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Senior - Surgery 1 > 8 - Colon - Rectum - Anus > Flashcards

8 - Colon - Rectum - Anus Flashcards

(54 cards)

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1
Q

Diverticulum

A

A pouch which involves all layers of the bowel wall

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2
Q

Pseudodiverticulum

A

Pouch which only involves the outer layers

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3
Q

Diverticulosis

A

Diverticula present

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4
Q

Diverticulitis

A

Inflammation of the diverticula

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5
Q

Diverticular bleeding

A

Common complication of diverticulosis

Not seen with acute diverticulitis

Erosion of the vessel in the bowel wall

MC cause of colonic hemorrhage

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6
Q

What is the MC cause of colonic hemorrhage

A

Diverticular bleeding

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7
Q

Pt presentation with diverticular bleeding

A

Benign abdomen with massive rectal bleeding

Transfusion often req’d

Normally stops spontaneously

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8
Q

Txt for diverticular bleeding

A

Admit
Resuscitate
NPO in case surgery is indicated

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9
Q

Pathophys of diverticulosis

A

Vessels perforate the bowel wall

Intracolonic pressure pushes mucosa out through where the vessels emerge

Mostly left-sided

Most do not develop sxs

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10
Q

Diverticulosis is mostly benign course if:

A

High fiber diet

Exercise

Statin use

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11
Q

MC complications of diverticulosis?

A

Bleeding

Infection -> diverticulitis

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12
Q

Pathophys of diverticulitis

A

Diverticula with stool in lumen -> inflammation -> perforation, peritonitis/abscess OR obstruction

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13
Q

Presentation of diverticulitis

A

LLQ pain and tenderness, mass or phlegmon

Leukocytosis
Anorexia, N/V, constipation or diarrhea

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14
Q

Workup for diverticulitis

A

H and P

KUB

CT rectal and oral contrast

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15
Q

What should you avoid with diverticulitis?

A

Colonoscopy or flex-sig

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16
Q

Diverticulitis - management?

A 
Admit, resuscitate 
Broad spectrum ABX
NPO with mIVF
NG suction if N/V
Serial ABD exams

Outpatient - metronidazole + fluoroquinolone for 10-14 days

6-8 wks later you should be able to do a colonoscopy

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17
Q

Complications of divertifuclitis

A

Perforated colon -> peritonitis / pneumoperitoneum

Abscess -> fever, chills, sepsis, TTP (tx with percutaneous drainage)

Colo-vesicle fistula (pneumouria, recurrent UTI - tx with segmental colectomy and bladder repair)

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18
Q

Indications for surgical management of diverticulitis

A

Perforation
Failure of other therapies
Fistula repair
>2 episodes

Segmental resection with anastomosis

Segmental colectomy with diversion (colostomy)

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19
Q

Lower GI bleeding originates below what anatomic landmark?

A

Ligament of Treitz

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20
Q

Don’t assume that GI bleeding is:

A

Hemorrhoids

Always investigate GI bleeding

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21
Q

Types of lower GI bleeding

A

Occult blood - guaiac positive

PRBPR - hematochezia

Black stools - melena

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22
Q

Diagnostics for LGI bleed

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A

Fecal occult blood test (FOBT)

NGT suction / EGD

Colonoscopy

23
Q

Txt for lower GI bleeding

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A

Admit and resuscitate

Surgical considerations: patient deterioration, persistent bleeding (>3 units PRBCs), recurrent bleeding

Prior to surgery: locate the bleed (colonoscopy, tagged RBC scan, CTA, mesenteric angiogram)

24
Q

Pathophys of colorectal CA

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A

Usually ADENOCARCINOMA

Normally first presents as: premalignant lesion

25
CRC types
Adenomatous polyp - tubular adenoma Villous polyp - villous adenoma larger polyps have higher CA risk
26
Screening for CRC starts when?
40 years of age or 10 yrs prior to Dx in a first degree relative Follow up ever 5-10 yrs
27
MC cause of colon obstruction in adults
Colorectal CA MC’ly left-sided Hematochezia Change in bowel habits (thinner stool) Right-sided - acute blood loss anemia, hematochezia, palpable RUQ mass Rectal - hematochezia and tenesmus
28
Workup for CRC
Iron deficiency anemia in patients is colon CA until proven otherwise Labs (CEA, CBC, CMP, CXR, CT abd and pelvis) Colonscopy, flex sig, ACBE PET scan Refer to surgery
29
CRC tx:
Curative - removes all tumor and nodes prior to mets Palliative - remove tumor burden to avoid obstruction and bleeding in metastatic lesion Check liver and lung for metastases Consider colectomy Neoadjuvant radiation and/or chemotherapy
30
Surgical techniques
Right/left sided hemicolectomy Left-sided - segmental resection with anastomoses Rectal - abdominal-peritoneal resection
31
Pathophys of colon obstruction
MC cause = colon CA Other causes = diverticulitis, volvulus, abscess Not normally caused by adhesions
32
Patient presentation for colon obstruction
Not passing stool, but may pass flatus initially Crampy abd pain with distention, N/V May have palpable mass
33
Colon obstruction workup
Admission and resuscitation mIVF and NPO with NGT suctioning Upright ABD film (air-fluid levels) Barium enema (apple core lesion = CA) CT abd/pelvis Colonoscopy
34
DDx for colon obstruction
Colonic volvulus - MC in elderly Abscess - common in perforated appendicitis or diverticulitis Hirschsprung - kids, massive stool in dilated colon
35
Ulcerative colitis
Diffuse inflammatory disease Limited to colon Superficial mucosa Abd pain, bloody diarrhea
36
Ulcerative colitis surgical considerations
Failed medical treatment Divert fecal stream helps symptoms Perforation, stricture, massive bleeding, toxic megacolon, colon CA
37
Pathophys of hemorrhoids
3 hemorrhoidal columns (venous) Left lateral Right anterior Right posterior These veins can dilate and prolapse -> hemorrhoids Dentate line (pain below, no-pain above)
38
Risk factors for developing hemorrhoids
Repeated straining Pregnancy Portal HTN
39
Presentation of hemorrhoids
Normally painful or non-painful perianal mass Extreme pain possible Bleeding can occur
40
Workup for hemorrhoids
H and P Inspect anus If not visible, have patient valsalva Perform DRE Anoscope to identify internal hemorrhoids
41
Txt for hemorrhoids
Stool softener Sitz bath Topical anesthetic Local anti-inflammatory wipes
42
Surgery for hemorrhoids
Grade I-II - scleropathy by injection, rubber band ligation, I and D Grade III-IV - formal procedure in OR, excision, stapling, hemorrhoidal columnectomy
43
Ligations for external hemorrhoids?
Don’t do it
44
If anal fissure lateral (3 or 9 oclock) consider
Crohns, TB, syphilis, CA
45
Txt for anal fissure
Same conservative as hemorrhoids Refer to colorectal surgery NTG or diltiazem cream Anal dilation Botox Lateral INTERNAL sphincterectomy (keep external intact to prevent incontinence)
46
Perirectal (ischio-rectal) abscess - pathophy?
Infected mucus-producing gland MC’ly found in the ischio-rectal fossa Rapidly progress to septic shock (especially in immunocompromised)
47
Presentation of perirectal abscess?
Pain in the ano-rectal area Deep-seated pain or fullness in higher lesions If abscess ruptures, seropurulent anal discharge
48
Physical exam for perirectal abscess
Red, raised, tender, fluctuant mass lateral to the anal canal Exquisitely tender rectal exam
49
Txt for perirectal abscess?
Admission and resuscitation IV antibiotics To OR for I and D under anesthesia
50
Perianal abscess - etiology?
Distal, vertical spread of infected cryptoglandular tissue of the anal canal More common than perirectal abscess
51
Perianal abscess physical exam
Tender, fluctuant mass on the anal verge Localized induration, inflammation
52
Perianal abscess treatment
May I and D in clinic or ER Rule out deeper infection Pain meds, ABX Loose packaging, daily changes Sitz bath High fiber diet Analgesia
53
Pilonidal dz
Hair nest along gluteal cleft Not true cysts - lack epithelial lining Young, hairy males Sometimes mass with foul smelling discharge Shaving, laser depilation, waxing Operative - I and D
54
Redneck word of the day | “Rectum”
I had to nice 4 wheelers but then i rectum

Senior - Surgery 1 (8 decks)

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