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Colorectal cancer (Investigation (imaging (Colonoscopy with endorectal…

- - - - barium enema
        
        for colon obstruction/ intussusception in proximal colon
        
        more accurate than conventional colonoscopy
        
        barium / gastrografin meal & follow through to detect ileus
    - - bird beak lesion in colonic volvulus
      - foreign body visulization
    - - confirm diganosis with biopsy
      - resection of polyps
      - EUS
        
        identify tumor site & staaging
        
        identify pelvic & perianal metastasis
    - - more accurate to determine the level of IO
    - - more accurate in determine the site of I
      - detect metastasis in pelvis
    - - detect distant metastases
    - - locate rare tumr & rapidly bleeding lesion
- - - - gene testing
      - flexible sigmodioscopy
    - - total restorative proctocolectomy
  - - - 2 stages operation of rectosigmoid cancer
        
        initial colonic resection with proximal colostomy, distal part sewn as hartmann's pouch
        
        subsequent closure of colostomy & anastomosis
    - - indication
        
        anorectum cancer < 5 cm
        
        rectum & anus removal & permanent colostomy
      - exenteration needed for advance stage
        
        anterior
        
        remove bladder & radical hysterectomy
        
        posterior
        
        remove radical hysterectomy & colon & rectum
        
        total
        
        uterus, vaginal, lymphatic nodes bladder, rectum
    - - pelvic reservoir of 2-4 ileum anastomosis with anal
      - voluntary fecal expulsion
      - Kock / Barnett continent internal reservior BCIR , nipple valve
      - in cases that need Proctocolectomy
      - Ileal reservoir pouch neorectum
        
        risk of recurrence
        
        no laxatives, irrigation / bowel prepeararion
    - - Right / left Hemicolectomy
      - end to end anastomosis (proximal-distal)
      - temporary diverting loop ostomy/ double barrel
        
        both end exteriorized to proximal ostomy / distal mucos fistula
        
        then proximal & distal bowel anastomosis
    - - subtotal resection of rectum
    - - short bowel syndrome
        
        enteral feeding
        
        parenteral nutrition
        
        fluid & electrolyte balance
      - AP Resection
        
        sitz bath to perineal wound
        
        34-37 degree
        
        KMNO4
        
        contraindication
        
        symptomatic hypotension
        
        goal
        
        promote wound heal by ↑ circulation ↓ inflammation
        
        immersion of pelvic
      - optimal nutrition
      - wound care
      - supporting a positive image
      - maintain fluid and electrolyte balance
      - moniitor for complication
  - - - shrink tumor prior to surgical exceision
      - eradicate tumor cells postoperatively
      - e.g.
        
        Oxiplatin, 5FU 5-fluorouracil, Folinic acid
    - - palliative
  - - - anxiety
        
        avoid overwhelming info when address knowledge deficit
        
        promote relaxation & rest
        
        treat hypovolemia to optimize tissue perfusion of analgesia across capillary membrane
      - regular analgesics
        
        Opiates morphine
        
        induce vomiting
        
        antiemetics stemetil
      - Buscopan
        
        control colicky spasmodic pain
      - Octreotide
        
        reduce fluid in gut to reduce distension
    - - low residue diet to ↓ fecal content
      - fluid diet 1 day preop
      - npo 8 hrs
      - ducolax suppository
      - cathartics (GoLytely p.o. 12-48 hrs preop
      - prophylactic antibiotics
        
        sulfonamides (septrin)
        
        cephalosporin cefuroxime (zinacef)
        
        aminoglycoside (neomycin)
  - - - NG tube care