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Ch5: Colorectal Surgery (ii) - Coggle Diagram
Ch5: Colorectal Surgery (ii)
Bowel obstruction
ileus: GIT hypomobility in absence of mechanical obstruction, often post-op
Ogilvie syndrome = post op paralytic ileus of colon
partial: gas + liquid stool can pass
tx
if uncomplicated can be managed conservatively
close monitoring
wide bore NGT
closed loop: obstruction @ 2 ends, emergency as necrosis/perf can occur in hours
Causes
adhesions
hernia
tumour
intussusception
volvulus
stricture
diverticulae
foreign body
gallstone
faecal impaction
drugs (opioids, antimuscarinics)
SMA syndrome (duodenum compressed between SMA + aorta)
Imaging
Erect CXR
PFA
3 6 9 rule
SB has valvulae conniventes (fully transverse width), LB has haustra
CT scan with contrast (PO/IV)
Haemorrhoids
can be int or ext
3 7 + 11 o clock
degrees
1st (don't prolapse)
2nd (spontaneously reduce)
3rd (manually reducible)
4th (permanent prolapse)
Tx
sclerotherapy or banding for 1st/2nd degree
haemorrhoidectomy for 3rd/4th degree
open (milligan-morgan)
closed (ferguson)
stapled
Anal fissure
primary vs secondary
tx
topical nitroglycerin + diltiazem
botox injection
lateral sphincterotomy (stops muscle spasm + promotes healing)
Anal fistula
PARKS CLASSIFICATION
intersphincteric
transsphincteric
extrasphincteric
suprasphincteric
Goodsall's rule
posterior fistulae = curvilinear
anterior fistulae = radial
tx
EUA
fistulotomy + laying open
fistulectomy
seton
advancement flap
plugs + glues
Pilonidal sinus surgery
abscess I+D + laying open (requires secondary definitive operation)
tract excision (laying open vs primary closure)
Bascom's + Karydakis operations
rotational flap procedures if recurrent
Anal ca
AIN
SCC precursor
I - II - III (Bowen's disease, CIS)
types
anal canal vs perianal (anal margin)
SCC
adenocarc (incl paget's disease)
melanoma
lymphoma
Tx
wide local excision if early
APR if advanced
sphincter sparing surgeries being researched
chemo + radio
Stomas
loop ileostomies usually performed to defunction bowel + protect newly formed anastomosis
end ileostomies a/w panproctocolectomy (permanent + total colectomy
APR a/w permanent end colostomy
Hartmann's a/w end colostomy that can be reversed
retraction (0.5cm below skin surface, most common in ileostomies) can be managed with stoma belt
high output stoma >1500ml in 24hrs
patient may need TPN
tx: loperamide (imodium) + codeine phosphate