General Surgery [COLORECTAL]
Colon Cancer
Right-Sided cancers bleed while Left-Sided cancers obstruct.
Suspect cancer in a post-menopausal woman or any age man
with an Iron Deficiency Anemia, or in any aged patient with a
change in stool caliber (alternating constipation and diarrhea or
Post-Menopausal Woman Alternating Diarrhea +
pencil thin stools). Diagnosis comes in the form of a biopsy,
achieved with colonoscopy. Screening begins at 50 years old or or any Age Man with Iron Constipation, pencil thin
10 years before the first degree relative. Screening is with either Deficiency Anemia stools
FOBTq1y, FOBTq3y+FlexSig q5y, or Colon q10y.
Ulcerative Colitis
This is a medical disease that can be treated with surgery when Colonoscopy
it’s refractory to medical treatment or with long-standing
disease (>8 years = malignant transformation). Do surgery to
remove the anal mucosa (which is always involved) through the
entire affected mucosa. This is usually curative for UC (unlike FAP Polyp Cancer
for Crohn’s, where surgery is not curative). Surveillance, q1y Total Biopsy CT scan
colonoscopy, is needed at year 8 from diagnosis. Colectomy Pathology Resection
Invasive
FOLFOX
Crohn’s = Fistulas Pathology
Surgeons should stay away from Crohn’s disease. However
severe Crohn’s will need a surgeon from time to time. This comes CIS
in the form of an infection or abscess (ischiorectal) which are
treated with drainage and antibiotics. The other time a surgeon is Cancer
needed is for fistulas. Fistulas can be anywhere - the ones we care More Frequent
about are to the vagina, urethra, skin, or bladder. Because of Screening
chronic inflammation, fistulas will not heal. Patients will present
with fecal soiling. Probe the fistula on exam to diagnose it, then
UC and Crohn’s are discussed in detail in GI inflammatory
a fistulotomy to remove it. Surgery is NOT curative.
bowel
Hemorrhoids
There are two types of hemorrhoids - External hurt while
Internal Bleed (bright red blood on toilet paper or stool). When
medical therapy (sitz baths, lidocaine jelly) fails, you can resect
external or band internal. Be cautious to leave endogenous
mucosa so as to prevent stenosis of the anal opening.
Anal Fissures
Caused by an abnormally tight sphincter, the mucosa tears with
passage of stools. It presents as pain on defecation that lasts for
hours. A physical exam (which may need to be done under
anesthesia) will reveal the fissure. Try sitz baths, NTG paste, or
Botulism. After that fails (and it usually does), do a lateral
internal sphincterotomy to release the tension.
Anal Cancer
A squamous cell carcinoma caused by HPV. It’s common in
HIV positive males and people who engage in anal receptive
sex. An anal pap can be done for high risk patients. Diagnosis is
made by biopsy. Treat with the Nigro Protocol (chemo-
radiation) followed by resection if necessary, usually surgery is
not needed.
Pilonidal Cyst
An abscess of an infected follicle found on the small of the back.
It requires a hairy butt to get the disease, but it’s probably a
congenital defect that allows the hair to travel into the skin. Treat
with drainage followed by resection.
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