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Flashcards in Colorectal Deck (40)
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1
Q

Diverticular disease differentials

A

colonic cancer

pelvic abcess

2
Q

Diverticulosis management

A

Asymptomatic in 95%
no treatment
increase dietary fibre

3
Q

What not to do in acute attack of diverticulitis

A

colonoscopy/sigmoidoscopy

4
Q

Acute diverticulitis

A

IV abx

can normally go home if no complications

5
Q

Perforation

A

A–> E ileus, peritonitis, shock

surgery

6
Q

stricture

A

hartmanns if obstructed

7
Q

Abcess

A

<5cm heal with abx and supportive care
>5cm needs draining
all pelvic abcesses need drainage

8
Q

Fistula

A

surgery but if not fit manage symptoms

ABx for recurrent UTIs

9
Q

uncomplicated but symptomatic diverticulae

A

Mebeverine

10
Q

inhibiting polyp growth

A

low dose aspirin (ulcer risk)

11
Q

CEA

A

tumor marker, used to monitor treatment

12
Q

CRC surgery

A

wide resection of growth and regional lymphatics

13
Q

right hemicolectomy

A

caecal, ascending, proximal transverse tumors
temporary: end ileostomy
ileo-colic anastamosis

14
Q

left hemicolectomy

A

distal transverse/descending colon tumours

temp end ileostomy/before colo-colic anastamosis

15
Q

high anterior resection (sigmoid colectomy)

A

sigmoid tumors

16
Q

Anterior resection

A

low sigmoid/high rectal tumors
colo rectal anastamosis acheived @ first operation
maybe covered by temp. loop ileostomy

17
Q

AP (abdominoperineal ) resection

A

tumors low in rectum
permenant colostomy
no anastamosis

18
Q

Hartmann’s

A

palliation

perforation

19
Q

endoscopic stenting

A

palliative

20
Q

Radiotherapy

A

pre-op in rectal cancer
high risk of dvt, pathological fractures, fistula formation
post op only if high recurrence risk

21
Q

Chemotherapy

A

adjuvant 5 FU and folic acid
reduces mortality
palliation if metastatic disease

22
Q

Anal carcinoma treatment

A

radio + chemo (5FU and mitomycin/cisplatin)
75% retain normal anal function
surgery for small tumors not affecting sphincter

23
Q

Management of obstructing colonic cancer

A
A--E
IVI, NGT
analgesia
FBC, u&amp;E, amylase
AXR
erect CXR
catheterise to monitor fluid status
consider early CT
stents in palliation
24
Q

Causes of SBO

A
adhesions
gall stone ileus
hernia
Crohns
intussception
caecal mass
25
Q

Causes of LBO

A

carcinoma of colon
diverticular disease
sigmoid volvulus
constipation

26
Q

contrast enema

A

differentiates obstruction and pseudo obstruction

gastrograffin may have therapeutic effect

27
Q

differentiating ileus + paralytic ileus

A

SBO: bowel sounds, no air in colon on AXR

Paralytic ileus: Diffuse air fluid levels, air in colon

28
Q

constipation IX

A

fbc, u+e, tfts, calcium, esr

then endoscopy

29
Q

1st degree haemorrhoids

A
laxative
analgesia
avoid opioids (constipation)
avoid NSAIDS if rectal bleeding
topical haemorrhoidal preparations for short term relief
30
Q

Non-surgical

if 1st degree medical management fails/for 2nd/3rd degree

A

rubber band ligation (up to 3 haemorrhoids in 1 visit)
Injection sclerotherapy w/ phenol oil
infrared coagulation/photocoagulation

31
Q

Surgical haemorrhoid treatment

A

heamorrhoidectomy
only if symptomatic
stapled haemorrhoidectomy
haemorrhoidal artery ligation

32
Q

Perianal haematoma management

A

evacuated under LA/resolve spontaneously with analgesia - hot baths and reassurance if already discharging/resorbing when seen

33
Q

anorectal abcess

A

I&D to prevent fistula formation/rupture

34
Q

pilonidal sinus

A

excise sinus tract, primary closure, pre-op abx
give hygenie + hair removal advice
if complex, laid open and packed /use skin flaps to cover

35
Q

perianal wart

A

podophyllin paint
cryotherapy
surgical excision

36
Q

investigation fistula in ano

A

v painful, under anaesthetic

endoanal USS

37
Q

Goodsall’s rule

A

o If the external opening of the fistula is in the anterior half of the anal canal, the fistula opens in a straight path directly into the canal
o If the external opening is in the posterior half, it will open at the midline of the posterior wall of the anal canal, with a curved track

38
Q

exception to Goodsall’s rule

A

anterior fistulas >3cm away from anus, can drain like posterior ones w/curved track

39
Q

Fistula in ano management

A

I+D of abcess
low fistulae = laid open, heal by secondary intention, division of sphincters = no risk to continence
High fistulae- need a seton suture –> tighthened over time to maintain continence

40
Q

Fissure management

A
small may heal spontaneously
-LA ointment, lubricant laxative
shallow warm bath
rectal GTN/botox
high fibre and fluid intake
bulk forming laxative
last line = sphincertotomy