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Absite Review > Fiser- Ch 36&37: Colon, Rectum, Anus > Flashcards

Fiser- Ch 36&37: Colon, Rectum, Anus Flashcards

(52 cards)

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1
Q

what marks the transition between anal canal and rectum?

A

levator ani muscle

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2
Q

main nutrient of colonocytes?

A

short chain fatty acids

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3
Q

layers of the colon: from lumen to exterior

A
  1. mucosa
  2. muscularis mucosa
  3. lymphatics
  4. submucosa
  5. muscularis propria
  6. subserosal connective tissue
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4
Q

what margin do you need for polypectomy of invasive cancer?

A

2mm

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5
Q

what can give a false positive guaiac stool test? 4

A
  1. beef
  2. iron
  3. vit c
  4. cimetidine
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6
Q

which organism infection is associated with colon cancer?

A

clostridium septicum

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7
Q

when do you perform an APR vs LAR in colon cancer?

A

you need at least 2cm margins, so if the cancer is within 2cm of the levator ani muscles, do an APR. otherwise LAR

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8
Q

T staging of colorectal cancer

A 
T1 = submucosa
T2 = muscularis propria
T3 = into subserosa or through muscularis propria
T4 = through the serosa
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9
Q

management of stage III colon cancer?

A
  • nodes + or distant disease

- postop chemo, NO XRT

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10
Q

management of stage II and III rectal cancer

A
  • NEOADJUVANT chemo and XRT
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11
Q

management of stage IV rectal cancer?

A

chemo and xrt, maybe not surgery unless just colostomy

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12
Q

what chemo is used in colorectal cancers?

A

FOLFOX

  • 5FU
  • Leucovorin
  • Oxaliplatin
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13
Q

gene associated with FAP

A

APC, chromosome 5

autosomal dominant

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14
Q

management of patients with FAP?

A

total proctocolectomy, rectal mucosectomy, ileoanal pouch by age 20

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15
Q

what are the amsterdam criteria for lynch syndrome?

A

3,2,1:

at least 3 first degree relatives, over 2 generations, 1 cancer before age 50

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16
Q

treatment of sigmoid volvulus?

A

decompress with colonoscopy, give bowel prep then plan for sigmoid colectomy during that admission

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17
Q

treatment of cecal volvulus?

A

OR for right hemicolectomy, decompression w colonoscopy only works in 20% of pts

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18
Q

buzzword: creeping fat

A

crohns

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19
Q

buzzword: crypt abscesses

A

ulcerative colitis

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20
Q

buzzword: skip lesions

A

crohns

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21
Q

perforation with ulcerative colitis is most commonly where?

Study These Flashcards
A

transverse colon

22
Q

perforation with crohns disease is most commonly where?

23
Q

management of low rectal carcinoids?

Study These Flashcards
A

<2cm = wide local excision w negative margins

>2cm or invasion into muscularis propria: APR

24
Q

management of colon or high rectal carcinoids?

Study These Flashcards
A 
<1cm = polypectomy
>1cm = formal resection
25
treatment of ogilvie's syndrome
initial: neostigmine, NGT, IVF | if colon >10cm, then decompression w colonoscopy and neostigmine
26
tagged RBC scan can pick up bleeding at what rate?
>0.1cc/min
27
management of thrombosed hemorrhoids
Within 72 hours: elliptical excision | After 72 hours: lance open
28
difference between internal and external hemorrhoids?
above and below the dentate line
29
Management of rectal prolapse?
Altemeier: transanal perineal rectosigmoid resection if old and frail LAR and pexy if in good condition
30
where are most anal fissures located?
posterior midline
31
what is the surgical treatment for anal fissure?
lateral subcutaneous internal sphincterotomy (DO NOT perform if 2/2 UC or Crohns)
32
whats goodsall's rule?
anterior fistulas connect with the anus/rectum in a straight line posterior fistulas go toward a midline internal opening in the anus/rectum
33
when can you perform wide local excision in an anal canal adenocarcinoma?
1. Size <4cm 2. <50% circumference 3. T1 (limited to submucosa) 4. Well differentiated 5. No LVI/perineural invasion
34
whats the difference between anal margin and anal canal cancers?
anal canal is above the dentate line (SCC, adenoca, melanoma) anal margin is below the dentate line (SCC, basal cell)
35
treatment of squamous cell carcinomas: anal canal vs anal margin
``` Anal canal (above dentate line) = nigro protocol Anal margin = WLE (if <5cm, need 0.5cm margin) or Chemo-XRT (5-FU and cisplatin) ```
36
``` nodal metastases: Superior and middle rectum: Lower rectum: Anal Canal: Anal Margin: ```
Superior and middle rectum: IMA nodes Lower rectum: IMA and internal iliac nodes Anal Canal: internal iliac nods Anal Margin:inguinal nodes
37
what is Haggitt's classification system for malignant polyps?
1: invading head 2: invade neck 3: invade stalk 4: invade base, bowel wall or sessile (require segmentectomy)
38
what is the most abundant bacteria in the flora of the normal colon?
bacteroides fragilis
39
what are indications for surgical management in massive GI bleeding?
transfuse >6 units PRBCs, ongoing hemodynamic instability
40
how to repair a parastomal hernia?
hernia repair with mesh! (lowest recurrence rate when fixed w mesh)
41
when is elective surgery indicated in the treatment of UC?
refractory to medical management, severe GI bleeding, if dysplasia is found on screening colonoscopy
42
what are the imaging modalities used to stage rectal cancer?
MRI or endoscopic US to eval depth of tumor and nodal involvement
43
what is nigro protocol used for?
squamous cell cancers of the anal canal
44
what is the neural control of the external anal sphincter?
voluntary control by branches of the internal pudendal and S4 nerves
45
treatment of cecal volvulus?
surgical resection: ileocolonic anastomosis unless perforation/gangrenous bowel
46
what are the criteria for candidates of transanal excision for rectal cancers? (5)
1. Well differentiated T1 lesion 2. <3cm in size 3. < 30% circumference 4. <8cm from anal verge 5. No LVI or mucin production
47
what are the extraintestinal conditions associated with crohns? (5) and do each improve/not improve w colectomy?
1. Arthritis- improves 2. Ankylosing spondylitis- does not improve 3. Erythema nodosum- resolves 4. Pyoderma gangrenosum- improve 5. PSC- does not improve
48
treatment of stage III colon cancer?
resection followed by FOLFOX: 5-FU, leucovorin, oxaliplatin
49
what are the 5 techniques for operative repair of internal hemorrhoids?
1. Miligan-Morgan: excision of hemorrhoids and leaving wound open 2. Ferguson: excision of hemorrhoids and closing wound 3. Whitehead: circumferential excision just above the dentate line 4. Stapled hemorrhoidectomy 5. Transanal hemorrhoid dearterialization
50
colonocytes: secrete and absorb what electrolytes?
absorbs: water, sodium and chloride secretes: potassium and bicarb
51
main energy source of colonocytes?
short chain fatty acids
52
name 3 short chain fatty acids
acetate, butyrate, propionate

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