Colorectal Review Flashcards by Jesse Santos

Q

How do you perform an extended left hemicolectomy?

A

Colonic resection between the left third of the transverse colon and the colorectal junction. The inferior mesenteric vessel and the left middle colic vessel are ligated at their origin in combination with a regional lymphadenectomy.

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What features of a colonic polyp biopsy would necessitate oncologic resection?

A

poor differentiation
vascular or lymphatic invasion
invasion below the submucosa
positive resection margin
cancer within 2mm of resection margin
involvement at the base of the polyp
incomplete resection of polyp

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Which Haggitt Classification necessitates oncologic resection?

A

level 4 - invading the submucosa, below the stalk of the polyp

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for the follow:

normal colonoscopy
<20 hyperplastic polyps < 1cm

A

Routine colonoscopy in 10 years, this is a normal colonoscopy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for the follow:

3-4 adenomas < 1cm in size
1 Hyperplastic polyp > 1cm in size

A

Follow up colonoscopy in 3-5 years

unlikely to be tested given the gray area of recommendation

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- 5-10 adenomas found on colonoscopy

A

Follow up colonoscopy in 3 years

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- Sessile polyp > 1cm

A

follow up colonoscopy in 3 years

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- Polyp with tubulovillous/villous features

A

follow up colonoscopy in 3 years

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- polyp with high grade dysplasia

A

follow up colonoscopy in 3 years

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- > 10 adenomas found on colonoscopy

A

repeat colonoscopy in 1 year

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Surveillance recommendation for following:

- adenoma removed piecemeal on colonoscopy

A

repeat colonoscopy in 3-6 months

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

treatment for pseudomyxoma peritonitis

A

Cytoreductive surgery

- Hyperthermic intraperitoneal chemotherapy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

What is cytoreductive surgery?

A

for treatment of PMP it is defined as having no gross disease greater than 2mm in size

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Preferred treatment for anal squamous cell carcinoma

A

radiation and chemotherapy upfront

- salvage APR for recurrences

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Preferred treatment for anal melanoma

A

wide local excision

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Preferred treatment for anal adenocarcinoma

A

APR followed by adjuvant chemotherapy

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

most common small bowel malignancy

A

metastatic lesion

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

small bowel tumor found to be a metastatic lesion…most likely source is?

A

melanoma

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Patient with chronic lower right quadrant pain, presumed appendicitis. In OR normal appendix with inflamed cecum and/or terminal ileum…what do you do?

A

take out appendix even if grossly normal

- patient likely has Chron’s and is presenting with terminal ileitis

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Peutz-Jeghers syndrome is characterized by what

A

hamartomatous polyps throughout GI

- hyperpigmented macules on the buccal mucosa, lips, and digits

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

Peutz-Jeghers increases the risk of what?

A

GI malignancy

- extraintestinal malignancy (breast, uterus, cervix, testes, pancreas, lung)

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

How do you diagnose Chronic Appendicitis

A

its a diagnosis of exclusion, must rule out everything else

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

patient with protocolectomy with J-pouch anastomosis, presenting with pouchitis…what is the treatment?

A

Antibiotic treatment with metronidazole or a fluoroquinolone
5-ASA can be used for refractory cases

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

Q

how do you close a previous ostomy site?

A

purse string closure…has lowest complication rate of any closure method

How well did you know this?

1

Not at all

2

3

4

5

Perfectly

What does Toxin A from Clostridium Difficile result in?

Intestinal necrosis

How much invasion in a T1 colorectal adenocarcinoma lesion?

to but not through the muscularis mucosa

How much invasion in a T2 colorectal adenocarcinoma lesion?

invades into muscularis propria

How much invasion in a T3 colorectal adenocarcinoma lesion?

invades through the muscularis propria into pericolorectal tissue

How much invasion in a T4 colorectal adenocarcinoma lesion?

invades through visceral peritoneum or into adjacent organs

N1 disease = how many + LNs

1-3

Patient has stage III rectal cancer after neoadjuvant therapy and surgery...what is next step

adjuvant chemo - this only pertains to stage III rectal cancer

when do you do recommend surgical intervention for an anal fissure?

after patient has tried stool softeners, laxatives, situ baths, and calcium channel blocker ointment like nifidepine

describe the delorme procedure

for rectal prolapse, incision in mucosa of prolapsed rectum is made 1 cm above dentate line. You take out the mucosa of all the redundant rectum and then plicate muscularis propria and bring mucosa edges together

How is the altemeier procedure different than the delorme?

used for rectal prolapse greater than 5 cm, full thickness excision is made instead of just a mucosal excision

1.7 cm adenocarcinoma at tip of appendix on final pathology of appendicitis, next step

Right hemicolectomy

1.7 cm appendiceal carcinoma at tip of appendix on final pathology of appendectomy, next step

no further steps necessary

patient had a left hemicolectomy, on follow up reports inability to ejaculate

injury to superior hypogastric plexus, occurs with high ligation of inferior mesenteric artery

what kind of nerve fibers constitute the superior hypogastric plexus

sympathetic nerves

what kinds of nerves constitute the inferior hypogastric plexus

parasympathetic and sympathetic nerve fibers

at what size should you drain an intra-abdominal abscess?

if its greater than 3 cm, any smaller should be treated with antibiotics

purpose of anal electromyography

- evaluate patients thought to be neurogenic sphincter weakness

use of defecography

detect enteroceles, rectoceles, and rectal prolapse

use of endoanal US

detect sphincter dysfunction in patients with fecal incontinence

standard treatment for a low rectovaginal fistula

endorectal advancement flap

best way to diagnose a fistula from diverticulitis?

CT scan of the abdomen and pelvis - will show air in the bladder

most common cause of lower GI bleeds in older patients?

diverticulosis

most common symptom of an abdominal carcinoid tumor

abdominal pain

secondary causes of constipation

- drugs - neurogenic - non-neurogenic - irritable bowel syndrome

how do you diagnose slow transit time constipation

- use radio-opaque markers, if there are more than 5 markers on day six you have a positive test

surgery for an upper rectum cancer?

left hemicolectomy

how far away from the anal verge is an upper rectum cancer?

10-12 cm above the anal verge

how far away is a middle rectal cancer from the anal verge?

7-10 cm from the anal verge

surgery indicated for a middle rectal cancer?

low anterior resection

surgery indicated for a lower rectal cancer

total abdominal perineal resection

when can you do a transanal excision of a rectal cancer?

a T1 rectal cancer with the following: - within 8 cm of anal verge - < 3cm in size / < 30% circumference - freely mobile

what is unique about the Lugano staging system for non-hodgkin lymphoma?

there is no Stage III

most common cause of severe GI bleeding?

- Diverticulosis

Infliximab

- monoclonal Ig-G1 antibody with affinity to TNFa

patient with Crohn's disease, what is the indication(s) for Infliximab?

- perianal fistula disease | - Crohn's disease refractory to medication

management of < 1cm rectal carcinoid tumor

endoscopic or local excision

management of 1-2 cm rectal carcinoid tumor

- full thickness excision | - if invades muscularis or LN involvement need full surgical resection (APR) with total mesolectal excision

management of > 2cm rectal carcinoid tumor?

full surgical excision (APR)

when would you need a hemicolectomy if pathology showed an appendices mucinous neoplasm

- > 2 cm in size - postive margin - lymphovascular invasion - mesoappendiceal invasion

what mutation would prevent you from using Cetuximab for advance colorectal cancer

KRAS mutation

if you see an anal fissure laterally what should you be suspicious of

``` Chron's disease malignancy HIV Syphilis tuberculosis ```

if you see multiple anal fissures what should you be suspicious of

trauma

how many lymph nodes do you need to harvest for a colon cancer

12 minimum

When would you do pre-sacral drainage for a rectal injury repair

- if you repair it trans-abdominally

how long should you wait to repair a rectovaginal fistula

- 3-6 months, some will spontaneously repair