Colorectal surgery Flashcards
What is the structure of the colon and rectum?
–smooth muscle tube
–lined by specialised epithelium
–enteric nerve supply
What is the function of the colon and rectum?
–fluid and electrolyte balance
–waste management
–continence
What are surgical problems of the colon and rectum as a result of
Tumour
Inflammation
Degeneration
Abnormal function
Congenital
- Tumour- colorectal cancer
- Inflammation- ulcerative colitis, Crohn’s disease
- Degeneration- diverticular disease
- Abnormal function- constipation, incontinence, IBD
- Congenital- atresia, Hirschsprung’s disease
What do patients often complain of when there is an issue in the colon and rectum?
Change in bowel habit / continence
Bleeding
Pain
Non-intestinal manifestations
What is the innervation associated with visceral pain?
Pain receptors are in the smooth muscle
Afferent impulses run with sympathetic fibres accompanying segmental vessels
Pain is usually the result of the colon distending and the smooth muscle contracting to compensate
When is visualisation of the large bowel indicated?
Involves colonoscopy
Sigmoidoscopy with or without barium enema
CT colonography
When high risk features exist:
Persistent change in bowel habit
Persistent rectal bleeding without anal symptoms
Right sided abdominal mass
Palpable rectal mass
Unexplained iron deficiency anaemia
Patients in whom there is clinical doubt
Or when there is low risk features that persist or deteriorate, or refuse to watch and wait
What is the major risk attached to rectal bleeding?
Bowel cancer
What is the investigation for CRC?
•Endoscopy
–colonoscopy and biopsy
•Contrast imaging
–barium enema
•Cross sectional imaging
–CT/ CT colonography
•MRI
What are the considerations when treating CRC?
- Medical vs. surgical
- Endoscopic vs. invasive
- Laparoscopy vs. laparotomy
- Consider:
–resection
–restoration of continuity
–preservation of function
–faecal diversion
How is informed consent ensured?
Providing all relevant information
Ensuring the patient has capacity
Having a meaningful discussion
Letting patient have time and reflection
What is involved in perioperative care of CRC?
Shared decision making and informed consent
Pre-admission assessment
Admission on the same day of surgery
DVT prophylaxis
Antibiotic prophylaxis
What is important for a bowel anastamosis?
Tension free
Well perfused
Well oxygenated
Clean surgical site
Acceptable systemic state
What are complications associated with bowel anastamosis and faecal diversion surgery?
Anaesthetic related
Bleeding
Sepsis
VTE
Anastomotic breakdown
Small bowel obstruction
Wound hernia
