10/4 Flashcards
What is in the spermatic cord?
- Cremasteric muscle fibers
- Vas deferens
- Testicular artery
- Pampiniform venous plexus
- +/- hernia sac
- genital branch of gen-fem nerve
Causes of Hypercalcemia
(CHIMPANZEES)
Calcium supplementation, Hyperparathyroidism, Immobility/ Iatrogenic. Mets, Paget disease, Addison’s disease/ Acromegaly, Neoplasm, ZE, Excess Vit D, Excess Vit A, Sarcoid
tests to perform in small bowel obstruction
electrolytes, CBC, type & screen, urinalysis
Left Sided Colon Cancer
- change in bowel habits (smaller stools)
- colicky pain
- signs of obstruction
- abdominal mass
- heme(+) or gross red blood in stool
- n/v
- constipation
Lynch Syndrome
Hereditary non-polyposis colon cancer
AD inheritance
Plicae Circularis
circular folds of mucosa in small bowel
Right Sided Colon cancer
- right side of bowel has large lumen so cancer can get large before Sx develop
- Microcytic anemia, occult/ melena
- post-prandial discomfort
- fatigue
Treatment of Small Bowel Obstruction
Initial: NPO, NGT, IVF, Foley
Complete: laparotomy & lysis of adhesions
Colorectal Carcinoma
- Adenocarcinoma
- 2nd most common cancer in US
- Peaks 70-80yo, incidece increases from 40yo
- lifetime risk of 6%
- equally common in men & women
Daily Secretions of gastric, bile, & small bowel
BGS 123
Bile: 1L
Gastric: 2L
Small bowel: 3L
Terminal Ileum
absorbs B12, fatty acids, bile salts
Types of hiatal hernias
Type 1: sliding; stomach & GE junction herniate into thorax
Type 2: paraesophageal; herniation of stomach w/o herniation of GE junction
Meckel’s Diverticulum
remnant of omphalomesenteric duct/ vitelline duct which connects yolk sac to primitive midgut in embryo
located within 2’ of ileocecal valve
true diverticulum (all layers of intestine)
2x more common in men
Borders of Femoral Canal
Cooper’s ligament posteriorly
Inguinal ligament anteriorly
Femoral Vein laterally
Lacunar ligament medially
How many LNs should be resected in colon cancer
12 minimum
Polyp size to cancer risk
>2cm = high risk of cancer
NG Tube Acid Base status
metabolic alkalosis w/ hypokalemia (gets rid of HCl so K+ goes into cells) & hypochloremia
Tx: NS w/ KCl
Littre’s Hernia
hernia involving Meckle’s diverticulum
Risks for Colorectal CA
- Dietary: low fiber, high fat diets
- Genetic (family histroy)
- IBD: UC > Crohn’s
- Previous Colon cancer
- increasing age
Who should have incidental Meckel’s removed?
all kids
adults with ectopic tissue or mesodiverticular bleed
Common Adult Maintenance Fluid
D5 ½NS w/ 20 mEq KCl/L
(dextrose added to prevent muscle breakdown)
Femoral Hernia
hernia medial to femoral vessels (under inguinal ligament)
Differential Dx of Colon Mass
Adenocarcinoma, Carcinoid tumor, lipoma, leiomyosarcoma, lymphoma, diverticular disease, UC, Crohn’s, polyps
Indirect vs Direct Inguinal Hernia
Direct- hernia within Hesselbach’s Triangle (does not go through internal ring)
Indirect- hernia lateral to Hesselbach’s Triangle (does go through internal ring)
Anatomic DIfferences of Small Bowel & Colon
Colon has teniae coli, haustra, & appendices epoploicae (fat appendages)
small intestine is smooth
chemo for stage 3 colon cancer
5-FU & leucovorin
Types of Neoplastic Polyps
- tubular adenoma
- tubulovillous adenoma
- villous adenoma
- highest potential for CA
Ilioinguinal Nerve
sensation to inner thigh or lateral scrotum
if cut, sensation returns in 6mo
travels on spermatic cord
Causes of Small Bowel Obstruction
- adhesions (most common cause in adults), hernia (Bulge), Cancer/ tumors
Layers of abdominal wall
skin, SQ fat, Scarpa’s fascia, external oblique, internal oblique, transversus abdominus, transversalis fascia, peritoneal fat, peritoneum
Where is Cremaster muscle from
internal oblique muscle
What electrolyte should you replace before K+?
Magnesium
Tumors of small intestine
- Benign: leiomyoma (most common), lipoma, lymphangioma, fibroma, adenomas, hemangiomas
- Malignant: adenocarcinoma, carcinoid, lymphoma, sarcoma
Stages of Colorectal Cancer
- Stage 1: invades submucosa or muscularis propria
- Stage 2: invades through muscularis propria but (-) LNs
- Stage 3: (+) nodes, no distant mets
- Stage 4: (+) distant mets
Complete SBO
complete obstrution of lumen
danger of closed loop strangulation of bowel → bowel necrosis
What is inguinal ligament derived from?
External Oblique Aponeurosis
Duodenum
- 12” long
- ends at Ligament of Treitz
Signs of Strangulated Bowel with Small Bowel Obstruction
fever, severe pain, hematemesis, shock, gas in bowel wall, abd free air, peritoneal signs, acidosis
How fast can you change Na+ concentration?
<12 mEq/L per day
Hesselbach’s Triangle Borders
inferior epigastric vessels
inguinal ligament
lateral border of rectus sheath
Floor: internal oblique and transversus abdominis
Pre-op Abx in colon surgery
cefoxitin or carbepenem
Peterson’s Hernia
herniation of small bowel through defect in mesentary after gastric bypass
Most common hernia
indirect inguinal hernia (in both men and women)
First Identifiable Subcutaneous Layer in Inguinal Hernia Repair
Scarpa’s fascia
Small Bowel Obstruction
- abd discomfort, cramping, nausea, abd distention, emesis, high-pitched bowel sounds
- Labs: electrolytes, CBC, type & screen, urinalysis
- must rule out incarcerated hernia
- X-Ray Finding: distended loops of small bowel, air fluid levels
Complications w/ Meckel’s diverticulum
- Intestinal Hemorrhage- painless; ½ of all lower GI bleeds in kids <2; d/t ectopic gastric mucosa that secretes acid
- Intestinal Obstruction- most common complication in adults; volvus and intussusception
- inflammation +/- perforation
Most common causes of colonic obstruction in adults
colon cancer, diverticular disease, colonic volvulus
