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Colorectal Surgery!!

Colorectal Surgery!!. Morag Sime and Chloe Hymers. Aims. Understand hernias- including types and complications Know main causes of bowel obstruction, the diagnosis and initial management Recognise stomas- colostomy vs ileostomy. Objectives (from your syllabus).

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Colorectal Surgery!!

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  1. Colorectal Surgery!! Morag Sime and Chloe Hymers

  2. Aims • Understand hernias- including types and complications • Know main causes of bowel obstruction, the diagnosis and initial management • Recognise stomas- colostomy vs ileostomy

  3. Objectives (from your syllabus) • Recognise the possibility of bowel obstruction • Initiate appropriate investigations and management • Understand anatomical factors that produce a potential defect at common hernia sites • Recognise common ways in which hernia present • Detect hernias in ant abdominal wall, inguinal and femoral region • Recognise common complications of hernias

  4. Hernias Definition of a hernia: • A hernia is the protrusion of a viscus or part of a viscus outside the cavity which normally contains it.

  5. Types of hernia

  6. Examining a hernia • What are you looking for?

  7. Complications of hernias • Incarcerated • Compromised bowel transit • Compromised blood supply • Obstructed • Irreducible • Strangulated

  8. Complications of complications • Perfortation • Peritonitis • Death

  9. Management • Conservative: • Reassurance • Watch and wait • Truss • Treat cause (eg??) • Medical • Surgical • Mesh repair • +/- Bowel resection

  10. Bowel Obstruction

  11. Main Causes • How to classify? • Intraluminal • Intramural • Extraluminal

  12. Main Causes • Intraluminal • Faecal impaction • Gallstone Ileus • Intramural • Cancer • Diverticular strictures • IBD strictures • Extraluminal • Adhesions • Hernias • Volvulus • Other cancers

  13. Management of bowel obstruction • DRIP AND SUCK • IV fluids • NG tube • Bloods • CXR, AXR ?CT • Catheter • Analgesia (IV) • NBM • Antiemetics • PR

  14. Stomas

  15. Case Study • A 72 year old man presents with a painful swelling in his right groin. He explains that he has ‘had a lump’ there for years and it’s never given him any trouble before. On examination he has a 4cm tender mass which is not reducible. The skin overlying is dusky coloured. It is located medially and inferior to the pubic tubercle.

  16. Questions • What are the differentials? • What investigations would you do? • What is the initial management? • Explain having a CT scanner to the patient • Explain post op care to the patient

  17. Most important things to know for finals… • 1) Definition of a hernia • 2) Anatomy of the inguinal canal • 3) Most common causes of bowel obstruction

  18. Most important things to know for life…. • 1) Is it a dangerous hernia?? • 2) Initial management of bowel obstruction • 3) Always do a PR

  19. Any Questions????

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