Q

What are some complications of colectomy?

A

Bleeding

Infection

Anastomotic leak

Stoma problems (ischaemia, retraction, prolapse, hernia, high output)

In low anterior resection, damage to pelvic nerves (bowel, urinary, sexual dysfunction)

35
Q

What are some possible stoma problems?

A

Ischaemia

Retraction

Prolapse

Hernia

High output

36
Q

When is colorectal cancer considered to be stage one?

A

T1 or T2

37
Q

When is colorectal cancer considered to be stage II?

A

T3

38
Q

When is colorectal cancer considered to be stage III?

A

N1 or N2

39
Q

When is colorectal cancer considered to be stage IV?

A

M1

40
Q

What is T1 colorectal cancer?

A

No deeper than submucosa

41
Q

What is T2 colorectal cancer?

A

Not through muscularis

42
Q

What is T3 colorectal cancer?

A

Through muscularis

43
Q

What is N1 colorectal cancer?

A

1-3 lymph node metastasis

44
Q

What is N2 colorectal cancer?

A

More than or 4 lymph node metastasis

45
Q

What is M1 colorectal cancer?

A

Distant metastasis

46
Q

What is the post-operative management of colorectal cancer dependant on?

A

Pathological staging

47
Q

What is the post operative management of colorectal cancer?

A

Adjuvant chemotherapy may be required (FOLFOX)

Post-operative complications might hinder or delay adjuvant treatment

Surveillance CT CAP, colonoscopy

48
Q

What is the clinical presentation of bowel obstruction?

A

Abdominal pain

Vomiting

Absolute constipation

Abdominal distension

49
Q

What is the golden rule to be remembered about bowel obstruction?

A

Never let a sun rise or set on a complete bowel obstruction

50
Q

Explain the pathophysiology of bowel blockage?

A
51
Q

What are the 2 different kinds of bowel obstruction?

A

Large bowel obstruction

Small bowel obstruction

52
Q

What is the aetiology of large bowel obstruction?

A

Malignancy (60%)

Stirctures (diverticular, ischaemic)

Volvulus

Faecal impaction

Intussusception

Pseudo-obstruction

53
Q

What is the aetiology of small bowel obstruction?

A

Adhesions

Hernias

54
Q

What is the management of bowel obstruction?

A

Fluid resuscitation

Analgesia

Nasogastric tube if vomiting

Consider IV antibiotics

Bloods (FBC, U&E, G&S, coagulation screen)

Blood gas (lactate, pH, BE)

CT abdomen/pelvis

07. Year 2: Alimentary System (41 decks)

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