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Ch5: Colorectal Surgery (i) - Coggle Diagram
Ch5: Colorectal Surgery (i)
Acute appendicitis
teens-early 20s
inflamm -> ischaemia -> perf -> contained abscess or generalised peritonitis
cause = usually appendiceal obstruction (faecolith, lymphoid hyperplasia, tumour)
McBurney's point: 2/3 along line from umbilicus to ASIS (max tenderness)
Rosving's, psoas + obturator signs
ALVARADO SCORE
based on signs, sx + lab values
good for excluding appendicitis (low score, low risk)
management
appendectomy with IV abx on induction
only continue abx if perf or abscess
Open: Gridiron or lanz incision
Lap = gold standard
abx alone not currently recommended
area of research
consider if patient unfit for surgery
Carcinoid tumour of appendix
most common appendiceal tumour
arises from argentaffin aka Kulchitsky cells
usually discovered intraop or in lab
Serotonin released - carcinoid syndrome (flushing, diarrhoea, bronchospasm)
if <2cm do appendicectomy, if >2cm do right hemicolectomy
can met
Diverticular disease
acquired mucosal outpouchings of colon wall (typically signmoid)
typically occur @ weak spot where arterioles enter between taenia coli
congenital: all 3 colon muscle layers involved
fistula
segment perfs into another structure
colovaginal
colovesical (pneumaturia, debris in urine)
stricture
can form due to chronic inflamm
tx: endoscopic dilation
don't do colonoscopy in acute diverticulitis - risk of perf
need to do one 6-8wks later to excl ca + look for comps
Hinchey classification of complicated diverticulitis
1A: paracolic phlegmon
1B: pericolic abscess
2: walled off abscess
3: purulent peritonitis (perf abscess)
4: faeculent peritonitis (perf segment)
Diverticulitis tx
medical if uncomplication/Hinchey 1/2
supportive, bowel rest, IV abx
if abscess can do IR drainage
lap, washout + Hartmann's for Hinchey 3/4
if bleeding usually conservative tx okay, if not CT angiography + embolism, or colectomy
Colorectal ca
Inherited polyposis syndromes
FAP
HNPCC
juvenile polyposis
usually adenocarc arising from an adenomatous polyp
tubular (most common type of polyp)
villous (most likely to transform into ca)
tubulovillous
morphology
polypoid
stenosing
ulcerative
infiltrative
most commonly in descending + sigmoid
do pelvic MRI + endoanal US in rectal ca to assess T stage
TUMOUR MARKER = carcinoembryonic antigen (CEA)
Staging: TNM or Dukes (A-D)
Tx
surgery
hemicolectomy
high ant resection if in sigmoid/upper rectum
low ant resection for low rectal tumours
APR for low rectal tumours <5cm from anal verge
resectable mets: liver/lung
adjuvant/neoadjuvant chemoradio
palliation
endoluminal stents
defunctioning stoma
transanal ablation for rectum obstructing tumours