Case 21 - Bowel Cancer Flashcards
(26 cards)
What is an acute anal fissure?
A break/tear in the skin of the anal canal associated with severe pain when passing hard faces
Sometimes blood is observed on toilet paper or toilet
What is the common presentation of bowel cancer? (Red Flags)
Rectal bleeding Change in bowel habit in person over 60 years Abdominal rectal mass Iron deficiency anaemia Unexplained weight loss Family history of bowel cancer
What are the differentials for bowel cancer?
Anal fissure
Haemorrhoids
IBD
IBS
List some of the common causes for fresh blood in stools
Haemorrhoids
Acute anal fissure (following trauma or severe constipation)
Colorectal cancer
Acute proctitis - inflammation of rectum
IBD
What investigations are done in a suspected colorectal cancer?
FBC - look for microcytic anaemia
Colonoscopy
CT scan - look for mets
Where do colorectal cancers commonly spread to?
Liver, lung, bone
How is colorectal cancer classified?
Dukes staging: A - limited to muscularis mucosa B - extension through muscularis mucosa C - involvement of regional lymph nodes D - metastatic spread
What is the difference between an anterior resection and an abdominal perineal (AP) resection?
Anterior resection - surgery for low sigmoid or high rectal tumours (involving the sphincter)
Abdominal Perineal (AP) resection - for tumours in lower rectum
What is an iliostomy and a colostomy?
Operations where a stoma is created
A stoma is an artificial opening into a hollow organ
What is a hemicoloctomy?
Removal of part of the colon
Right hemicolocetomy - removal for cecal, ascending or proximal transverse tumours
Left hemicoloctomy - removal for distal transverse or descending colon
What is the colorectal cancer national screening programme?
Offers screening every 2 years to all men and women ages 60-69
They receive a faecal occult blood home test kit - sample 3 separate bowl motions and return for analysis
Patients which test positive will undergo colonoscopy
What is a polyp?
A lump that appears above the mucosa in the colon. They can be pre malignant
What are the two genetic forms of colorectal cancer?
FAP - familial adenomatous polyposis
HNPCC - hereditary non-polyposis colorectal cancer
What is diverticular disease?
Outpouchings of the colonic mucosa and submucosa through inherent weakness in the outer muscle layers
What are the risk factors for diverticular disease?
Chronic constipation Low fibre diet Increasing age Smoking Long term use of ibuprofen or aspirin Family history
What are the frequent complications of colonic diverticuli?
Diverticulitis - infection in the diverticular
Bleeding - occult or overt
Perforation (note this can be very serious due to leakage of faeces giving rise to faecal peritonitis)
Abscess formation
What is an acute abdomen?
A condition of severe abdominal pain, usually requiring emergency surgery
Caused by acute disease or injury to internal organs
What are the classic signs of acute abdomen?
Fever
Tenderness
Rigidity and guarding
Rebound tenderness
Absent bowel sounds - in peritonitis
Increased bowel sounds - in small bowel obstruction
Abdominal distention - due to bowel obstruction and filling with gas or fluid
What must you always do in a women of child bearing age presenting with an acute abdomen?
Pregnancy test
Don’t want to miss ectopic pregnancy
What is rossvigs sign?
Palpation the left iliac fossa and see if you get pain on the right side
What are the differentials for constipation?
Opiates
Bowl obstruction - adhesions, Volvulus, cancers, strictures, hernias
What are the typically symptoms of appendicitis?
Dull pain near the naval that becomes sharp as it moves to the lower right abdomen
Loss of appetite, associated with nausea and vomitting
What should be considered thinking about acute abdomen in the elderly?
They tend to show less specific signs and symptoms
A serious pathology is more likely
Morbidity and mortality in older patients presenting with acute abdominal pain are high
Aortic aneurysm and bowel ischaemia are more prevalent - don’t forget to examine them
What investigations should be done in acute abdomen?
FBC, U&E, LFTs, CRP Serum amylase Serum glucose Blood gas, including lactate measurement Pregnancy test in women (always!) Urine dipstick Erect chest x ray (if perforation is suspected) Supine abdominal X ray USS CT abdomen
