Explain the blood supply of the colon?
Sup. Mesenteric Art
- -> Ileocolic/Right Colic/Middle Colic arteries
- -> Caecum/Asc. Colon/proximal 2/3rds of transverse colon
Inf. Mesenteric Art
- -> Left Colic/Sigmoid/Rectal
- -> Distal 1/3 of transverse colon/Desc. Colon/Sigmoid Colon/Rectum
How do we maintain continence?
- Internal anal sphincter contracts at rest
- Rectal wall is distended by blood at rest
- Anything that increases intra-abdominal pressure or predicts it (E.g. lifting or fight/flight) will cause the external anal sphincter to contract
- Pelvic floor muscles contract to maintain continence
What are the most common surgical problems of the colon?
Tumour - Colorectal Cancer
Inflammation - Ulcerative colitis, Crohn’s disease
Degeneration - Diverticular disease
Abnormal functions - Constipation, incontinence, IBD
Congenital - Atresia, Hirschsprung’s disease
What are the common complaints of patients with a colon issue?
- Changes in bowel habit
- Changes in continence
- Bleeding
- Pain
- Non-intestinal manifestations
How common is rectal bleeding?
Actually very common, a large proportion of people have it at some point.
Around 1 in 30 who attend the GP with it turn out to have bowel cancer
What are non-intestinal manifestations?
Some bowel disorders can cause symptoms elsewhere
E.g. Crohn’s can cause eye problems and joint pain which can be more noticeable than the intestinal symptoms (which can sometimes be very minor)
What is the most common cause of visceral pain?
The gut distending and the smooth muscle trying to contract against it.
Pain receptors in the smooth muscles have afferent sympathetic fibres accompanyin the major segmental vessels
What kind of investigations are there for colorectal issues?
Endoscopy - Colonoscopy & biopsy
Contrast Imaging - Barium Enema
Cross Sectional Imaging - CT or CT colonography
MRI
What are the considerations when deciding on treatment for a colorectal disordeR?
Medical vs surgical?
Endoscopic vs Invasive?
Laparoscopy vs laparotomy?
Consider consequences of resection and faecal diversion (stoma)
Remember you want to restore continuity and function while minimizing the effect on their lives
What are the factors in an informed consent?
- Information provided by the medical team
- Patient’s capacity to understand & make a decision
- A meaningful discussion in which we learn what the patient wants and what important to them
- Time and help to reflect on their options
How should you ensure your patient can comply with treatment and understands?
Take into account many people dont have the literacy to understand your language or meds instructions.
Try to explain in detail and laymans terms, maybe record your instructions for them to take home and listen to.
Ask for Teach back
What is a bowel anastomosis?
Reconnective two sections of bowel after resection of a diseased section
What factors are required for a bowel anatomosis to be carried out?
- Tension free
- Well perfused
- Well Oxygenated
- Clean surgical site
- Patient in an acceptable systemic state
What is a faecal diversion?
Connecting small intestine (Ileostomy) or colon (colostomy) to the skin thorugh an opening called a stoma
What are the common complciations of colorectal surgery?
- Anesthetic related
- Bleeding
- Sepsis
- VTE
- Anastomotic Breakdown
- Small Bowel Obstruction
- Wound Hernia
