Colorectal surgery

MED I CAL ST UDENT L OWE R G I
S URG ERY




KNOWLEDGE FOR FINALS


, Final Year Notes


Lower GI surgery

Smooth hepatomegaly causes:

 Hepatitis, CCF, sarcoidosis, early alcoholic liver (small liver is typically later
on in cirrhosis), tricuspid regurgitation

Craggy hepatomegaly causes:

 Secondary metastasis
 Primary hepatoma

Pelvic masses:

 Fibroids
 ovarian cysts
 bladder
 malignancies – If the mass is truly pelvic then you won’t be able to get below
it.

Diverticulitis

 A diverticulum is an outpouching of the GI tract wall usually at the site of the
perforating arteries.
 They usually occur in the sigmoid colon (95%) due to increased intraluminal
pressure due to low dietary fibre
 Usually out-pouches between the layers of taeniae coli where perforating
arteries enter – for this reason the rectum is often spared as it does not have
any taeniae coli.
 30% of westerners will have them by the age of 60

Symptoms

 CIBH
 Left sided colic relieved by defaecation
 Flatulence and nausea
 DIVERTICULITIS includes all the above symptoms with pyrexia, generalised
abdominal tenderness, inflammatory blood changes and peritonism

Investigations

 Bloods (FBC, WCC, CRP, amylase etc.)
 Imaging (AXR and CXR, contrast CT)
 Endoscopy (flexi sig but more often a full colonoscopy)