COLON

Question 1

What branches are taking in a right hemicolectomy

Answer 1

Ileocolic
Right colic
Right branch of the middle colic

Question 2

Pitfalls to mention with right hemicolectomy

Answer 2

Identify the ureter
gonadal vessels
Watch out for the duodenum

Question 3

Surgery performed for right hepatic flexure or proximal transverse colon cancer

Answer 3

Extended right hand selected

Ileocolic
Right colic
Middle colic

Inferior mesenteric bang!

Watch out for
The pancreas
The duodenum
the spleen

Question 4

Transverse colectomy

Answer 4

Middle colic vessel

Possibly inferior mesenteric vien

Mobilize both hepatic and splenic lectures to have enough life

Question 5

Left hemicolectomy vessels and key piont

Answer 5

Left branch of the middle colic

Left colic

Inferior mesenteric vein

Mobilize splenic flexure

Question 6

Sigmoidectomy vessels in key points

Answer 6

Inferior mesenteric artery
(this is why the sigmoid dies after AAA)

Watch out for the ureter
Watch out for gonadal vessels

Question 7

Workout for Ogilvy’s syndrome

Answer 7

Rule out distal extraction with Gastrografin enema!

Cardiac monitor

Neostigmine

Question 8

Hinche class

Answer 8

I Micro perf

II abscess near sigmoid perf

III permanent peritonitis (eg, pelvic abscess large)

IV feculent peritonitis

Question 9

Cecal cancer resection

Answer 9

Right hemicolectomy

If ANY other previous bal surgery subtotal colectomy

Question 10

Medication for diarrhea

Answer 10

Cholestyramine

paregoric

Question 11

List blood supply today:

Answer 11

Ilioinguinal -distal ilium, cecum, ascending

Right colic - ascending, hepatic flexion

Middle colic - transverse colon

Left colic - splenic flexure descendingcolon

Inferior mesenteric artery - sigmoid

Question 12

Management of colon metastasis to the long

Answer 12

Resect

Question 13

major Family cancer syndromes

Answer 13

Gardener syndrome
Peutz jegher
HNPCC
FAP

Question 14

HNPCC history and screening

Answer 14

Amsterdam criteria:

Three relatives with colorectal cancer (endometrial, small bowel, GU cancers)

Over two generations

One primary relative under the age of 50 at time of Dx

Age 25:
first scope
screen endometrial

Question 15

Treatment of FAP

Answer 15

PROCTOcolectomy wiht IPAA during teenage years

Question 16

colon cancer screening lab

Answer 16

CEA

Question 17

when does polypectomy needed a cancer operation

Answer 17

Invading submucosa - haggitt level 4

Sessile

Lymphovascular invasion

Poorly differentiated

Question 18

management of small adenoma

Answer 18

repeat scope in 3 years

Question 19

Screening options for colon cancer

Answer 19

age 50

I. felx sig q 5 yrs and yearly FOBT

II. Double contrast barium enema q 5 yrs

positive contrast: barium or barium-like agent, e.g. Gastrograffin ®
negative contrast: air or CO2

C scope q 10

Question 20

Lynch syndrome

What is the treatment

Answer 20

If found to have colorectal cancer

Total abdominal colectomy with ileorectal anastomosis

and

With post op ANNUAL
endoscopic surveillance of the remaining rectum

Females after children
get TAH BSOO

(40 – 60% chance of endometrial cancer)

Question 21

If there is any previous colon resection what is needed for further procedure

Answer 21

Total colectomy

Question 22

What is the Niagara protocol

Answer 22

5-FU because everyone gets this

Mitomycin-c

mity mouse will see if chemo works

5-FU

Mitomycin C

45 gy (uptodate)

Question 23

Treatment of carcinoid in the appendix at the base known preoperatively what medication should you prepare the patient with set timer for 15 minutes

Answer 23

If known cancer:
Give octreotide preoperatively

Right hemicolectomy

Question 24

What extra colonic cancer do patients get with FAP

And what is the treatment

Answer 24

Periampullary adenocarcinoma

Whipple

Question 25

FOLFOX

Answer 25

Fu L Ox

Fluorouracil
Leucovorin
Oxaliplatin

Question 26

Management of carcinoma in a polyp

Answer 26

can be effectively managed by endoscopic removal (polypectomy) alone as long as the resection margins are free of cancer for:

severe dysplasia
or
carcinoma in situ (no evidence of invasive cancer),

The presence of any of the following factors should prompt consideration of radical surgery:

●Poorly-differentiated histology

●Lymphovascular invasion

●Cancer at the resection or stalk margin

●Invasion into the muscularis propria of the bowel wall (T2 lesion)

●Invasive carcinoma arising in a sessile (flat) polyp with unfavorable features (eg, lower third submucosal penetration, lymphovascular invasion, poorly differentiated)

Question 27

If the patient is seen with a painful thrombosis within 24 to 48 hours, the treatment of choice is

Answer 27

immediate excision of the hemorrhoid

(not evacuation of the clot) under local anesthesia.

The patient who presents later:
treated with Sitz baths; 
stool softeners; 
topical anesthetics, 
astringents, 
 steroids 

to aid in rapid resolution of symptoms
since natural reabsorption of the clot has started

Question 28

If an outside provider has done the scope to diagnose calling cancer what needs to be done for preoperative arrangements

Answer 28

Tattoo colon cancer sight

Consider Re-scope to get distance measurements.

Question 29

After Acute appy with IR drain draining feculent material

Answer 29

DDX:

Drain may have been put through the bowel

This may be a fistula from Cecal stump leak

Tx:
TPN