Surgery

Question 1

Which resection type is ideal for cancer in the caecum, ascending or proximal transverse colon?

Answer 1

Right hemicolectomy

Question 2

Which resection type is ideal for cancer in distal transverse or descending colon?

Answer 2

Left hemicolectomy

Question 3

Which resection type is ideal for cancer in sigmoid colon?

Answer 3

High anterior resectiom

Question 4

Which resection type is ideal for cancer in upper rectum?

Answer 4

Anterior resection

Question 5

Which resection type is ideal for cancer in low rectum?

Answer 5

Low Anterior resection

Question 6

Which resection type is ideal for cancer in anal verge?

Answer 6

Anal verge is where the anus transitions to the outer skin. Abdomnoperinela excision of rectum is ideal, especially if it involves the anal sphincter

Question 7

What is Hartmann’s procedure?

Answer 7

Sigmoid colectomy where sigmoid colon is removed and an end colostomy is formed.

Question 8

What type of anastomosis is made in right hemicolectomy?

Answer 8

Ileo-colic to join the ileum to the colon

Question 9

What type of anastomosis is made for left hemicolectomy?

Answer 9

Colo-colon anastomosis

Question 10

What type of anastomosis is made for colo-rectal?

Answer 10

High anterior resection

Question 11

What type of anastomosis is made for anterior resection?

Answer 11

Colo-rectal anastomosis

Question 12

What type of anastomosis is made for ow anterior resection?

Answer 12

Colo-rectal or de-functioning stoma

Question 13

What type of anastomosis is made for abdomin0perineal excision of rectum?

Answer 13

No anastomosis as it is close to the opening of the anal canal

Question 14

Which type of colectomy is at highest risk of anastomosis?

Answer 14

Anterior resection, including Low and ultra low resection of rectum

Question 15

What is a risk with low and ultra low anterior resection?

Answer 15

With low and ultra-low anterior resection, there is a risk of low anterior resection syndrome, which is characterised by faecal incontinence/leakage, tenesmus, diarrhoea and incomplete bowel movements.

Intervention includes dietary management with high fibre and pharmacotherapy with anti-diarrhoea agents and bulking agents.

Question 16

How can risk of anastomotic leak be reduced?

Answer 16

anastomotic leakage is high in anterior resection and can be fatal, because the anastomosis formed is close to where the tumour previously was. To reduce the risk of this, faecal matter is diverted out of the body proximal to the anastomotic site. This is done via a loop ileostomy,

Question 17

What is the difference between loop and end colostomy?

Answer 17

Loop is temporary
End is permanent

Question 18

How does a loop ileostomy work?

Answer 18

temporarily diverts faecal matter out from the small bowel instead of passing into the colon. This allows for the reconnected colon to heal and reduces the risk of anastomotic leakage, ideal to protect a rectal anastomosis.

Question 19

Where are loop ileostomy located?

Answer 19

Right iliac fossa

Question 20

When is an end ileostomy performed?

Answer 20

Usually following complete colon excision. Occasionally may be used to de function colon but has a more difficult reversal

Question 21

Where is an end ileostomy located?

Answer 21

Typically in right iliac fossa

Question 22

What is a loop colostomy?

Answer 22

To divert stool away from colon, like a fistula or obstruction in colon that requires stool diversion

Question 23

Where are loop colostomy located?

Answer 23

Can be in any region of the abdomen at the site of obstruction

Question 24

When is end colostomy performed?

Answer 24

Colon is diverted or resected and anastomosis is not achievable, such as Hartmann’s;s procedure

Question 25

Where is end colostomy located?

Answer 25

Left or right iliac fossa

Question 26

What are the features of an ileostomy?

Answer 26

Located on the right. It is SPOUTED and formed from the small bowel to prevent alkaline bowel contents causing skin irritation. It is found in the right iliac fossa.

Question 27

What are the features of a colostomy?

Answer 27

They are flush to the skin and emit thicker faeces

Question 28

When are double opened stomas used?

Answer 28

Typically with temporary colostomy

Question 29

What are possible anastomotic complications?

Answer 29

* minor and major bleeding * dehiscence and leaks * strictures * fistulas ## Footnote These complications can arise after surgical procedures involving anastomosis.

Question 30

What is an anastomotic leak?

Answer 30

A leak through a colorectal anastomosis that allows feculent material into the peritoneal cavity ## Footnote This condition can lead to serious complications such as peritonitis or colonic abscess formation.

Question 31

What is the typical leak rate for experienced surgeons?

Answer 31

3-7% ## Footnote This range is considered even in the hands of skilled surgeons.

Question 32

Which type of anastomosis has the highest leak rate?

Answer 32

Coloanal anastomoses (10-20%) ## Footnote This indicates a higher risk compared to other types of anastomoses.

Question 33

Which type of anastomosis has the lowest leak rate?

Answer 33

Ileocolic anastomoses (1-3%) ## Footnote This type is associated with fewer complications regarding leaks.

Question 34

When do anastomotic leaks typically occur post-operation?

Answer 34

5-7 days post-op ## Footnote This timeline is critical for monitoring patients after surgery.

Question 35

What are common features of anastomotic leaks?

Answer 35

* abdominal pain * pyrexia * prolonged ileus * abdominal findings consistent with peritonitis * feculent/purulent drainage ## Footnote These symptoms can help in identifying leaks early.

Question 36

What is the investigation of choice for anastomotic leaks?

Answer 36

CT abdomen and pelvis with contrast ## Footnote This imaging technique is preferred for diagnosing leaks.

Question 37

What is the initial management for anastomotic leaks?

Answer 37

* IV fluids * IV antibiotics ## Footnote These treatments are crucial for stabilizing the patient.

Question 38

How can smaller/subclinical leaks be managed?

Answer 38

Conservatively ## Footnote This approach may involve monitoring and supportive care.

Question 39

What may larger leaks require for management?

Answer 39

* exploratory laparotomy * possible further surgery/percutaneous drain insertion ## Footnote These interventions aim to address the leak and prevent further complications.

Question 40

What is gastronomy sued for?

Answer 40

Gastric decompression or fixation Feeding Located in epigasyrium

Question 41

What is loop jejunostomy used for?

Answer 41

Seldom used as very high output May be used following emergency laparotomy with planned early closure Located NYWHEERE

Question 42

Where is Percutaneous jejunosotmy?

Answer 42

Left upper quadrant for feeding purposes and is in the small bowel

Question 43

When is caecostomy used?

Answer 43

Last resort when loop colostomy isn’t possible and is in right iliac fossa

Question 44

What is a mucous fistula??

Answer 44

To decompress a distal segment of bowel following colonic division or resection Where closure of a distal resection margin is not safe Located anywhere

Question 45

Which stoma is in the right iliac fossa, spouted with high liquid output?l

Answer 45

Loop ileostomy