Colorectal surgery

22 flashcards · Other · by Anonymous Sloth

  1. Describe the function of the colon

    Absorption of water and electrolytes Synthesis of vitamins K and B Storage of faeces Hosts the gut culture (role in immune function and disease)

  2. Describe the gross anatomy of the colon

    Ascending colon transverse colon Descending colon Sigmoid colon Rectum

  3. Describe the arterial vasculature of the colon and rectum

    Superior mesenteric artery supplies everything from the beginning of the ascending colon to the proximal 2/3 of the transverse colon. Inferior mesenteric colon supplies from the distal 1/3 of the transverse colon to the end of the rectum. Descending aorta supplies the superior and inferior mesenteric arteries

  4. Describe the venous vasculature of the colon and rectum

    Superior mesenteric artery drains everything from the beginning of the ascending colon to the proximal 2/3 of the transverse colon. Inferior mesenteric artery drains the distal 1/3 of the transverse colon to the end of the rectum. Superior and inferior mesenteric arteries drain into the hepatic portal vein

  5. Describe the nerve supply of the colon and rectum

    Supplied by the Autonomous nervous system Vagus nerves Pelvic splanchnic nerves

  6. What are the factors affecting continence

    Anatomy Puborectalis sling Sphincter complex Anal cushions Rectal compliance Stool consistency Harder to control when watery Central control Spinal cord injury Loss of sensory and motor control Anorectal sensation

  7. Aetiology of colorectal cancer

    4th most common cancer 1/15 risk male, 1/18 women Risk factors include; high fat diet, red meat and obesity Decreased incidence due to better screening efforts

  8. What is the role of screening in CRC

    Pro-phylactic identification of an undiagnosed disease in an effort to diagnose its asymptomatic phase Screening must be fast and easily appleid to a large population

  9. How is CRC screened for

    Quantitative faecal immunochemical test (qFIT) Once off flexible sigmoidoscopy (england)

  10. Describe the sequence of an adenoma becoming a carcinoma

    The loss of tumour suppressor genes and activation of oncogenes. Systems that act as breaks to prevent cancers stop working

  11. Presentation of CRC

    Abdominal pain - colic and dull Rectal bleeding - pain?, colour, mixed ins tools? Change in bowel habits - constipation or diarrhoea Weight looss Tenesmus - constant feeling of needing to evacuate bowels Fatigue Vomiting Palpable abdominal mass

  12. Investigations for CRC

    Colonoscopy (gold standard) Radiological imaging CT colonoscopy (imaging and biopsy) CT abdo/pelvis CT confirms the cancer as well as stages the level of cancer MRI scan - detecting local invasion metastases

  13. Describe the pre-op management of CRC

    Colon and rectal cancer is treated separately MDT meeting (surgeons radiologists, oncologists, pathologists, specialist nurses etc) Anaesthetic assessment, stoma nurse appointment CRC almost always involves surgery without neo-adjuvants (if metastatic disease is not found and the patient is fit) MRI to detect local invasion (dictates if neoadjuvant chemo/radiotherapy is required)

  14. Describe the principles of surgery in rectal cancer

  15. What is the role of pre-operative MRI in CRC

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  16. Treatment in CRC

    Surgical or medical Open vs minimally invasive Types Resection Restoration intestinal continuity Faecal diversion - stoma Functional preservation Palliation if advanced metastatic

  17. Principles of bowel anastomose s

    Free of tension Well perfused Well oxygenated Sterile Acceptable systemic state

  18. Complications of Colorectal surgery

    Bleeding Infection Anastomotic leak Stoma problems Pelvic nerve damage (bowel, urinary, sexual dysfunction) Impaired fecundity in younger women

  19. Describe the post-operative management of CRC

  20. Presentation of bowel obstruction

    Abdominal pain Vomiting Absolute constipation Abdominal distension Never leave it too late (can lead to ischaemia from pressure and perforation)

  21. Pathophysiology of bowel obstruction

  22. Aetiology of bowel obstruction

    Large bowel malignancy Benign (Strictures, volvulus, faecal impaction, intussusception, pseudo-obstruction) Small bowel obstructions Hernia Adhesions