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SURGERY > Colon, Rectum, Anus > Flashcards

Colon, Rectum, Anus Flashcards

1
Q

Colonic segment which is most prone to perforation

A

Cecum

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2
Q

Blood supply of distal anus

A

Internal pudendal a.

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3
Q

Most common site of volvulus and diverticulitis

A

Sigmoid colon

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4
Q

Colonic segment most prone to obstruction or volvulus

A

Sigmoid Colon

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5
Q

Diagnose:
25 y/o with abdominal pain, vomiting
FPA: kidney shaped, air filled structure in the LUQ

Treatment?

A

Cecal Volvulus

Tx: Right hemicolectomy with ileotransverse anastomosis

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6
Q

Diagnose:
Abdominal pain and distention, obstipation
Abdominal xray: inverted U-shape, omega-like sign
Enema: bird’s beak sign
Adbominal CT: Whirl pattern

A

Volvulus

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7
Q

Treatment for strangulated sigmoid volvulus

A

Hartmann’s Procedure (Rectosigmoid resection with end colostomy)

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8
Q

Diagnose:
25 y/o with abdominal pain, vomiting
FPA: kidney shaped, air filled structure in the LUQ

Treatment?

A

Cecal Volvulus

Tx: Right hemicolectomy with ileotransverse anastomosis

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9
Q

Mgt for

Uncomplicated diverticulitis
Recurrent attacks
Generalized peritonitis

A

Clear liquid diet
Broad spectrum antibiotics for 7-10 days
High fiber diet

Elective resection of diseased colon

Urgent laparotomy

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10
Q

Role of contrast enema or Colonoscopy in the maangement of Acute Diverticulitis

A

done ~6 weeks after an acute attack to rule out malignancy

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11
Q

Common location of colorectal polyps

A

Rectosigmoid area

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12
Q

Histologic type/s of colorectal polyp that is premalignant

A

Serrated polyp
Hyperplastic polyp >2cm or multiple
Hamartomatous or juvenile polyp that is part of a syndrome

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13
Q

Colorectal adenomatous polyposis + CNS tumors

A

Turcot syndrome

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14
Q

Germline mutations of Peutz-Jeghers syndrome

A

STK11 at chr 19p13

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15
Q

Amsterdam criteria for dx of HNPCC

A

Atleast 3 relatives must have histologically verified colorectal CA
One must be a first-degree relative of the other 2
Atleast 2 successive generations affected
Atleast 1 relative received dx before age 50
FAP excluded

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16
Q

Hamartomatous polyp characterized by macrocephaly, trichilemmomas, benign and malignant neoplasms of the thyroid, breast, uterus and skin

Dx?
Germ-line mutation?

A

Cowden syndrome

PTEN at chr 10q22

17
Q

ACS screening options for early detection of colorectal CA

A

Beginning age 50 yo
FOBT or FIT every year plus flexible sigmoidoscopy every 5 years, or
Double-contrast barium enema every 5 years, or
Colonoscopy every 10 yrs

18
Q

Grading of internal hemorrhoids

A

I- protrudes but not beyond the anal verge
II- spontaneous reduction
III- manual reduction
IV- cannot be resuced

19
Q

Hinchey Stages for Perforated Diverticulitis and recommended treatment

A

Stage I: Pericolic Abscess
Tx: Percutaneous drainage of absess, resection with primary anastomosis +/- diverting stoma
Stage II: Distant abscess
Tx: Percutaneous drainage of absess, resection with primary anastomosis +/- diverting stoma
Stage III: Purulent Peritonitis
Tx: Hartmann procedure; or Diverting colostomy + percutaneous drainage (unstable)
Stage IV: Fecal Peritonits
Tx: Hartmann procedure; or Diverting colostomy + percutaneous drainage (unstable)

20
Q

Management of right-sided diverticulitis

A

Segmental Ileocecal Resection

21
Q

Management of Uncomplicated Diverticulitis

A

Antibiotics for 7-10 days
Clear liquid diet
High fiber diet?

22
Q

Most common risk factor for anal CA

A

HPV infection

23
Q

Supralevator abscess that result from inter-sphincteric abscess should be drained ____________ to prevent _________________

A

Transrectally

Suprasphincteric fistula

24
Q

Standard of tx for anal canal SCC

A

Nigro protocol (5-FU, mitomycin-C, RT)

<1cm, well-differentiated: wide local excision
Sessile: piecemeal

25
Q

Parameters of Alvarado score (with scoring)

A

[MANTRELS]

Migratory RLQ pain
Anorexia
Nausea, vomiting
Tenderness on RLQ
Rebound tenderness on right iliac fossa
Elev temp
Leukocytosis >10x10^9cells/s
Shift to the left of neutrophils

Score of 2: RLQ tenderness and leukocytosis

26
Q

Most favorable time to re-operate intestinal fistula

A

Either within 10 days of dx or after 4mos

27
Q

Histologic subtype of adenoma that carries the highest cancer risk

A

Villous Adenoma

28
Q

Hamartomatous Polyps + perioral, buccal, or genital melanin pigmentation

A

Peutz-Jegher Syndrome

29
Q

Diffuse polyposis + Ectodermal abnormalities (hair, skin, nails)

A

Cronkite-Canada Syndrome

30
Q

What is Goodsall Rule?

A

Perianal opening posterior to transverse perineal line - fistulous tract opens into the posterior midline of the anal canal, taking a curvilinear tract.
Anterior opening - direct radial tract to the anal canal EXCEPT if >2.5 cm from anus, the fistulous tract will also open to the posterior midline

SURGERY (8 decks)

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