Shared Flashcard Set

Details

36 Colorectal
absite
185
Bartending
Beginner
12/01/2017

Additional Bartending Flashcards

 


 

Cards

Term
what part of colon is retroP?
Definition
asc, desc, sig, rectum
**all except Tverse**
Term
parts of rectum covered by peritoneum?
Definition
upper and middle 1/3
Term
transverse bands that form haustra =
Definition
plicae semi-lunaris
Term
longitudinal bands running along colon
Definition
taenia coli
Term
muscle layers of colon =
Definition
muscularis mucosa
muscularis propria
taenia coli
Term
rectal blood supply
Definition
IMA-->sup rectal art
Int iliac -->Mid rectal art
int iliac-->int pudendal-->inf rectal a
Term
Sudecks point =
Definition
Sup rectal and middle rectal junction
Term
rectal venous drainage?
Definition
sup and middle --> IMV-->Portal system

Inf-->internal iliac --> caval system
Term
What makes up internal vs external anal sphincter?
Definition
internal = muscularis propria
external = puborectalis muscle
Term
external anal sphincter innervation?
Definition
-inferior rectal br of internal pudendal (sympathetic)
-perianal br of S4
Term
internal anal sphincter innervation
Definition
pelvic splanchnics (parasymp only)
Term
meissner vs auerbach =
Definition
Meissner = inner
Outerbach = outer
Term
distances from anal verge
-anal canal
-rectum
-RS junction
Definition
canal = 0-5 cm
rectum = 5-15 cm
RS junction = 15-18 cm
Term
levator ani as anatomic landmark?
Definition
transition from anal canal to rectum
Term
main nutrient of colonocytes?
Definition
Short chain FA
Term
colonic inertia
-tx
Definition
-inc fiber (30 gm/d) + water cures most
*subtotal colectomy w/ileo-rectal anasatomosis = last option*
Term
Rectocele
-definition
-RF
-Tx
Definition
-ant wall of rectum bulges into vag
-Multoparous F
-Kegel, +/- surg to strengthen fascia
Term
Pouchitis
-types
-tx
Definition
1. diversion/disuse (hartmans)->SCFAcid
2. Infectious-> Cipro/Flagyl
Term
Lymphocytic colitis
-sx
dx
tx
Definition
-watery D, inflam bowel-like sxs
-normal scope, but bx: epithelial lymphocytes
-diet mod (dec caf, fat, lactose), roids, sulfasalazine
Term
UC
-classic pres
Definition
bloody D, pain/fever/weight loss
*Spares anus*
*bleeding @ rectal exam*
Term
UC
scope findings
Definition
-contiguous lesions, friable mucosa,
Term
UC
-barium enema findings
Definition
loss of haustra
narrow caliber, short colon,
loss of redundancy
Term
stable UC tx
Definition
5 asa (sulfasal)
Azathio/6 MCTP
Loperamide if mild dz
*not for acute exac*
low residual diet
Term
UC exacerbation tx
Definition
continue medical mgmt
-add cipro-flagyl
-add steroids
-add inflix +/- cyclosporin
Term
% needing surg w/toxic megacolon?
Definition
50%
Term
MC perf location with UC vs CD?
Definition
UC = tverse colon
CD = distal ileum
Term
UC
-MC systemic sx
Definition
FTT
Term
UC surgical indications
Definition
-hemorrhage
-refractory TMC/colitis
-obstruction/stricture
-ANY dysplasia, or CA, CA prophy if long-standing dz
- >10-12 bloody BM/day
-failed steroid wean
-perf
Term
UC
-what operation for emergent surg?
Definition
-total procto-colectomy + ileostomy
**LATER: ileoanal anast w/J-pouch**
Term
UC
-elctive surg options
Definition
1. total procto-colectomy, rectal mucosectomy, J pouch from ileum, ielo-anal anast w/loop ileostomy ...OR
2.APR w/ostomy
Term
UC elective pre-op considerations?
Definition
if for longstanding dz..need ro RO CA w/scope

steroids + bowel prep pre-op
Term
best elective UC surg option to preserve bladder/sexual function?
Definition
total proctocolectomy w/J pouch better than APR
Term
UC
% of ileoanal anastomosis that need resection and why
Definition
15% (get APR and ileostomy)
-CA/dysplasia
-refractory proctitis/sepsis
-incontinence (MC reason for takedown)
Term
MC reason for ileoanal anast take down?
Definition
incontinence
Term
Ileoanal anastomosis
complications?
Definition
1. leak = MC major fx
2. pouchitis
3. bladder/sexual dyfunction
4. stenosis
Term
UC
tx total procto-colectomy /ileoanal anastomosis
--->now w/dysplasia?
Definition
APR + ileostomy
Term
Contraindications to J pouch + Ileoanal ansatomosis?
Definition
1. acute exacerbation
2. crohns
3. severe rectal DZ/incontinence
Term
UC
CA risk
Definition
1-2% per year starting 10 years after dx
-pan colitis = highest risk
-left sided w/hx PSC are high risk
Term
UC
scenario WITHOUT elevated CA risk
Definition
NOT elevated @ pts w/isolated ulcerative proctitis
*any dysplasia = indicaton for total colectomy*
Term
UC
-prophy colectomy ?
Definition
some argue @ 10 years
-others say 20 years esp in pts w/fam hx, early age dx, hx PSC
Term
UC
-surveillance
Definition
@ 8 years for pts w/pan colitis
-15 years w/isolated left side dz
Term
UC
% with dysplasia that have CA?
Definition
20% @ low grade
40% @ high grade
Term
UC
MC extra-intestinal manifestations requiring surg?
Definition
1. MC requiring colectomy = FTT
Term
UC
-extra-intestinal manifestations that DO vs Dont vs 50% get better?
Definition
1. does NOT-->PSC, ank spond
2. Does-->ocular sx, arthritis, anemia
3. 50% get better-Pyoderma gang
-(deep ulcers)*tx roids*
Term
Amoebiasis tx
Definition
flagyl
diiodohydroxyquin (iodoquinol)
Term
Actinomyces
-pres
Definition
-commonly misdiagnosed..presents as a mass vs chronic fistula
-Gm pos rods w/yellow sulfer granules
-Tx = HIGH dose penicillin G
**alternate = drainage + amoxicillin**
Term
Lymphogranuloma venerum
pres
tx
Definition
-chlamydia infx-->ulcers, proctitis, tenesmus, bleeding, adenopathy, fistulas
-doxy
Term
LBO
-MCC
Definition
-MC = colon CA
-Divertic = #2
..sig>cecal volvulus
Ogilvies
Term
clinical scenario
-sig volvulus
Definition
-eldrly, nursing home, using laxatives
Term
clinical scenario
-Pseudo-obstruction
Definition
-Narcotics, very sick, in-patient
Term
MC place for obstruction to perf colon?
Definition
Cecum
-2/2 LaPlace law
Term
1 vs multiple stage colon resections?
Definition
??
Term
ddx true SBO vs Ogilvies?
Definition
air in the rectum w/Ogilvie
Term
Neostigmine SE?
Definition
bradycardia
-have atropine ready
Term
Failed conservative mgmt of ogilvies?
Definition
cecostomy
Term
sig volv
-success vs recurrence rate w/scope?
Definition
80% reduce
50% recur
*sigmoid colectomy @ same admission*
Term
Cecal volvulus
tx
Definition
right hemi w/anastomosis if stable
Term
MC Cx w/divertic?
Definition
abscess
Term
basic divertic mgmt
Definition
cipro + flagyl
bowel rest
Term
MC fistulas w/divertic?
Definition
colo-vesicle @ men
colo-vag @ women
Term
suture for bladder/vag repair @ divertic fistula?
Definition
chromics
Term
Divertic elective surg option
Definition
2 stage procedure
-resection w/ostomy
Term
MC scenario for right sided divertic?
Definition
80% found @ time of appy
-tx = right hemi, primary anastomosis
Term
distal target of resection for sigmoidectomy?
Definition
take sigmoid up to upper rectum
*where taenia coli disapear*
Term
pre-op imaging before colostomy take down?
Definition
-Barium enema to look for distal obstruction
-CT
-consider pre-op ureteral stents
Term
indications for elective divertic rsxn?
Definition
1. recurrent divertic
2. hospitalization < 40
3. complicated divertic (abscesses, obstruction)
Term
pre-op imaging before colostomy take down?
Definition
-Barium enema to look for distal obstruction
-CT
-consider pre-op ureteral stents
Term
indications for elective divertic rsxn?
Definition
1. recurrent divertic
2. hospitalization < 40
3. complicated divertic (abscesses, obstruction)
Term
Colon Ca epidemiology
Definition
3rd MC CA
2nd MC CA death
Term
Colon Ca
-MC location
Definition
sigmoid
**but 50% are proximal to sigmoid**
Term
Colon Ca
-higher risk adenoma
Definition
-villous, sessile, > 2 cm = inc CA risk
Term
Colorectal CA
major RF
Definition
1. FAP = 100% lifetime risk
2. HNPCC = 80% lifetime risk
3. Inflamm bowel dz
*red meat*
Term
rectal CA
-best test for TN status>
Definition
TRUS
Term
which rectal lesions get pre-op C-XRT>
Definition
T3 or t4
+ve nodes
Term
Colorectal CA
-best test for M status
Definition
CT
Term
Colorectal CA
-most important prognostic factor
Definition
N status
Term
Colon CA
MC met location
Definition
liver
*5% get drop mets to ovaries*
Term
Colorectal CA w/isolated spine mets-
origin?
Definition
rectal CA via Bastons plexus
Term
how does Colorectal CA met to lung?
Definition
iliac v
Term
Colorectal CA
-better vs worse prog cellular features?
Definition
better = lymphocytic penetration

worse = mucinous (signet ring cell)
..also mucoepidermoid, perf/obstruction, inc CEA, rectal tumors, ulcerative tumors,
Term
4 genes involved in colorectal CA
Definition
1. APC (tumor supressor, binds GSK)
2. p53 (tumor sup)
3. k-ras (oncogene, GTPase)
4. DCC (deleted in colorectal CA)
Term
CRCa
-T staging
Definition
Tis = mucosa only
T1 = past musc mucsa, into subM
T2 = musc. propria
T3 = subserosa
T4 = through colon wall, into other organ/tissue
Term
CRCa
-N staging
Definition
N0 = none
N1 = 1 to 3 nearby LN
N2 = 4+ nearby nodes
Term
CRCa stages
Definition
1 = T1 or T2 only
----
2A = T3 only
2B = T4 only
----
3A = T1 or T2, N1 only
3B = T3 or T4, N1 only
3C = N2 (any T)
----
4 = M1 (any T, any N)
Term
Colorectal CA
-margins needed and exceptions?
Definition
2 cm margins except...
1. T1 rectal lesions w/trans-anal excision
-->2-3 mm
2. pedunculated adenoma/sessile rectal adenoma w/small T1 focus (2-3 mm)
Term
Extended hemi
-indications? -arteries taken?
Definition
-hepatic flex tumors
-Right colic, ilio-colic, middle-colic
Term
Right hemi
-arteries taken
Definition
right and ilio-colic
Term
resection for splenic flex tumors?
Definition
extended left hemi
-left colic + middle colic
Term
surg mgmt of left sided colon CA?
Definition
leave temporary loop ileostomy
Term
margins needed to safely perform LAR?
Definition
2 cm margins
-2 cm from levator ani (6 cm from anal verge)
..if not--> APR
Term
distance from verge to..
dentate
levator ani
Definition
2 cm to dentate line..
then another 2 cm to levator ani
Term
mgmt of colorectal CA s/p neo-adj chemo-XRT with complete response?
Definition
still need resection
-25% have occult CA
Term
uncontrolled sacral vein bleeding
mgmt?
Definition
suture ligation, thrombin, bone wax
-->otherwise damage control and take back later
Term
Mgmt of local recurrence after LAR?
Definition
APR
*re-stage before re-op*
Term
LAR: basic steps
Definition
Term
mgmt rectal pain with rectal CA?
Definition
APR
Term
basic APR concept
Definition
remove rectum and anus w/permanent colostomy
Term
APR indications?
Definition
MALIGNANT lesions not amenable to LAR
Term
highest local recurrence risk with colon vs rectal CA?
Definition
rectal > colon
Term
ureter path?
Definition
over iliacs
Term
arteries contained in "lateral stalks"
Definition
middle rectal arteries
Term
Criteria for trans-anal excision of rectal CA?
Definition
1. < 4 cm + < 1/3 circumf. + < 8 cm away
3. neg margins (2 mm)
4. no neuro/vasc/lymph invasion
5. well differentiated
Term
recurrence / survival w/trans-anal excision?
Definition
T2 = higher recurrence/lower survivial vs T1.
Term
which stages of CRCa get chemo/xrt?
Definition
-Stg 3 + 4 COLON--> post op chemo
-----
-stg 2 + 3 RECTAL-->Neoadj CXRT + Adj chemo
-stg 4 RECTAL --> CXRT +/- surg
Term
which colon cancer stages get XRT?
Definition
NONE!!
-stg 3 and 4 get neoadj chemo, but no XRT
Term
Colorectal CA chemo reg
Definition
5FU, Leucovorin, Oxaliplatin (FOLFOX 6 cycles)
-add Bevacizumab vs mets (MAb to VEGF)
Term
chemo med to add w/CRCA mets?
Definition
Bevacizumab (MAb to VEGF)
Term
CRCa XRT
-benefit?
-MC site of XRT injury>?
Definition
-dec local rec + inc survival
-MC = rectum (vasculitis, ulcers, strictures)
Term
rectal CA getting pre-op CXRT?
-next step?
Definition
repeat proctostocpy w/TRUS
-re-stage
Term
Follow up studies after CRCA surg?
Definition
1. CEA q6 month x 5 years if T2 or greater
2. CT CAP qY x 3 years
3. Colonoscopy @ 1 year (unless never done, then get it 3 months post op)
Term
CEA t 1/2?
-mgmt if cant find source?
Definition
18 days
-if persistent elevation but cant find source-->2nd look lap
Term
% CRCa recurrence?
-recurrence time-frame?
Definition
20% recurrence rate
-50% w/in 6 mo
-100% w/in 3 years
**5% have another primary**
Term
best method for liver met detection?
Definition
Intra-op US
3-5 mm resolution
Term
Mgmt liver met discovered at time of colon CA rsxn?
Definition
1. if easy.. wedge it w/ 1 cm margins

2. if not.. send bx, finish case, re-stage 6-8 wk later..then +/- resect it
Term
indication for 1 vs 2 vs 3 stage colorectal CA procedure?
Definition
?
Term
mgmt of unresectable mets @ time of APR?
Definition
often don't need APR.. still do it if sxs were significant bleeding or pain
Term
unresectable CRCA w/ascites?
Definition
PD dialysis w/PRN drainage
(really??)
Term
poor prog factors after liver met resection w/colorectal CA?
Definition
1. < 1y dz free
2. > 3 tumors
3. Size > 5 cm
4. CEA> 200
5. +ve nodes
6. synchronous primary and liver mets
Term
outcome of formal hepatic met rsxn vs wedge?
Definition
formal rsxn improves loco-regional control.
Term
margins for liver met resection?
Definition
1 cm
-number of tumors, size, location don't matter as long as resectable
Term
5YSR after liver met resection?
Definition
35%
(25 % 5YSR if lung mets)
Term
CRCA screening @ normal risk pt
Definition
1. @ 50: Yearly FOBT, DRE qy + flex sig Q5 year OR
2. colonoscopy Q10 year
*polyp on sig requires Cscope*
Term
Surveillance after polypectomy?
Definition
1. High risk (>3 adenoma, high grade dysp, villous, > 1 cm)--> 3y f/u scope

2. Low risk --> 5 year f/u scope
Term
CRCA screening @ high risk pt?
Definition
1. age 40 or 10 y before..
-FOBT x 3 + DRE qY + C-scope q2-3Y
Term
When NOT to do colonoscopy for screening?
Definition
1. recent MI, splenomegaly, pregnancy if fluoro is planned
Term
efficacy of FOBT screening?
Definition
Dec mortality by 1/3 due to earlier dx
Term
FAP gene
Definition
APC tumor supressor mutation
*20% spont w/no fam Hx*
Term
FAP mgmt
Definition
total colectomy @ age 20
Term
FAP non colon CA risk?
Definition
duodenal and periampullary polyps/adenoCA
*EGD q 1-2 years
Term
FAP surgical mgmt
Definition
Total proctocolectomy + rectal mucosectomy + ileoanal pouch
-lifetime surveillance of residual rectum
*can also do totalproctocolectomy w/end ileostomy*
Term
MCC death with FAP after colectomy?
Definition
duodenal periampullary CA
*whipple*
Term
MC cx after J pouch?
Definition
Incontinence
Term
Ileal pouchitis
sxs
dx
tx
Definition
bloody D, urgency
Colonoscopy, friable pouch
-cipro flagyl
*might need APR if refractory or ANY dysplasia*
Term
Gardners features
Definition
Colon CA (APC gene)
Osteomas (forehead bumps)
Desmoid tumors (benign, locally invasive)
Term
desmoid tx
Definition
WLE +/- NSAIDs, anti-estroges, CXRT
*if involving significant SB, dont resect it..cang et worse*
Term
Turcot features
Definition
Colon CA
brain tumors
Term
Lynch syndrome genes
Definition
DNA mismatch repair genes
-MSH, MLH, PMS1, PMS2
Term
HNPCC features
Definition
AD, < 100 polyps, 80% lifetime risk Colon CA
-inc right sided CA, multiple colon CAs
Term
HNPCC types?
Definition
type 1 = just colon CA
type 2 = + ovarian, endometrial, bladde,r stomach, panc CA
Term
Amsterdam criteria =
Definition
"3-2-1"
-3 relatives, over 2 gen
-1 relative w/colon Ca before 50
*Amsterdam 2 criteria includes any combination of CA*
Term
HNPCC
-surveillance?
Definition
Cscop..
1. q2 year @ 21 or 10 years before..until 40 then yearly
Term
HNPCC operation?
Definition
total colectomy @ time of first CA operation
Term
HNPCC female screening?
Definition
1. yearly..pelvic/trans-vag/CA-125 @ age 25
-->+/- endometrial bx
2. Breast: yearly mammo @ 30, breast exam @ 20
*consider TAH/BSO after child-bearing years*
Term
% villous adenoma w/CA
Definition
50%
Term
polyps:
inc CA risk?
Definition
> 2cm, sessile, villous
Term
colon polyp showing T1 lesion after polypectomy..
when is polypectomy adequate>
Definition
-clear 2-3 mm margins
-well dif
-no vascular/lymph/neuro invasion
*o/w get formal rsxn*
Term
mgmt:
-low rectal villous adenoma w/atypia
Definition
trans-anal excision
-no ARP unless CA is present
Term
trans anal adenoma excision showing T1 lesion
-mgmt
Definition
adequate if well diff, clear 2-3mm margins, no invasion
Term
trans-anal excision of rectal polyp showing T2 lesion.. mgmt
Definition
APR or LAR
*pre-op CXRT if t3 or t4
Term
MC intestinal neoplastic polyp?
Definition
tubular adenoma
Term
Juvenile polyposis
-CA risk
-p/w
-why CA risk?
Definition
1-% lifetime CRCA risk (inc polyps = inc rsk)
-p/w painless rectal bleed. anemia, FTT
-hamartomas (risk for adenomatous change)
Term
Juvy polyposis
-surveillance
Definition
q2 years scope
Term
Cronkite-Canada
-features
Definition
hamartomas->chronic D, enteropathy
-nail/hair atrophy, hypopigmentation
-stomach and colon polyps
-10% lifetime CA risk 2/2 adenomatous change
Term
low rectal carcinoid tx?
Definition
< 2 cm = WLE w/neg margins
**colon or high rectal = formal rsxn + adenectomy**

> 2 cm OR musc propria invasion = APR
Term
Neutropenic typhitis
-pres/tx
Definition
after chemo..cecal inflammation
-no OR unless perf
avoid endoscopy
Term
acute XRT proctitis mgmt
Definition
first few weeks after XRT
-p/w D and tenesmus
-Tx w/ roid enema
*avoid scopes due to perf risk*
Term
Late XRT proctitis
-pres/tx
Definition
a. bleeding-->formalin fixation = best
b. obstruction 2/2 stricture--> 6-8 wks conservative mgmt +/- roids
*+/- dilation or trans anal excision +/- ostomy diversion*
Term
late radiation proctitis w/fistula
-mgmt
Definition
bx to R/O CA recurrence
**Avoid APR**
Term
late radiation colitis
mgmt
Definition
-bx to r/o ca
-likely ostomy / bypass
Term
how to RO UGI bleed?
Definition
NGT lavage showing BILE
-clear fluid could mean closed pylorus w/blood just beyond it
Term
mgmt hard to find GI bleed?
Definition
-arteriography (>0.5 cm/min bleeds)

-tagged RBC (most sensitive: >0.1 cc/m)
Term
LGIB
-meds to slow the bleed?
Definition
vasopressin
octreotide
Term
MCC LGIB
Definition
diverticulosis
*MC right side, but higher proportion of right sided -osis have bleeding*
-75% stop spontaneously
Term
MC location of angiodysplasia bleeding?
Definition
MC right side colon
-venous bleeding
(Diverticulosis is arterial bleeding)
*more likley to recur vs Dosis*
Term
assoc condition w/angiodysplasia?
Definition
20% have AORTIC STENOSIS
Term
angiodysplaisa tx
Definition
1. scope
2. amicar if diffuse
3. resection if recurrent
Term
% with diverticuLOSIS
Definition
35%
Term
Ischemic colitis RF
Definition
-IMA ligation / thrombosis
-low flow state
Term
Colon watershed anatomy?
Definition
1. Splenic (Griffith) = SMA (middle colic) & IMA (left colic) =

2. Rectal (Sudeck)= Sup rectal (IMA) & middle rectal (int iliac)
Term
area spared with low flow state ischemic colitis?
Definition
middle and lower rectum
*middle rectual (int iliac) and inf rectal (int pudendal)
Term
Embolic mesenteric ischemia RF
Definition
-recent agnio, CABG, A fib, endocarditis, MI
Term
MCC mesenteric ischemia
Definition
1. arterial embo (50% = MCC)
2. arterial thrombosis (25%)
3. NOMI (15%)
4. venous thrombosis (5%)
Term
imaging findings of SMA embolic mesenteric ischemia vs thrombotic>
Definition
embolic: meniscus 5 cm down the SMA, near origin of SMA
**Spares Jej**

thrombotic: involves jejunum
Term
criteria for intra-art thrombolysis of embolic acute mesenteric ischemia
Definition
< 8 hours
no peritonitis
Term
MCC SMA thrombosis
Definition
atherosclerosis
-hx chronic problems
Term
surg approach of embolic vs thrombotic arterial mesenteric ischemia?
Definition
1. embolic = fogarty
2. thrombotic = usually bypass
Term
meds to inc blood flow in NOMI?
Definition
glucagon
papavarine
nitrates
Term
mesenteric VEIN thrombosis
-usual pattern seen
Definition
short segment of bowel involved
Term
SMA to celiac colaterals = ?
Definition
arc of Riolan
Term
chronic mesenteric angina
-best tx
Definition
PTA + stent
Term
Median Arcuate Lig syndrome
-pphys
-pres
-tx
Definition
-celiac compression
-bruit near epigastrium, chronic pain/WL/D
-transect median arcuate lig
Term
MC org causing mesenteric lymphadenitis
-pt pop?
-tx?
Definition
yersinia
*MC kids*
-tetracycline or bactrim
Term
MC area affected by Hirschsprung dz?
Definition
-rectosigmoid MC
*dx rectal bx*
Term
Chagas Dz pphys
Definition
-2/2 trypanosome cruzi
*Auerbach plexus nerve destruction*
Term
Chilaidit's Syndrome =
Definition
loop of colon above liver
-confused w/free air
Supporting users have an ad free experience!