colorectal surgery

Question 1

function of the colon

Answer 1

water and electrolytes absorption

production and absorption of vitamins

storage of faeces

hosts the gut microbiota: role in immune function and disease

Question 2

structures present in the foregut

Answer 2

esophagus
stomach
proximal duodenum
liver
gall bladder
pancreas

Question 3

structures of midgut

Answer 3

distal duodenum
jejunum
ileum
cecum
appendix
ascending colon 
proximal 2/3 of transverse colon

Question 4

structures of hindgut

Answer 4

distal 1/3 of transverse colon
descending colon
sigmoid colon
rectum
proximal anus

Question 5

important factors of incontinence

Answer 5

anorectal sensation
central control
stool consistency
renal compliance
anatomy- sphincter complex, anal cushions

Question 6

whats the 4th most common cancer?

Answer 6

colorectal cancer

Question 7

whst id the overall 10 year survival rate?

Answer 7

59.9%

Question 8

what is screening defined as?

Answer 8

defined as the presumptive identification of unrecognised disease in an apparently healthy, asymptomatic population by means if tests, examinations or other procedures that can be applied rapidly and easily to the target population

Question 9

is colorectal preventable?

Answer 9

yes 54.4%

Question 10

how do we screen patients for colorectal cancer?

Answer 10

Quantitative faecal immunochemical test (qFIT)

Replaced Faecal occult blood test (FOBT) in November 2017 in Scotland

Once off flexible sigmoidoscopy (In certain areas in England only >age 55)

Question 11

symptoms of colorectal cancer

Answer 11

Abdominal pain - colicky
Rectal bleeding – anorectal pain?, colour?, mixed in stool?
Change in bowel habits (diarrhoea, constipation)
Weight loss
Tenesmus
Fatigue
Vomiting

Question 12

investigations for rectal bleeding

Answer 12

Colonoscopy +/- biopsies (gold standard)

Radiological imaging
CT colonography
Plain CT abdo/pelvis with contrast

Staging CT if confirmed CRC (CT chest)

Pre-op MRI in confirmed rectal cancer

Others i.e PET scan

Question 13

where is the tumour most likely to be in the colon

Answer 13

proximal

Question 14

where is the tumour most likley not to be?

Answer 14

rectum

Question 15

do you treat colorectal cancer and rectal cancer the same?

Answer 15

no

Question 16

rectal cancer basic surgical principles

Answer 16

Rectum surrounded by fatty envelope called the mesorectum. This contains all the draining lymph nodes of the rectum.

To reduce local recurrence rate, the rectum and it’s surrounding mesorectum has to be excised en bloc. (TME)

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

Question 17

why should you do MRI before operating om rectal cancer?

Answer 17

Best imaging modality for looking at CRM

Neoadjuvant treatment for circumferential resection margin (CRM) threatened disease, Extramural venous invasion (EMVI), nodal disease, Very low rectal cancer

Restaging 6-8 weeks later following neoadjuvant treatment

Surgery 8-10 weeks after treatment (Total Mesorectal Excision)

Question 18

bowel anastomosis principles

Answer 18

Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state

Question 19

where is the site of a stoma for a ileostomy?

Answer 19

usually RIF

Question 20

where is the site of a stoma for a colostomy

Answer 20

usually LIF

Question 21

what are the contents of a stoma for a ileostomy?

Answer 21

liquid, looser stools

Question 22

what are the contents of a stool of a colostomy?

Answer 22

solid stools

Question 23

what is the appearance of an ileostomy stoma?

Answer 23

spouted

Question 24

what is the appearnance of a colostomy stoma?

Answer 24

no spout, flush with skin

Question 25

what are the complications of a stoma?

Answer 25

bleeding
infection
anastomotic leak
stoma problems- ischaemia, retraction, prolapse, hernia, high output

Question 26

post op management

Answer 26

Adjuvant chemotherapy may be required (FOLFOX)
Post-operative complications might hinder or delay adjuvant treatment
Surveillance CT CAP, colonoscopy.
In NHSG alternate USS liver + CT CAP every 6 months

Question 27

aetiology of large bowel obstruction

Answer 27

Malignant (60%)
Benign
Strictures (diverticular, ischaemic)
Volvulus
Faecal impaction
Intussusception
Pseudo-obstuction

Question 28

aetiology of small bowel obstruction

Answer 28

adhesions

hernias

Question 29

management of bowel obstruction?

Answer 29

Fluid resuscitation
NBM and consider nasogastric tube if vomiting
Analgesia and antiemetics
Consider IV antibiotics
Bloods (FBC, U&Es, G&S, Coagulation screen)
Blood gas (Lactate, pH, BE)
CT abdo/pelvis