Colon, Rectum, Anus Flashcards
(105 cards)
1
Q
Goals for short term follow-up after bariatric surgery?
A
- Maximize care of the patient in the post-operative period.
- Assist in the adjustment to new eating , exercise, and lifestyle patterns.
- Be on alert for and treat postoperative complications.
- Recommend measures to limit such complications.
2
Q
Goals of long- term follow up after bariatric surgery?
A
- Weight gain
- Management of comorbid condition relapse
- Emergence of recurrent depression, substance and alcohol misuse and nutritional complications.
3
Q
Most common omental neoplasms?
A
Metastatic disease
4
Q
Blood vessels involved in rectus sheath hematoma?
A
Inferior epigastric artery
5
Q
Most common cause of small bowel obstruction ?
A
Adhesions
6
Q
Rare disease defined as compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery.
A
Superior Mesenteric Artery Syndrome / Wilkie’s Syndrome
7
Q
Second cancer diagnosed more than 6 months after the diagnosis of the first primary cancer
A
Metachronous colorectal cancer
8
Q
Grade of hemorrhoids for which infrared photocoagulation may be used?
A
Grade I & II
9
Q
Nonbilious vomiting that becomes increasingly projectile , inability to tolerate feeds and sometimes associated with jaundice?
A
Hypertrophic pyloric stenosis
10
Q
Surgical management of infant with low type imperforate anus?
A
Perineal operation (Anoplasty) without a colostomy
11
Q
Goals for post-bariatric surgery?
A
- Hemoperitoneum
- Adjusting to eating patterns
- Early identification of post-operative complications and preventive measures
12
Q
Contributory factors to the development of GERD?
A
- Defective lower esophageal sphincter tone
- Degree of hiatal herniation
13
Q
Important lab test for pre-op management of patient with acute abdomen?
A
Specimen of blood for cross matching should be sent whenever urgent surgery is anticipated
14
Q
Signs of acute abdomen requiring urgent surgery
A
- Bleeding
- Ischemic bowel
- Perforated viscus
15
Q
Best approach for vertical band gastroplasty in bariatric surgery?
A
Laparoscopic
16
Q
Clinical features of acute abdomen?
A
- Washboard abdomen
- Absent bowel sounds
- Involuntary guarding
17
Q
Surgical objectives for resection of gastric carcinoma?
A
- Tumor with adjacent uninvolved stomach
- Duodenum
- Regional lymph node
18
Q
Management of paralytic ileus ?
A
Conservative with clinical and pharmacological management
19
Q
Bowel preparation prior to surgical resection of bowel?
A
- Antibiotics
- Enema
- Laxatives
20
Q
Risk factors for the development of colon cancer?
A
- Ulcerative colitis
- Crohn’s colitis
- Inflammatory Bowel diseases
21
Q
Most common cause of mechanical bowel obstruction for post hysterectomy patients?
A
Adhesion
22
Q
Condition associated with synchronous GIT adenocarcinoma?
A
Extramammary perianal paget’s disease
23
Q
Laxative that produces hydrogen and methane gases that can explode with electrocautery?
A
Mannitol
24
Q
Management for complete small bowel obstruction?
A
Expeditious surgery
“ the sun should never rise or set on a complete bowel obstruction “
25
Watershed area of the colon supplied by SMA & IMA?
Splenic flexure
26
After massive bowel resection due to mesenteric vascular occlusion resulting in short gut syndrome, A 55 yo M is started with TPN. Which of the ff electrolyte abnormalities characterizes re-feeding syndrome?
1. Hypokalemia
2. Hypomagnesemia
3. Hypophosphatemia
4. Hypocalcemia
27
Prolonged post-operative ileus is defined as that which is seen beyond how many days after surgery?
5 days
28
After colonoscopic polypectomy a 2cm polyp, 4 cm from the anal verge turned out to be an adenomatous polyp. The most appropriate step to do next is?
Abdomino-perineal resection
29
Colonic pseudo-obstruction is also known as?
Ogilvie’s Syndrome
30
Massive dilatation of the colon in the absence of mechanical obstruction?
Colonic pseudo-obstruction ( Ogilvie Syndrome)
31
Pre-op bowel preparation is not done in which case?
Complete intestinal obstruction
32
The development of rectus sheath hematoma after a prolonged labor is usually due to a break in which vessel?
Inferior epigastric artery
33
The most common tumor of the omentum is?
Lipoma
34
Hepatic resection is most commonly considered for localized metastatic spread from which of the following primary site?
Colorectal
35
A 50 yo / F complains of constipation and anal pain with a MRI finding of posterior extra rectal mass that is adherent to the sacrum. What is most likely the diagnosis?
Chordoma
36
Which of the following is true regarding mesh hernia repair?
Must be done for recurrent hernias
37
The most common content of a complete indirect inguinal hernia is?
Small intestine
38
Which of these abdominal wall hernias arise from the arcuate line?
Spigelian
39
The life-threatening complication of obstructive hydrocephalus is ?
Herniation
40
Through a McBurney incision, the appendix and the rest of the visible / palpable structures were normal. Which of the following is true?
The normal appendix should be removed
41
Layer of the abdominal wall that does not have a corresponding layer in the scrotum ?
Transversus abdominis
Doesn’t reach the scrotum
42
Anatomic areas of interest seen in laparoscopic hernia repair?
1. Triangle of doom
2. Triangle of pain
3. Circle of death
43
Borders of the inguinal triangle of Hasselbach?
1. Rectus abdominis muscle (medial)
2. Inferior epigastric vessels (superolateral)
3. Inguinal ligament (inferolateral)
44
Most common subtype of groin hernia in women?
Indirect inguinal hernia
45
Location of direct inguinal hernia in relation to the epigastric vessels?
Medial or inferior to the inferior epigastric vessels
46
Location of indirect inguinal hernia in relation to the epigastric vessels?
Lateral or superior to the inferior epigastric artery
(ILSI)
47
Gold standard for the diagnosis of inguinal hernias?
History & PE
48
Findings of trans illumination test for cystic and solid testicular masses?
Cystic- light shines through
Solid- light blocked by mass
49
Location of the neck of a femoral hernia in relation to the pubic tubercle?
Above and Medial to the Public tubercle
50
Location of the indirect inguinal hernia in relation to the pubic tubercle?
Below and lateral to the pubic tubercle
IBL
FAM : Femoral Above & Middle
51
Operative technique for primary unilateral inguinal hernias in males?
Mesh repair
Either Litchenstein or Laparoscopic repair
52
Type of SBO where the bowel is occluded at two points such that the proximal and distal loops and mesentery are entrapped in a single constrictive lesion?
Closed-loop obstruction
53
Parameters used to assess bowel viability during surgery? (5)
1. Color
2. Peristalsis
3. Marginal arterial pulsations
4. Necrosis
5. Perforations
54
Temporal sequence of normal gastrointestinal motility?
1. Small intestinal : 24 hrs
2. Gastric: 24-48 hrs
3. Colonic: 2-5 days
Its in reverse alphabetical order
( S - G- C )
55
Factors that inhibit spontaneous closure of intestinal fistulas?
FRIEND
1. Foreign body
2. Radiation enteritis
3. Infection or Inflammation at the fistula origin
4. Epithelialization of the fistula tract
5. Neoplasm at the fistula origin
6. Distal obstruction of the intestine
56
Anatomic definition of short bowel syndrome?
<200cm of residual bowel in adults
57
Meeting points of the 3 taenia coli?
Base of the appendix and rectosigmoid junction
58
Location of the appendix when abdominal findings are less striking and flank maybe the most tender part?
Retrocecal
59
Ultrasound findings in appendicitis?
1. Wall thickening
2. Periappendiceal fluid
60
Imaging of choice for appendicitis in pregnancy?
Ultrasonography
61
Standard care of presumed uncomplicated appendicitis?
Operative treatment
62
Management of an appendiceal carcinoid 1.5 cm in size located at the base of the appendix?
Right hemicolectomy
63
Tumors that may present with diffuse collection of gelatinous fluid and mucinous implants on peritoneal surfaces and omentum?
Appendiceal and Ovarian tumors
This case is Pseudomyxoma peritonei
64
Finding seen in water-soluble contrast enema in sigmoid volvulus ?
Birds beak deformity
65
Timing of contrast (barium) enema or colonoscopy in diverticulitis?
6 weeks after an attack
These may cause perforation during an acute attack. They are one to rule out malignancy.
66
Indications for surgery of Crohn’s disease?
Management of complications
Note:
Not a cure for disease since recurrence is common vs Ulcerative colitis where total protocolectomy can be curative
67
Genes linked to hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch Syndrome.
DNA mismatch repair (MMR) Genes
68
Location of colon cancer associated with changes in bowel habits and hematochezia?
Left sided lesions
69
Location of colon cancer where there is postprandial discomfort , weakness , occult bleeding , anemia, melena.
Right sided lesions
70
Starting age for colorectal cancer screening in average risks individuals?
50 years old
71
Glycoprotein absent from normal adult intestinal mucosa but present in primitive endoderm?
Carcinoembryonic antigen (CEA)
Cannot be used as screening test but useful in treatment monitoring after apparently successful surgical treatment
72
Second cancer diagnosed more than 6 months after diagnosis of first primary?
Metachronous
Note:
Synchronous : if second cancer was diagnosed within 6 months of the primary cancer
73
8-14 longitudinal mucosal folds present in the anus?
Columns of Morgagni
74
Surgery correlated with lower recurrence rates among patients with rectal cancer due to the mesorectum being a site for matastasis of rectal cancer.
Total Mesorectal Excision (TME)
75
Another name for parasympathetic fibers originating from S2-S4 that innervate the anoderm?
Nervi erigentes
76
Tissue fold configuration in rectal prolapse vs hemorrhoids?
Rectal prolapse: Circumferential
Hemorrhoids: Radial
77
Internal hemorrhoid grades where infrared photocoagulation is an acceptable procedure?
Grade I & Grade II
78
Tear in the anoderm just distal to the dentate line ?
Anal fissure
79
Suprasphincteric fistula that encompasses the entire sphincter apparatus?
Type 3 Fistula in ano
80
Absent in Hirschsprung’s disease resulting in functional obstruction?
Auerbach plexus = Myenteric plexus
81
Condition resulting from the failure of the rectum to descend through the external sphincter complex?
Imperforate anus
82
Hernia that occurs superior or lateral to the Inferior Epigastric vessels.
Indirect Inguinal Hernia
ISLI ( Indirect Superior Lateral Inferior epigastric vessels)
83
Hernia that occurs inferior or medial to the Inferior Epigastric vessels.
Direct Inguinal Hernia
DIMI ( Direct Inferior / Medial Inferior epigastric vessels)
84
What type of Hernia where its neck located **above and medial** to the pubic tubercle.
Inguinal Hernia
IAM
85
What type of Hernia where its neck located **below and lateral** to the pubic tubercle.
Femoral Hernia
BeLat ( Below & Lat = MC in Females - Femoral)
86
Examination technique used in hernia where the index finger is placed at the deep inguinal ring, middle finger at the superficial ring, and ring finger at the saphenous opening.
Three Finger Test / Zeimans Technique
87
Zeiman’s technique: What Type of Hernia?
Impulse Felt at deep inguinal ring
Indirect Hernia
88
Zeiman’s technique: What Type of Hernia?
Impulse Felt at superficial ring
Direct Hernia
89
Zeiman’s technique: What Type of Hernia?
Impulse Felt at saphenous opening
Femoral Hernia
90
What type of Hernia?
Ring Occlusion Test : No bulging
Indirect Hernia
91
What type of Hernia?
Ring Occlusion Test : Bulging
Direct Hernia
Rationale: you occlude the inguinal ring so Indirect hernia will have no bulging. Direct hernia doesn’t pass to the inguinal ring that’s why there’s bulging.
92
Hernia located in the superior lumbar triangle.
Grynfeltt’s Hernia
93
Hernia located in the inferior lumbar triangle.
Petit’s Hernia
94
Hernia eponyms:
Ritcher’s Hernia
Only antimesenteric part
95
Hernia eponyms:
Littre’s Hernia
Meckel’s Diverticulum
96
Hernia eponyms:
Mickel’s diverticulum
Littre’s Hernia
97
Hernia eponyms:
Direct + Indirect Hernia
Pantaloon Hernia
98
Hernia eponyms:
Two loops in the same ring ( W Shaped)
Maydl’s Hernia
99
Hernia eponyms:
Appendix
Amyand’s Hernia
100
Hernia eponyms:
Anterior diaphragm
Morgagni’s Hernia
101
Hernia eponyms:
Posterior Diaphragm Hernia
Bochdaleck’s Hernia
102
Hernia eponyms:
Lateral to rectus muscle Hernia
Spigelian Hernia
103
Hernia eponyms:
Hernia found only in antimesenteric part
Ritcher’s Hernia
104
Which type of hernia does the fundus of the stomach herniate?
Type II ( Rolling)
Type I : cardia
Type II - fundus
Type III: cardia + fundus
Type IV: Intestine
105
Fistulas with an external opening located **anteriorly 2.75 cm** from the anal margin connect to the internal opening by what direction?
Short, radial tract to the anterior midline.
Goodsall’s rule dictates that fistulas with an external opening ** anteriorly** connect to the internal opening by short, radial tract. Fistulas with an external opening **posteriorly** track in a curvilinear fashion to posterior midline. However if the anterior external opening is **>3cm** from the anal margin, such fistulas tract to the posterior midline.
