Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ABSITE > ABSITE > Flashcards

ABSITE Flashcards

1
Q

Which electrolyte does colon secrete?

A

K- potassium via Na/K ATPase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is vascular supply of ascending colon?

A

SMA (ascending colon and proximal 2/3 of transverse) via the ileocolic, right colic and middle colic arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which portions of colon are supplied by the IMA? what are the branches?

A

distal 1/3 of transverse colon, descending colon, sigmoid colon, and upper portion of rectum via the left colic, sigmoid branches, and superior rectal artery.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Path of the Artery of Drummond

A

aka marginal artery, travels along colon margin, connecting SMA to IMA as a collateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the arc of riolan?

A

meandering mesenteric artery- short direct connection bt proximal SMA and proximal IMA; becomes enlarged w SMA or IMA stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the source of the superior rectal artery?

A

IMA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the source of the middle rectal artery?

A

internal iliac artery (Lateral stalks during LAR/APR contain the middle rectal arteries)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the source of the inferior rectal artery?

A

internal pudendal (off the iliac artery)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the hemorrhoidal arteries?

A

The rectal arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

AKA the hypogastric arteries?

A

Internal iliac arteries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is Griffith’s point? Why is this significant?

A

splenic flexure- watershed area at SMA-IMA junction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is Sudeck’s point? Why is this significant?

A

superior rectal and middle rectal artery junction; watershed area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Which is more sensitive to ischemia- colon or small bowel? Why?

A

Colon is more sensitive due to poor collaterals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Into which vessel does the IMV drain?

A

drains to the splenic vein; splenic vein joins the SMV to create the portal vein behind neck of pancreas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Into which vessel do the superior rectal veins drain?

A

into IMV (then to portal vein)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Into which vessel do the middle rectal veins drain?

A

dual drainage system into IMV and internal iliac veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Into which vessel do the inferior rectal veins drain?

A

into internal iliac veins and then IVC- which is how rectal tumors can cause isolated lung mets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is the lymph node drainage of the rectum?

A

Superior and middle rectum drain to IMA nodes

Lower rectum drains to IMA and internal iliac nodes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is the innervation of the external anal sphincter?

A

inferior rectal (anal) branch of the internal pudendal nerve (sympathetic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

From which muscle does the external anal sphincter arise?

A

Continuation of the puborectalis muscle which is part of the levator ani muscle group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the innervation of the internal anal sphincter?

A

pelvic splanchnic nerves S2-S4, parasympathetic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

From which muscle does the internal anal sphincter arise?

A

continuation of the muscularis propria (smooth muscle, circular layer)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What marks the junction between rectum and anal canal?

A

Levator ani

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the main nutrient of colonocytes?

A

short chain fatty acids (e.g. butyrate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is Denonvillier’s fascia?

A

Fascia on anterior aspect of rectum: recto-prostatic fascia in men; recto-vaginal fascia in women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What is Waldeyer’s fascia?

A

Fascia on posterior aspect of rectum: recto-sacral fascia/pre-sacral fascia; separates the rectum from the presacral venous plexus and the pelvic nerves

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What is disuse proctitis?

A

Diversion proctitis- occurs with Hartman’s pouch

S/S: grey mucous drainage (sloughed dead mucosa), urgency to defecate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the treatment for disuse proctitis?

A

short chain fatty acid enemas

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What is the most common long term complication from pouch formation? What is the diagnosis and treatment?

A

Infectious pouchitis- can be acute or chronic
Sx: purulent drainage, diarrhea, hematochezia, fever, low abd pain, malaise
Dx: colonoscopy- friable, inflamed pouch; biopsy to rule out Crohn’s disease
Tx: Cipro and flagyl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

At what age do you start screening for colon cancer?

A

50 for normal risk; 40 for intermediate risk or 10yrs younger than family member at diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are the screening options for colon cancer?

A
  1. Colonoscopy every 10yrs
  2. high sensitivity fecal occult blood testing every 3yrs with flex sig every 5yrs
  3. high sensitivity fecal occult blood testing every year
  4. double contrast barium enema or CT colonography every 5 yrs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What can cause false positive stool guaiac test?

A

beef, vitamin C, iron, cimetidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are the risk factors for sigmoid volvulus?

A

debilitated, pysch hx, elderly, nursing home residents, laxative abuse, high fiber diets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What is the initial treatment for sigmoid volvulus?

A

Decompressive colonoscopy followed by sigmoid colectomy during that admission– do NOT attempt colonoscopy if gangrenous bowel is seen on colonoscopy, pt has peritoneal signs or perforation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What is the treatment if decompressive colonoscopy fails to detorse a sigmoid volvulus?

A

go to OR for sigmoid colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What is the treatment for cecal volvulus?

A

right hemicolectomy with primary anastomosis (only 20% detorse with colonoscopy)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

What is seen on pathology of ulcerative colitis?

A

Spares the anus but involves the rectum, contiguous (no skip lesions), mucosal inflammation, crypt abscesses, Bimodal age of onset (20’s and 60’s)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

What is seen on barium enema of a pt with ulcerative colitis?

A

“lead pipe” colon- loss of haustra, narrow caliber, short colon, loss of redundancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

What medications are for chronic management of UC?

A

sulfasalazine (5-ASA) and loperamide; azathioprine, cylcosporine, infliximab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

What common med can worsen symptoms and cause flares in UC?

A

NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the treatment for acute flare of UC?

A

steroids (hydrocortisone 100mg q8)

add cipro and flagyl if concern for toxic megacolon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What is toxic megacolon?

A

bloody stools, fever, tachycardia, hypotension, leukocytosis, abd distention, abd pain and tenderness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

What is the initial treatment for toxic megacolon?

A

NGT, fluids, steroids, bowel rest, abx

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

What percentage of toxic megacolon will resolve with medical management?

A

50%– other 50% will require surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

What are the surgical indications for toxic colitis/megacolon?

A

Absolute: pneumoperitoneum, diffuse peritonitis, major hemorrhage, uncontrolled sepsis, colonic distention >10-12cm w worsening pain and localized peritonitis
Relative: controlled sepsis, worsening colitis/failure to improve after 72 hrs, clinic deterioration, cont blood transfusions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

What is the most common site of perforation in UC?

A

transverse colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What is the most common site of perforation in Crohn’s?

A

distal ileum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

What resection is performed in emergent UC cases?

A

total proctocolectomy with end ileostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

What are the indications for elective/semi urgent surgery in UC?

A

significant hemorrhage, persistent obstruction/stricture, any dysplasia, cancer, failed medical tx resulting in 10-12 bloody BMs per day, failure to wean high dose steroids, failure to thrive, long standing disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

What is the most common reason for takedown of ileana anastomosis after colectomy in UC pts?

A

incontinence (i.e. pouch failure)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

What is the cancer risk with UC?

A

1% per year starting 10yrs after initial diagnosis of pan-colitis; start colonoscopies 8-10yrs after diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Which pts are indicated for prophylactic colectomy after 20yrs of UC?

A

pts with primary sclerosing cholangitis, family hx of colon ca, young age at diagnosis, left sided colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

What is the risk of finding cancer in specimen when total colectomy is performed for dysplasia in UC pt?

A

30% of UC pts w dysplasia will have cancer found on pathology.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is the most common extra-intestinal indication for total colectomy?

A

failure to thrive in children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Which extra-intestinal manifestations of UC do NOT improve after colectomy?

A

primary sclerosing cholangitis, ankylosing spondylitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

Which extra-intestinal manifestations of UC actually DO improve after colectomy?

A

ocular problems, arthritis, anemia; 50% with pyoderma gangrenosum will improve

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What blood test is associated with UC?

A

HLA B27 (UC, sacroiliitis, ankylosing spondylitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

What is the treatment for pyoderma gangrenosum?

A

steroids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

MCC of colonic obstruction in infants

A

Hirschsprung’s disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Epidemiology of Hirschsprung’s

A

more common in males 4:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

Most common sign of Hirschsprung’s

A

failure to pass meconium in first 24hrs; other s/s distention, constipation, vomiting, colitis; explosive release of watery stool with anorectal exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Abd XR in Hirschsprung’s

A

dilated proximal colon or small bowel with distal decompression (decompressed portion does NOT have ganglion cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Diagnosis of Hirschsprung’s:

A

rectal suction cup biopsy- absence of ganglion cells in Auerbach’s myenteric plexus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

Pathogenesis of Hirschsprung’s

A

failure of neural crest ganglion cells to progress in caudal direction; causes a functional colonic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Extent of colon involved in Hirschsprung’s

A

75% just have rectal involvement, 5% the rectum and entire colon is affected

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

Treatment for Hirschsprung’s

A

Resect rectum and colon until proximal to where ganglion cells appear (send margins to path intra op to confirm presence of ganglion cells)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Order of procedures in Hirschsprungs

A

Initially bring up colostomy

eventually connect good residual colon to anus - Soave or Duhamel pull through procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

S/S of Hirschsprung’s colitis

A

tenderness, foul smelling diarrhea, sepsis, lethargy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

MCC of death in Hirschsprung’s

A

hirschsprung’s colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Tx for Hirschsprung’s colitis

A

rectal irrigation to try and empty colon, may need emergency colectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

Pathophys of imperforate anus

A

rectum fails to descend through the external sphincter complex; rectum ends as blind pouch usually with fistulous track to the GU system (males: urethra, bladder, scrotum; females: vagina)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Syndromes associated w imperforate anus

A

VACTERL (60% have anomaly, MC anomaly is urinary tract)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

Location of anomalous anus

A

males: high lesion >50%; females: low lesions 90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

High lesion imperforate anus

A

rectum ends above levator ani muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Which gene mutation has been found in Hirschsprung’s?

A

RET protooncogene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Dx of imperforate anus

A

physical exam will show defects from no anus to perineal fistulas; plain xr/obsructive series; contrast study

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

What is a low lesion imperforate anus?

A

rectum ends below levator ani muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

How is a low lesion discovered in imperforate anus?

A

meconium is seen on perineal skin/along median raphe, scrotum, or in lower vagina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

How is a high lesion imperforate anus defect discovered?

A

males: meconium in urine; MC is fistula from rectum to prostatic urethra;
Females: meconium is seen in upper vagina- may have cloacal deformity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

What is the procedure to correct imperforate anus?

A

colostomy
delayed anal reconstruction with posterior sagittal anoplasty to place rectum in external anal sphincter complex
closure of colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

How to prevent problems with long term constipation in pts after correction of imperforate anus?

A

need post-op dilation to avoid stricture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Most likely location of colon perforation with obstruction?

A

cecum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

Most common cause of colon obstruction

A
  1. cancer 60%

2. diverticulitis 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

pneumotosis intestinalis

A

air in bowel wall, asstd with ischemia and dissection of gas into bowel wall; NOT always an indication for resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

air in portal system

A

indicates significant infection or necrosis of the large or small bowel; often an indication for resection if due to bowel ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Pseudo-ostruction of the colon

A

Ogilvie’s syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Risk factors for Ogilvie’s

A

opiate use, bedridden, elderly, recent surgery, infection, trauma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Treatment for Ogilvie’s

A

IVF’s, replace electrolytes, dc narcotics, NGT, bowel rest, consider rectal tube, decompressive colonoscopy
If colonoscopy fails, proceed with cecostomy or resection if perforation or non viable bowel; neostigmine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Side effect of neostigmine

A

(MOA- acetylcholinesterase inhibitor)

Bradycardia– have atropine available

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Organism in amebic colitis

A

entamoeba histolytica, primary infection occurs in colon, secondary infection occurs in liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Transmission of entamoeba histolytica

A

oral-fecal: from contaminated food/water with feces that contain cysts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Risk factors for amebic colitis

A

travel to Mexico, EtOH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Diagnosis and treatment of amebic colitis

A

endoscopy–> ulceration, trophozoites; stool O&P; Tx w flagyl, diiodohydroxyquin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

most common location of actinomyces

A

mouth (poor dentition), lung, and cecum (can be confused with cancer)
Path shows yellow-white sulfur granules

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Treatment of actinomyces

A

penicillin or tetracycline, drainage of any abscesses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

How long can stool guaiac stay positive after bleed?

A

can be positive up to 3 weeks after a bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Hematochezia

A

lower GI bleed; maroon colored stools

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

Hematemesis

A

bleeding anywhere from pharynx to ligament of Trietz (UGI bleed); melena and hematochezia can occur with UGI bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

Melena

A

passage of black tarry stools; requires only 50cc of blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

Azotemia after GI bleeds

A

increased BUN after GI bleed- caused by production of urea from bacterial action on intraluminal blood

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Rate of bleed to be picked up on arteriography

A

> 0.5cc/min

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

Rate of bleed to be picked up by tagged RBC scan

A

> 0.1cc/min; most sensitive test but hard to localize the exact area

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

What is a double balloon endoscopy and when is it used?

A

AKA push endoscopy- upper endoscopy using a rigid over tube to prevent coiling in the stomach in order to get down into small bowel

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

What protocol should be followed in severe GI bleed?

A

Follow trauma protocol: massive transfusion and permissive hypotension (SBP >70) until bleeding is found and treated, avoid excessive crystalloids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Diagnosis of GI bleed

A
  1. NG lavage to rule out UGI source- be sure to see bile!
  2. proctoscopy to rule out hemorrhoids
  3. vasopressin to slow bleeding if hypotensive
  4. Colonoscopy to be diagnostic and therapeutic. tattoo the bleeding area
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Diagnostic studies guidelines for mild LGIB

A

colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

Guidelines for moderate LGIB (BP>90)

A

colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

Guidelines for massive LGIB (SBP <90 despite blood transfusion)

A

colonoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Guidelines for massive LGIB with persistent shock, unstable pt, SBP 60’s

A

Angiography to embolize or to localize which side of colon then to OR for segmental resection; may need blind total abd colectomy if massive bleeding and clinical condition does not allow attempt at localization or if bleeding is not localized on angio (life saving maneuver)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

What must be done prior to total abd colectomy for GI bleed?

A

RULE OUT upper GI bleed and hemorrhoids as source of bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

If colonoscopy does not localize bleed, what steps are next?

A

angiography –> tagged RBC scan –> video capsule study –> Meckel scan –> Push endoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

MCC of small bowel bleeding

A
  1. Angiodysplasia 2. tumor 3. Meckel’s 4. Crohn’s
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

MCC of painless lower GI bleed in kids and teens

A

Meckel’s diverticulum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

pathophys of diverticula

A

straining causes increased intraluminal pressure, herniation of mucosa through the colon wall at sites where arteries enter the muscle; circular muscle thickens adjacent to the diverticulum leading to luminal narrowing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
115
Q

What percentage of the population has diverticulosis?

A

35%; 90% occur in sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
116
Q

Where do most diverticular bleeds occur?

A

right side

117
Q

MCC Of lower GI bleed

A

diverticular bleed

118
Q

Most common location in colon for angiodysplasia bleeds

A

right side of colon, small bowel

119
Q

Which bleeds are more severe- diverticular or AVMs?

A

Diverticular

120
Q

Which bleeds are more likely to recur- diverticular or AVMs?

A

AVMs

121
Q

MCC of obscure GI bleeds

A

AVMs

122
Q

What are the signs of angiodysplasia on angiography?

A

slow emptying, tufts

123
Q

What associated pathology do pts with AVMs have?

A

aortic stenosis- AVMs improve after valve replacement

Also high incidence with LVADs

124
Q

Which medications can be used to help control bleeding in AVMs?

A

aminocaproic acid, octreotide

125
Q

What are common causes of ischemic colitis?

A

low flow states- recent MI/CHF, sepsis, medical ICU pt, cardiac surgery, severe dehydration, massive diarrhea, hypoxia (COPD, ARDS) ligation of IMA during surgery such as AAA repair

126
Q

Which areas of the colon are most vulnerable to low flow states?

A

Griffith’s Point (splenic flexure)

Sudeck’s point (rectum)

127
Q

Which areas are spared in ischemic colitis?

A

middle and lower rectum spared bc blood supply from middle rectal (off internal iliac) and inferior rectal (off internal pudendal)

128
Q

Ischemic colitis on CT

A

(thumbprint sign) thick edematous mucosa, thick colon wall, fat stranding

129
Q

Best test for diagnosis of ischemic colitis and what will it show?

A

colonoscopy- thick cyanotic, edematous mucosa covered in exudates

130
Q

Best tx for ischemic colitis

A

antibiotic and fluid resuscitation; if gangrenous, hemorrhage, or perforation then no colonoscopy, go straight to OR
If necrotic bowel seen on colonoscopy–> OR

131
Q

Whats the risk of cancer in hyperplastic polyps?

A

none

132
Q

Risk of cancer in tubular adenomas

A

<5%

133
Q

risk of cancer in tubovillous adenoma

A

20% contain cancer

134
Q

Which polyp type is most likely to be symptomatic and contain cancer

A

villous adenoma, <2cm, these are also usually sessile too; 40% contain cancer

135
Q

MC location of polyps

A

left side

136
Q

What do you do if entire polyp can’t be removed endoscopically?

A

need segmental resection

137
Q

What is carcinoma in situ?

A

high grade dysplasia with basement membrane intact

138
Q

When is polypectomy adequate?

A
  1. if margins are clear (2mm)
  2. is well differentiated
  3. no neuro/vascular/lymphatic invasion
139
Q

Pathology shows T1 lesion after transanal excision of rectal villous adenoma. Transanal excision is adequate if:

A
  1. margins are clear (2mm)
  2. is well differentiated
  3. no neuro/vascular/lymphatic invasion
140
Q

If pathology shows T2 lesion after transanal excision of rectal polyp, what does pt need?

A

APR or LAR; can do pre-op chemo-XRT if T3 or T4

141
Q

Most common location of colon cancer

A

sigmoid colon

142
Q

Main gene mutations in colon cancer:

A

tumor suppressors: APC, p53, DCC, proto-oncogene: k-ras

143
Q

What bacteria is associated with colon cancer?

A

step gallolyticus (strep bovis biotype I) and clostridium septicum

144
Q

what can cause false positive fecal occult blood test

A

beef, Vit C, iron, antacids, cimetidine

145
Q

Most important prognostic indicator

A

node status

146
Q

path of colon mets to liver and lung

A

portal vein –> liver mets

iliac vein –> lung mets

147
Q

5 year survival of pts with colon ca w liver mets

A

35%

148
Q

5 year survival of pts with colon ca w lung mets

A

25%

149
Q

how does rectal cancer spread to spine

A

spreads directly to spine via Batson’s plexus

150
Q

What are adequate margins for colon cancer? rectal cancer?

A

colon cancer margins: 4-5cm
rectal cancer margins: >2cm
low rectal cancer T1 margins: >2mm

151
Q

What does rectal pain indicate?

A

that rectal cancer is growing into sphincters or pelvic floor; patient needs APR

152
Q

MC location of colon perforation

A

cecum- Law of LaPlace (tension = pressure x diameter)

153
Q

Best method for detecting intrahepatic metastases

A

intra operative US- has resolution of 3-5mm

154
Q

which arteries are ligated in right hemicolectomy

A

ileocolic and right colic arteries

155
Q

which arteries are ligated in left hemicolectomy

A

left colic artery

156
Q

which arteries are ligated in extended right hemicolectomy

A

ielocolic, right colic, and middle colic arteries

157
Q

which arteries are ligated in extended left hemicolectomy

A

middle and left colic artery

158
Q

which arteries are ligated in transverse colectomy

A

middle colic artery

159
Q

whats resected in LAR?

A

sigmoid colon and rectum

160
Q

which arteries are ligated in LAR?

A

sigmoid and rectal arteries

161
Q

why do you need a 2cm margin on rectal cancer?

A

need 2cm above anal canal to be resected with the end to end stapler as the donut– send donut to path!!

162
Q

LAR easier in men or women?

A

generally easier in women bc wider pelvis

163
Q

What is the benefit of diverting loop ileostomy when doing LAR?

A

decreases complications of a leak should one occur

164
Q

what are the complications of injured pudendal nerves?

A

risk of incontinence and ejaculatory failure– watch when taking down lateral stalks

165
Q

T for colorectal cancer

A 
Tis: in mucosa/carcinoma in situ
T1: submucosa
T2: muscularis propria
T3: invades subserosa
T4: through serosa into free peritoneal cavity (perforates into visceral peritoneum or invades adjacent tissues/organs)
166
Q

N for colorectal cancer

A

N0: nodes negative
N1: 1-3 nodes positive
N2: >=4 nodes positive

167
Q

Stage 0 for colorectal cancer

A

Tis, N0 M0

168
Q

Stage 1 for colorectal cancer

A

T1-2, N0 M0

169
Q

Stage 2 for colorectal cancer

A

2a: T3 N0 M0
2b: T4 N0 M0

170
Q

Stage 3 for colorectal cancer

A

3a: T1-2, N1, M0
3b: T3-4, N1 M0
3c: Any T, N2, M0

171
Q

Stage 4 colorectal cancer

A

any T, any N, M1

172
Q

What are criteria for trans anal excision of low rectal lesions

A 
T1
< 4cm
< 1/3 of circumference
negative margins of at least 2mm
well differentiated
no neuro/vasc/lymph invasion
173
Q

Which colon cancers get chemo?

A

Stage 3 and 4

174
Q

Which rectal cancers get chemo?

A

Stage 2 and 3 get prep chemo-XRT, then adjuvant chemo

175
Q

What is the chemo protocol in colorectal cancer?

A

FOLFOX, 6 cycles (5-FU, leucovorin, oxaliplatin)

176
Q

What are the side effects of 5-FU

A

myelosuppression

177
Q

What are the side effects of oxaliplatin?

A

nephrotoxicity, neurotoxicity, ototoxicity

178
Q

Which chemo drugs are added for pts with metastatic colorectal cancer?

A

can add bevacizumab (avastin) or cetuximab (erbitux)

179
Q

What is the MOA of bevacizumab?

A

monoclonal antibody to VEGF-A

180
Q

What is the MOA of cetuximab?

A

monoclonal antibody to EGF receptor

181
Q

What is the MOA of fluorouracil?

A

5-FU- thymidylate synthase inhibitor to block synthesis of pyrimidine thymidine needed to DNA replication

182
Q

What is the MOA of leucovorin?

A

aka folinic acid- assists with selective reactivation of dihydrofolate reductase in normal cells in presence of methotrexate type chemos

183
Q

What is the MOA of oxaliplatin?

A

inhibition of DNA replication and transcription

184
Q

5-year survival for colorectal cancer

A

Stage 1: 95%
Stage 2: 80%
Stage 3: 65%
Stage 4: 10%

185
Q

What is the survival benefit of chemo in colorectal cancer?

A

improves 5 year survival for stage 3 colorectal cancer

186
Q

What is the main reason for surveillance colonoscopy after colorectal ca treatment?

A

to check for another primary (metachronous) cancer (5%!!)

187
Q

Rate of recurrence of colorectal cancer?

A

20%- usually within first year

188
Q

poor prognostic indicators for colon ca w liver mets

A 
disease free interval <12 months
> 3 tumors
CEA >200mcg/L
size >5cm
positive nodes
synchronous primary and liver met
189
Q

5 year survival after resection of liver mets

A

35%

190
Q

what is the treatment for acute radiation proctitis?

A

butyrate enemas

191
Q

Pathophys behind late radiation proctitis

A

obliterative arteritis of submucosal vessels

192
Q

Genetics of familial adenomatous polyposis

A

FAP, autosomal dominant, chromosome 5, mutation in APC tumor suppressor gene

193
Q

Lifetime risk of CA with FAP

A

100% lifetime risk by age 50; rarely before age 20

194
Q

Tx for FAP

A

total colectomy by age 20

195
Q

Other common site of CA in FAP (not colon)

A

duodenal periampullary polyps and adenocarcinoma–> get EGD every 1-2 yrs; intra-abdominal desmoid tumors

196
Q

What is the surgical procedure for FAP?

A

total proctocolectomy, rectal mucosectomy, ileo-anal pouch; total proctocolectomy with end ileostomy also an option

197
Q

Surveillance for FAP post-colectomy

A

lifetime proctoscopy surveillance of residual rectal area and EGD every 1-2 yrs

198
Q

MCC of death with FAP

A

peri-ampullarf CA of the duodenum– need whipple

199
Q

Genetics of Gardner’s Syndrome

A

FAP variant; APG gene

200
Q

Gardner’s syndrome

A

colon ca, osteomas, desmoid tumors

201
Q

recurrence rate of desmoid tumors

A

70%, benign but locally invasive

202
Q

Turcot’s syndrome

A

FAP variant- colon Ca and brain tumors

203
Q

Genetic mutation in Lynch syndrome

A

HNPCC, defect in DNA mismatch repair genes, autosomal dominant

204
Q

Lynch 1

A

just colon ca risk

205
Q

Lynch 2

A

colon ca plus increased risk of ovarian, endometrial, bladder, and stomach ca

206
Q

Amsterdam criteria

A

“3,2,1”

  • at least 3 family members, one is a first degree relative of the other 2
  • over 2 generations
  • 1 relative with cancer before age 50
  • FAP has been excluded
207
Q

Familial Juvenile polyposis

A

hamartomatous polyps occur in upper GI tract and colon before age 20.

208
Q

Risk of cancer and adenomatous change in familial juvenile polyposis

A

20%

209
Q

Surveillance for familial juvenile polyposis

A

upper and lower endoscopy every year

210
Q

Indication for colectomy in familial juvenile polyposis

A

adenomatous change in polyps

211
Q

lap vs open colon surgery

A

less blood loss, longer operative time, shorter hospital stay, no difference in path margins, number of nodes, or mobility/mortality

212
Q

method for controlling bleeding of pelvic venous plexus

A

bone wax or sterile thumbtacks

213
Q

Treatment for ureter injury

A

<7 days post op- reoperate and repair

<= 7 days post op- place percutaneous drain and wait 6-8 weeks before repair

214
Q

damage to which nerves causes bladder dysfunction

A

pelvic splanchnic plexus (parasympathetic)

215
Q

damage to which nerves causes sexual dysfunction

A

erectile- pelvic splanchnic plexus (parasympathetic)
retrograde ejaculation- damage to hypogastric plexus (sympathetic, T10-L2)
Ejaculatory failure- damage to pudendal nerve (sympathetic, S2-4) in pelvic sidewall

216
Q

Course of type 1 branchial cleft cyst

A

From angle of mandible to external auditory canal

217
Q

Course of type 2 branchial cleft cyst

A

From anterior SCM to tonsillar pillar

218
Q

Course of type 3 branchial cleft cyst

A

Deep SCM to pyriform sinus

219
Q

Rate of wound infection in colorectal surgery

A

10%

220
Q

MC location for head and neck cancer of unknown origin

A

tonsils

221
Q

MC malignant parotid tumor

A

mucoepidermoid

222
Q

Electrolyte derangements in primary hyperparathyroidism

A

Elevated PTH, Ca, renal cAMP, urine Ca
Cl:PO4 ration >33
Phos will be normal to low

223
Q

MCC of mortality in pts w parathyroid ca

A

Hypercalcemia

224
Q

MEN 1

A 
Pancreatic tumors (MC is gastrinoma) 
Parathyroid hyperplasia
Pituitary tumors (MC is prolactinoma)
225
Q

MC endocrine pancreatic tumor

A

Insulinoma

226
Q

Genetic defect in MEN 1

A

MEN1

227
Q

Genetic defect in MEN2a and MEN2b

A

Ret proto oncogene

228
Q

Major side effect of Herceptin (trastuzumab)

A

Cardiac toxicity

229
Q

Major side effect of taxol

A

Neurotoxicity

230
Q

The greatest change in lung dimension during inspiration is in which direction?

A

superior-inferior due to diaphragm movement

231
Q

where does the thoracic duct cross the mediastinum?

A

thoracic duct crosses right to left at T4-5 level

232
Q

Which pneumocytes produce surfactant?

A

Type II

233
Q

What is the most commonly involved structure in thoracic outlet syndrome?

A

brachial plexus– usually involving C8-T1/ulnar distribution

234
Q

location of phrenic nerve to the scalenes?

A

anterior to the anterior scalene muscle

235
Q

location of long thoracic nerve to the scalenes?

A

posterior to the middle scalene muscle

236
Q

Superior vena cava syndrome

A

apical lung ca grows into SVC causing acutely swollen face, arms, hands. Tx is emergent XRT; MC small cell lung ca

237
Q

Horners syndrome

A

ptosis, miosis, anhydrosis due to invasion of the sympathetic chain at T1

238
Q

What ca releases PTH-rp?

A

squamous cell lung ca

239
Q

MC location of significant hemoptysis

A

bronchial arteries

240
Q

Horners syndrome

A

ptosis, miosis, anhydrosis due to invasion of the sympathetic chain at T1

241
Q

Pancoast tumors

A

apical lung tumors in superior sulcus; invasion into sympathetic chain or brachial plexus

242
Q

MC congenital heart defect

A

ventricular septal defect

243
Q

primary blood supply to the trachea

A

inferior thyroid and bronchial arteries

244
Q

Overall MC mediastinal tumors

A

neurogenic tumors

245
Q

Treatment for carotid stenosis due to medial fibromuscular dysplasia

A

percutaneous transluminal angioplastydmr [78

246
Q

MC type of endoleak

A

Type 2

247
Q

Types of endoleak

A

Type 1: leak at proximal or distal graft attachment site
Type 2: back filling from collateral branches
Type 3: leak at junction bt stents
Type 4: porous graft material
Type 5: endotension

248
Q

Treatment for carotid stenosis due to medial fibromuscular dysplasia

A

percutaneous transluminal angioplasty

249
Q

Types of endoleak

A

Type 1: leak at proximal or distal graft attachment site
Type 2: back filling from collateral branches
Type 3: leak at junction bt stents
Type 4: porous graft material
Type 5: endotension

250
Q

What do the parietal cells of the stomach secrete?

A

HCl and intrinsic factor

251
Q

What do chief cells of the stomach secrete?

A

Pepsinogen

252
Q

What surgical conditions can lead to B12 deficiency?

A

Gastric bypass (lose intrinsic factor)
Terminal ileum resection (where B12 gets absorbed)
Blind loop syndrome (bacteria consume all the B12)

253
Q

Where is gastrin produced?

A

By G cells in the antrum and duodenum

254
Q

UES pressures at rest and during early swallow

A

at rest: 60mmHg

early swallow: 15mmHg

255
Q

LES pressures at rest and during earl swallow

A

at rest: 15mmHg

early swallow: 0mmHg

256
Q

Diffuse esophageal spasm

A

high amplitude repetitive NON peristaltic contractions

257
Q

nutcracker esophagus

A

high amplitude peristaltic contractions

258
Q

scleroderma esophagus

A

peristalsis and low LES pressure with massive reflux and severe esophagitis

259
Q

achalasia

A

high LES pressure and absence of peristalsis

260
Q

Tx for Schatzki’s rings

A

occur in pts with hiatal hernias; tx is ring dilatation and PPI. (NEVER resect)

261
Q

MC location for Boerhaave’s

A

left lower esophagus; left thoracotomy is usually best incision for repair; repair should be multiple layers bc mucosal tear is usually longer than the muscular tear

262
Q

Best test to find esophageal tear

A

gastrograffin swallow study followed by barium swallow study

263
Q

Where do the adrenal veins drain?

A

RIGHT adrenal vein drains into IVC

left adrenal vein drains into left renal vein

264
Q

Pylephlebitis

A

infection of the portal system that can occur after diverticulitis or appendicitis- fever, elevated LFTs, air in portal system. Liver abscess and portal thrombosis can occur

265
Q

MCC of upper GI bldg in children >1

A

portal vein thrombosis

266
Q

Schistosomiasis

A

RUQ pain and maculopapular rash- tx w praziquantelghx

267
Q

Dx of amebic liver abscess

A

symptoms, CT scan (large single abscess with peripheral rim of enhancement), serology

268
Q

Focal nodular hyperplasia on imaging

A

CT- hypervascular lesion with enhancing central stellate scar
positive lesion on technetium labeled albumin scan

269
Q

Where does active reabsorption of conjugated bile acids occur?

A

in terminal ileum

270
Q

most sensitive indicator of obstructive jaundice

A

alk phos

271
Q

DNA polymerase is involved in

A

duplication of DNA– polymerase chain reactions

272
Q

RNA polymerase is responsible for

A

transcription – copying DNA into mRNA

273
Q

proteins are translated from

A

mRNA (ribosomes translate mRNA into amino acid sequences which make up proteins)

274
Q

How do steroids work to create proteins?

A

bind a receptor in the cell cytoplasm, enter the nucleus as s steroid-receptor complex, then affect transcription of mRNA for protein synthesis.

275
Q

How does thyroid hormone work to create proteins?

A

crosses into the nucleus then binds a receptor to affect transcription of mRNA

276
Q

What activates protein kinase A?

A

cAMP

277
Q

What activates protein kinase c?

A

Ca or DAG

278
Q

How does thromboxane increase platelet adhesion?

A

increases Ca release inside of platelets which then triggers expression of GpIIB/IIIa on plts to allow plts to bind

279
Q

Which clotting factors are contained in cryoprecipitate

A

contains highest levels of Factor 8, vWF, and fibrinogen; use when fibrinogen levels are low

280
Q

What treatment can cause a relative anti-thrombin 3 deficiency?

A

heparin– if a pt is on heparin course and then quits responding, give anti-thrombin 3 or FFP

281
Q

How do thrombolytics work?

A

convert plasminogen to plasmin; plasmin degrades fibrin

282
Q

How does prostatectomy cause bleeding issues?

A

prostatectomy/TURP can release urokinase which causes fibrinolysis and bleeding. Give aminocaproic acid

283
Q

What are the types of intestinal atresia?

A

Type I: mucosal atresia w intact bowel and no mesenteric defect
Type II: two separate atretic segments of bowel connected by a fibrous cord
Type III: two segments separated by a V-shaped mesenteric defect
Type IIIb: apple-peel or Christmas tree anomalies
Type IV: multiple atresias

284
Q

where is the highest incidence of biliary atresia?

A

asia

285
Q

Does biliary atresia occur more frequently in males or females?

A

biliary atresia occurs more frequently in females

286
Q

Does biliary atresia occur more frequently in males or females?

A

biliary atresia occurs more frequently in females

287
Q

Prothrombin complex concentrate

A

plasma mix of Vit K dependent factors

- 3 factor type has low levels of Factor VII and requires additional FFP to reverse warfarin

288
Q

black widow spider venom

A

alpha-latrotoxin is neurotoxic

289
Q

brown recluse spider

A

sphingomyelinase-D causes local skin necrosis with ulceration

ABSITE (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions