Adenocarcinoma 2nd most common cancer in US Peaks 70-80yo, incidece increases from 40yo lifetime risk of 6% equally common in men & women

10/4 Flashcards by Beth P

What is in the spermatic cord?

Cremasteric muscle fibers
Vas deferens
Testicular artery
Pampiniform venous plexus
+/- hernia sac
genital branch of gen-fem nerve

How well did you know this?

Not at all

Perfectly

Causes of Hypercalcemia

(CHIMPANZEES)

Calcium supplementation, Hyperparathyroidism, Immobility/ Iatrogenic. Mets, Paget disease, Addison’s disease/ Acromegaly, Neoplasm, ZE, Excess Vit D, Excess Vit A, Sarcoid

How well did you know this?

Not at all

Perfectly

tests to perform in small bowel obstruction

electrolytes, CBC, type & screen, urinalysis

How well did you know this?

Not at all

Perfectly

Left Sided Colon Cancer

change in bowel habits (smaller stools)
colicky pain
signs of obstruction
abdominal mass
heme(+) or gross red blood in stool
n/v
constipation

How well did you know this?

Not at all

Perfectly

Lynch Syndrome

Hereditary non-polyposis colon cancer

AD inheritance

How well did you know this?

Not at all

Perfectly

Plicae Circularis

circular folds of mucosa in small bowel

How well did you know this?

Not at all

Perfectly

Right Sided Colon cancer

right side of bowel has large lumen so cancer can get large before Sx develop
Microcytic anemia, occult/ melena
post-prandial discomfort
fatigue

How well did you know this?

Not at all

Perfectly

Treatment of Small Bowel Obstruction

Initial: NPO, NGT, IVF, Foley

Complete: laparotomy & lysis of adhesions

How well did you know this?

Not at all

Perfectly

Colorectal Carcinoma

Adenocarcinoma
2nd most common cancer in US
Peaks 70-80yo, incidece increases from 40yo
lifetime risk of 6%
equally common in men & women

How well did you know this?

Not at all

Perfectly

Daily Secretions of gastric, bile, & small bowel

BGS 123

Bile: 1L

Gastric: 2L

Small bowel: 3L

How well did you know this?

Not at all

Perfectly

Terminal Ileum

absorbs B12, fatty acids, bile salts

How well did you know this?

Not at all

Perfectly

Types of hiatal hernias

Type 1: sliding; stomach & GE junction herniate into thorax

Type 2: paraesophageal; herniation of stomach w/o herniation of GE junction

How well did you know this?

Not at all

Perfectly

Meckel’s Diverticulum

remnant of omphalomesenteric duct/ vitelline duct which connects yolk sac to primitive midgut in embryo

located within 2’ of ileocecal valve

true diverticulum (all layers of intestine)

2x more common in men

How well did you know this?

Not at all

Perfectly

Borders of Femoral Canal

Cooper’s ligament posteriorly

Inguinal ligament anteriorly

Femoral Vein laterally

Lacunar ligament medially

How well did you know this?

Not at all

Perfectly

How many LNs should be resected in colon cancer

12 minimum

How well did you know this?

Not at all

Perfectly

Polyp size to cancer risk

>2cm = high risk of cancer

How well did you know this?

Not at all

Perfectly

NG Tube Acid Base status

metabolic alkalosis w/ hypokalemia (gets rid of HCl so K+ goes into cells) & hypochloremia

Tx: NS w/ KCl

How well did you know this?

Not at all

Perfectly

Littre’s Hernia

hernia involving Meckle’s diverticulum

How well did you know this?

Not at all

Perfectly

Risks for Colorectal CA

Dietary: low fiber, high fat diets
Genetic (family histroy)
IBD: UC > Crohn’s
Previous Colon cancer
increasing age

Who should have incidental Meckel’s removed?

all kids

adults with ectopic tissue or mesodiverticular bleed

Common Adult Maintenance Fluid

D5 ½NS w/ 20 mEq KCl/L

(dextrose added to prevent muscle breakdown)

Femoral Hernia

hernia medial to femoral vessels (under inguinal ligament)

Differential Dx of Colon Mass

Adenocarcinoma, Carcinoid tumor, lipoma, leiomyosarcoma, lymphoma, diverticular disease, UC, Crohn’s, polyps

Indirect vs Direct Inguinal Hernia

Direct- hernia within Hesselbach’s Triangle (does not go through internal ring)

Indirect- hernia lateral to Hesselbach’s Triangle (does go through internal ring)

Anatomic DIfferences of Small Bowel & Colon

Colon has teniae coli, haustra, & appendices epoploicae (fat appendages) small intestine is smooth

chemo for stage 3 colon cancer

5-FU & leucovorin

Types of Neoplastic Polyps

* tubular adenoma * tubulovillous adenoma * villous adenoma * highest potential for CA

Ilioinguinal Nerve

sensation to inner thigh or lateral scrotum if cut, sensation returns in 6mo travels on spermatic cord

Causes of Small Bowel Obstruction

* adhesions (most common cause in adults), hernia (Bulge), Cancer/ tumors

Layers of abdominal wall

skin, SQ fat, Scarpa's fascia, external oblique, internal oblique, transversus abdominus, transversalis fascia, peritoneal fat, peritoneum

Where is Cremaster muscle from

internal oblique muscle

What electrolyte should you replace before K+?

Magnesium

Tumors of small intestine

* Benign: leiomyoma (most common), lipoma, lymphangioma, fibroma, adenomas, hemangiomas * Malignant: adenocarcinoma, carcinoid, lymphoma, sarcoma

Stages of Colorectal Cancer

* Stage 1: invades submucosa or muscularis propria * Stage 2: invades through muscularis propria but (-) LNs * Stage 3: (+) nodes, no distant mets * Stage 4: (+) distant mets

Complete SBO

complete obstrution of lumen danger of closed loop strangulation of bowel → bowel necrosis

What is inguinal ligament derived from?

External Oblique Aponeurosis

Duodenum

* 12" long * ends at Ligament of Treitz

Signs of Strangulated Bowel with Small Bowel Obstruction

fever, severe pain, hematemesis, shock, gas in bowel wall, abd free air, peritoneal signs, acidosis

How fast can you change Na+ concentration?

\<12 mEq/L per day

Hesselbach's Triangle Borders

inferior epigastric vessels inguinal ligament lateral border of rectus sheath Floor: internal oblique and transversus abdominis

Pre-op Abx in colon surgery

cefoxitin or carbepenem

Peterson's Hernia

herniation of small bowel through defect in mesentary after gastric bypass

Most common hernia

indirect inguinal hernia (in both men and women)

First Identifiable Subcutaneous Layer in Inguinal Hernia Repair

Scarpa's fascia

Small Bowel Obstruction

* abd discomfort, cramping, nausea, abd distention, emesis, high-pitched bowel sounds * Labs: electrolytes, CBC, type & screen, urinalysis * must rule out incarcerated hernia * X-Ray Finding: distended loops of small bowel, air fluid levels

Complications w/ Meckel's diverticulum

* Intestinal Hemorrhage- painless; ½ of all lower GI bleeds in kids \<2; d/t ectopic gastric mucosa that secretes acid * Intestinal Obstruction- most common complication in adults; volvus and intussusception * inflammation +/- perforation

Most common causes of colonic obstruction in adults

colon cancer, diverticular disease, colonic volvulus