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Surgery > Chapter 12 > Flashcards

Chapter 12 Flashcards

1
Q

What is the main purpose of the colon?

A

Absorption of water and sodium

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2
Q

Tx of uncomplicated diverticulitis

A

IV abx and bowel rest

If complicated and/or recurrent: elective colectomy

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3
Q

What is the leading cause of LBO?

A

Cancer

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4
Q

Tx for ulcerative colitis

A

Can do total protocolectomy with end end ileostomy or total protocolectomy with ileal pouch and anastamosis

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5
Q

What is the most common form of intestinal volvulus?

A

Sigmoid volvulus

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6
Q

Tx of sigmoid volvulus

A

Detorsion via sigmoidoscopy followed by bowel prep and elective sigmoidoscopy with primary anastamosis or Hartmann’s procedure

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7
Q

What is the initial tx for anal squamous cell carcinoma?

A

Chemoradiation

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8
Q

What are the most common tumors of the appendix?

A

Carcinoid tumors

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9
Q

Where is the foregut? What is it supplied by?

A

End at 2nd portion of the duodenum

Supplied by the celiac artery

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10
Q

Where is the midgut?

What is it supplied by?

A

Duodenal ampulla to the 1st 2/3 of the transverse colon

Supplied by the SMA

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11
Q

Where is the hindgut?

What is it supplied by?

A

Distal transverse and descending colon as well as proximal rectum
Supplied by IMA

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12
Q

What supplies the distal rectum?

A

Internal iliac artery

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13
Q

How is the anus formed?

A

By an invagination of the ectomdermal anal pit and fuses with the distal rectum at the dentate line

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14
Q

What are the four major layers of the colon?

A

Mucosa (columnar epithelium)
Submucosa (muscularis mucosa)
Muscularis propria
Serosa

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15
Q

Muscularis propria

A

Inner circular
Outer longitudinal smooth muscle: forms three bands
-Teniae coli (run along the colon and converge distally at the top of the rectum)
-Produce haustra, which give the colon its appearance on X-ray

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16
Q

How long is the colon?

A

150 cm

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17
Q

Where does the colon start and end?

A

Starts at the cecum in the RLQ

Ends 15 cm from anal verge

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18
Q

How long is the rectum?

A

12-15 cm long

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19
Q

Where does the rectum start and end?

A

Peritoneal reflection to the dentate line (2-4 cm from anal verge)

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20
Q

What is the most common site of rupture secondary to obstruction or pseudo-obstruction?

A

Cecum

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21
Q

What is the average diameter of the cecum?

A

7.5 cm

Most capacious area of the colon

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22
Q

Where is the appendix?

A

Arises from base of cecum-within 2-3 cm of ileocecal valve

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23
Q

What is the MC position of the appendix tip?

A

Posterior to the cecum

24
Q

Position of the right colon

A

Posterior surface is retroperitoneal and lies near the duodenum

25
Q

Position of transverse colon

What is it suspended by?

A

Completely intraperitoneal

Suspended by broad mesentery

26
Q

Which flexure is higher than the other?

A

Splenic flexure is higher than the hepatic flexure

27
Q

Greater omentum

A

Gastrocolic ligament (coming from greater curve of the stomach) fuses to peritoneal covering of the colon

28
Q

Position of the descending colon

A

Partially retroperitoneal and fixed

29
Q

Position of the sigmoid colon

A

Intraperitoneal

30
Q

How is the upper 1/3 of the rectum covered?

A

Anteriorly and laterally by peritoneum

31
Q

How is the middle 1/3 of the rectum covered?

A

By peritoneum anteriorly

32
Q

Position of the distal rectum

A

Entirely extra-peritoneal

33
Q

How is the posterior rectum covered?

A

By fascia propria

34
Q

What preserves the lymphatics during rectal cancer surgery?

A

Dissecting in the plan between the fascia propria of the rectum and sacrum

35
Q

How many rectal ligaments are formed by the fascia propria?

What do they contain?

A

2

Middle rectal artery and mixed autonomic nerves

36
Q

If the mixed autonomic nerves in the two rectal ligaments of the fascia propria get injured, what can result?

A

Erectile of bladder dysfunction

37
Q

Where does the anus begin?

A

At dentate line

Surgically begins at the level of the pelvic floor muscle

38
Q

What do the mucosa at the dentate line form?

A

Longitudinal folds called columns of Morgagni

39
Q

If the bases of the columns of Morgagni are infected, what is the result?

A

Anorectal abscesses and fistulas

40
Q

How is fecal continence controlled?

A

By muscles of the pelvic floor

41
Q

What are the muscles of the pelvic floor that control fecal continence called?

A

Levator ani
Internal anal sphincter (involuntary smooth muscle)
External anal sphincter (striated voluntary muscle)

42
Q

What supplies the right colon and first 2/3 of transverse via its branches (middle, right, and ileocolic)?

A

The SMA via the aorta

43
Q

Where does the ileocolic branch of the SMA go to?

A

Appendiceal artery

44
Q

What is the blood supply of the proximal and middle thirds of the transverse colon?

A

The middle colic artery branch of the SMA which branches off into left and right branches

45
Q

What is usually ligated during a right colectomy?

A

Right branch of the middle colic branch of the SMA

46
Q

What supplies the left colon and proximal rectum?

A

The IMA via the aorta, which branches into the left colic, sigmoidal, and superior rectal vessels

47
Q

What supplies the distal rectum and anus?

A

The middle rectal artery via the internal iliac AND

the inferior rectal artery via the internal pudendal artery

48
Q

Marginal artery of Drummond

A

Series of arterial arcades running along the mesenteric border of the entire colon

49
Q

Arc of Rioland

A

Connects proximal SMA and IMA

50
Q

What is at risk for ischemia because it lies between the SMA and IMA?

A

Splenic flexure

51
Q

Venous drainage

A

IMV leads to splenic vein, joins with SMV to form the portal vein
Distal rectum and anus drained by the middle and inferior rectal veins, goes to internal iliac veins, goes to systemic circulation

52
Q

Lymphatics

A

Follows blood supply

Tumor in mid/distal rectum goes to iliac nodal basins

53
Q

Sympathetic innervation

A

Runs along blood vessels
Thoracic roots supply SMA distribution
Lumbar roots supply IMA distribution
Sacral roots supply tpelvic floor, distal rectum and anus

54
Q

When can occur if the hypogastric nerve is injured when ligating the IMA?

A

Ejaculatory dysfunction

55
Q

Parasympathetic innervation

A

Right vagus innervates the right and transverse colon

Sacral roots innervate left colon and rectum

Surgery (30 decks)

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