Colon and Rectum

Question 1

Lateral peritoneal reflections of the ascending and descending colon

Answer 1

White lines of Toldt

Question 2

What parts of the GI tract do not have a serosa

Answer 2

Esophagus
Middle and distal rectum

Question 3

What are the major anatomic differences between the colon and the small bowel

Answer 3

Colon has teniae coli, haustra, and fat appendages; whereas, the small intestine is smooth

Question 4

Identify A, B, and C

Answer 4

A = Superior mesenteric artery
B = Inferior mesenteric artery
C = Ileocolic artery

Question 5

How are tumors staged

Answer 5

TMN staging system

Question 6

What are the common preoperative IV antibiotics

Answer 6

Cefoxitin (Mefoxin), carbapenem*

Question 7

What decides low anterior resection (LAR) versus abdominal perineal resection (APR)

Answer 7

Distance from the anal verge, pelvis size

Question 8

Why is follow-up so important the first 3 postoperative years

Answer 8

90% of colorectal recurrences are within 3 years of surgery

Question 9

Tissue growth into the bowel lumen, usually consisting of mucosa, submucosa, or both

Answer 9

Rectal polyps

Question 10

How are polyps classified

Answer 10

Sessile (flat)
Pedunculated (on a stalk)

Question 11

Where are most polyps found

Answer 11

Rectosigmoid (30%)

Question 12

Condition in which diverticula can be found within the colon

Answer 12

Diverticulosis

Question 13

What is the most common site for diverticulosis

Answer 13

95% of people with diverticulosis have sigmoid colon involvement

Question 14

What are the associated lab findings with diverticulitis

Answer 14

Increased WBC

Question 15

Is a colonoscopy safe in an acute diverticulitis setting

Answer 15

No - increased risk of perforation

Question 16

What the most common fistula with diverticulitis

Answer 16

Colovesical fistula (to bladder)

Question 17

What is the best test for diverticulitis

Answer 17

CT scan

Question 18

What is the most common carcinoma of the anus

Answer 18

Squamous cell carcinoma (80%)
(think - ASS = Anal Squamous Superior)

Question 19

Anal fistula from rectum to perianal skin

Answer 19

Fistula in Ano

Question 20

Thick suture placed through fistula tract to allow slow transection of sphincter muscle

Answer 20

Seton

Question 21

Abscess formation around the anus/rectum

Answer 21

Perirectal abscess

Question 22

Tear of fissure in the anal epithelium

Answer 22

Anal Fissure

Question 23

What is the “rule of 90s” for anal fissures

Answer 23

90% occur posterior
90% heal with medical treatment
90% of patients heal successfully

Question 24

Engorgement of the venous plexuses of the rectum, anus, or both with protrusion of the mucosa, anal margin, or both

Answer 24

Hemorrhoids

Question 25

What condition is a contraindication for hemorrhoidectomy

Answer 25

Crohn's disease

Question 26

What must be ruled out with lower GI bleeding believed to be caused by hemorrhoids

Answer 26

Conon cancer (colonoscopy)

Question 27

Bleeding distal to the ligament of Treitz, vast majority occurs in the colon

Answer 27

Lower GI bleeding