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Alimentary Block > Week 5.2 - Colorectal Surgery > Flashcards

Week 5.2 - Colorectal Surgery Flashcards

1
Q

What is the most to least common site of CRC?

A
  • 43% proximal colon
  • 30% distal colon
  • 27% rectum
    colon and rectum respond differently to chemo
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2
Q

What do we perform surgery on?

A
  • CRC
  • Polyps
  • Functional bowel problems
  • Pelvic floor disease
  • benign issues - fistulas, fissures, piles, peritoneal malignancies, anal cancers
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3
Q

What are types of surgery we carry out?

A
  • open surgery
  • endoscopic
  • laparoscopic/robotics/NOTES
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4
Q

What are functions of the colon?

A
  • water+electrolyte absorption
  • production and absorption of vitamins K and B
  • Storage of faeces
  • hosts gut microbiota
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5
Q

What do we use to screen colorectal cancers and who do we screen?

A
  • qFIT - quantitative faecal haemoglobin levels.
  • 50-74
  • range 0-200. 80+ is concern and we do colonoscopy to caecum
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6
Q

Why do we remove polyps?

A
  • prophylatic purposes
  • commonly involves in transition from normal epithelium to malignancy
  • develop mutation which then can become severe dysplasia and eventually adenocarcinoma
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7
Q

How do we remove polyps?

A
  • depends on size
  • some hot snare polypectomy
  • larger take longer
  • when many, sometimes resort to colectomy
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8
Q

What symptoms do colorectal patients commonly complain of?

A
  • abdominal pain
  • bleeding
  • change in bowel habits
  • weight loss, fatigue, vomiting
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9
Q

What differentiates low risk from watch-and-wait patients?

A
  • low risk under 40 and less than 6 weeks - typically haemorrhoids
  • watch and wait 6 weeks and older - assess and review to see recurring symptoms. try colonoscopy or CT colon
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10
Q

How do you investigate a colon abnormality?

A
  • colonoscopy with biopsies
  • CT abdomen and pelvis with contrast
  • do MRI if tumour in pelvis.
  • PET for metastasis
  • Stage with TNM
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11
Q

What do you often do pre-op for colon surgery?

A
  • for colon, straight to surgery often
  • for rectum, commonly chemo/RT neo-adjuvant if tumour threatens our ability to get full resection, determined by MRI.
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12
Q

What occurs during a rectal cancer surgery?

A

entire rectum removed, as well as mesorectum, lymph tisse and blood supply to the rectum - ensures R0 resection

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13
Q

What is an R0 vs R1 resection?

A

R0 - full resection of tumour
R1 - some tumour left

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14
Q

How do we ensure we get a R0 resection?

A

CT and (MRI for rectum) scanning to see if perforation of tumour. if present, do chemo/RT neo-adjuvant therapy to shrink first

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15
Q

What are different aims of treatment?

A
  • resection
  • restoring intestinal continuity via anastamoses
  • stoma
  • palliative
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16
Q

What does the decision to anastamose the colon depend on?

A
  • good perfusion
  • good oxygenation
  • good blood pressure
  • risk of anastamotic leak death
17
Q

How do you carry out an anastamosis?

A

staple the small colon and large. then remove area of abnormality

18
Q

What are types of stoma and surgeries that lead to them?

A
  • ileostomy has spout usually due to liquidy loose stools, typically in right iliac fossa
  • colostomy has no spout - usually solid stools and in left iliac fossa.
19
Q

What are complications of anastamosis and stoma?

A

of anastamoses
- anastamotic leak
of stoma
- ischaemia
- retraction or prolapse of stoma
- hernia
- high output

20
Q

What is post-op for bowel surgery?

A
  • depends on lymph node or vascular invasion - may need adjuvant therapy. determine if patient is fit enough
  • do CT chest abdomen and pelvis for 1st 3 years
21
Q

What causes small bowel obstruction and large bowel obstruction?

A

small
- adhesions, hernias, tumours
large
- 60% malignant, rest benign - strictures, diverticular disease, ischaemia

22
Q

What is bowel obstruction regarded as?

A

medical emergency. treat same day otherwise high risk of perforation

23
Q

How do you manage a bowel obstruction?

A
  • IV fluids, nasogastric tube, IV painkillers, IV antibiotics, unblock.
  • then take bloods, blood gas for lactate, CT abdomen and pelvis
24
Q

What does bowel ischaemia lead to?

A

agonising pain but no abdomen feeling

25
Q

What is defunctioning colostomy?

A

dont remove colon but add stoma higher up to colon not functioning but stoma works

26
Q

When would we do colonic stenting?

A

before surgery to wait for patient to be fit enough for surgery

27
Q

What are 3 pelvic floor diseases?

A
  • urinary incontinence
  • fecal incontinence
  • and pelvic organ prolapse

Alimentary Block (38 decks)

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