Colorectal surgery

Question 1

what are the features of acute mesenteric ischaemia?

Answer 1

history of atrial fibrillation
severe, sudden onset abdominal pain out of keeping with physical exam findings
nausea and vomiting
metabolic acidosis
PR bleeding with advanced ischaemia

Question 2

what is the management for acute mesenteric ischaemia?

Answer 2

immediate laparotomy

Question 3

how is acute mesenteric ischaemia diagnosed?

Answer 3

CT angiography - most commonly occlusion of superior mesenteric artery

Question 4

what are the risk factors for anal cancer?

Answer 4

HPV infection
anal intercourse
HIV, immunosuppressive medication
history of cervical cancer
smoking

Question 5

what are the features of anal cancer?

Answer 5

perianal pain and bleeding
palpable lesion
faecal incontinence
may have rectovaginal fistula

Question 6

where is the most common site for colorectal cancer?

Answer 6

1. rectum
2. sigmoid colon
3. descending colon
4. transverse colon
5. ascending colon and caecum

Question 7

what are the risk factors for colorectal cancer?

Answer 7

increasing age
FAP, HNPCC, juvenile polyposis, Peutz-Jeghers syndrome
alcohol, smoking
processed meat
obesity
IBD
FHx

Question 8

what are the features of right-sided colon cancers?

Answer 8

abdominal pain
iron deficiency anaemia
palpable mass in RIF
often presents late

Question 9

what are the features of left-sided colon cancers?

Answer 9

rectal bleeding
change in bowel habit
tenesmus
palpable mass in LIF or on rectal exam

Question 10

when should patients be urgently referred on 2 week pathway for colorectal cancer?

Answer 10

≥40yrs with unexplained weight loss and abdominal pain
≥50yrs with unexplained rectal bleeding
≥60yrs with iron‑deficiency anaemia or change in bowel habit
Positive occult blood screening test

Question 11

what are the features of volvulus?

Answer 11

constipation
abdominal bloating
abdominal pain
nausea/vomiting

Question 12

how is volvulus investigated?

Answer 12

CT with contrast: whirl sign
abdominal X-ray
sigmoid volvulus: large bowel obstruction (large, dilated loop of colon, with air-fluid levels) and coffee bean sign
caecal volvulus: small bowel obstruction

Question 13

how is volvulus managed?

Answer 13

sigmoid volvulus: decompression via rigid sigmoidoscopy with rectal tube insertion, flatus tube insertion
caecal volvulus: management is usually operative. Right hemicolectomy is often needed

Question 14

where is the most common site for diverticula to form?

Answer 14

sigmoid colon

Question 15

what are the features of haemorrhoids?

Answer 15

painless rectal bleeding
pruritis
pain: usually not significant unless piles are thrombosed

Question 16

what are the features of thrombosed haemorrhoid?

Answer 16

significant pain and tender lump
purplish, oedematous, tender subcutaneous perianal mass