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Fiser Absite > 36 - Colorectal > Flashcards

36 - Colorectal Flashcards

1
Q

Colon secretes _ and absorbs _

A

Secretes - K

Absorbs - water and Na

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2
Q

Layers of colon

A

Mucosa, submucosa, muscularis propria, serosa

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3
Q

Small interwoven inner muscle layer below mucosa but above basement membrane in colon

A

Muscularis mucosa

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4
Q

Portions of colon that are retroperitoneal

A

Ascending, descending and sigmoid

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5
Q

Peritoneum cover this portion of rectum

A

Anterior upper and middle 1/3

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6
Q

Transverse bands forming haustra

A

Plicae semilunaris

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7
Q

3 bands running longitudinally along the colon

A

Taenia coli

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8
Q

Distance of dentate line from anal verge

A

2cm

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9
Q

SMA supplies which portions of the colon (name branches)

A

Ascending - ileocolic, right colic

2/3 Transverse - middle colic

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10
Q

IMA supplies which portions of the colon/rectum (name branches)

A

1/3 Transverse - left colic
Descending - left colic
Sigmoid - sigmoidal branches
Upper rectum - superior rectal

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11
Q

Collateral flow connecting SMA and IMA

A

Marginal artery

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12
Q

Short direct connection between SMA and IMA

A

Arc of Riolan

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13
Q

Superior, middle and inferior rectal artery branches from

A

Superior - IMA
Middle - Internal iliac
Inferior Internal pudendal (branch of internal iliac)

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14
Q

Watershed areas of colon and there junctions

A 
Splenic flexure (Griffith's point) - SMA and IMA junction
Rectum (Sudaks point) - superior and middle rectal junction
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15
Q

Anal sphincter with voluntary control

A

External sphincter

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16
Q

Anal sphincter with involuntary control

A

Internal sphincter

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17
Q

External anal sphincter innervation and muscle (type)

A 
Inferior rectal nerve (internal pudendal nerve branch)
Levator ani (skeletal)
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18
Q

Internal anal sphincter innervation and muscle (type)

A 
Pelvic splanchnic nerves
Muscularis propria (smooth)
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19
Q

The inner and outer nerve plexus of the colon, respectively

A

Inner - Meissner’s plexus

Outer - Auerbach’s plexus

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20
Q

What forms the anal verge

A

0-5cm anal canal, 5-15cm rectum, 15-18cm rectosigmoid junction

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21
Q

Mucin secreting goblet cells of colon

A

Crypts of Lieberkuhn

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22
Q

Slow transit time of the colon

A

colonic inertia

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23
Q

Main nutrient of colonocytes

A

Short chain fatty acids

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24
Q

Tx for stump/diversion pouchitis of colon

A

Short chain fatty acid enema

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25
Tx for infectious pouchitis
Metronidazole
26
Anterior colorectal fascia (rectovesicular/rectoprostatic - men; rectovaginal - women)
Denonvilliers fascia
27
Posterior colorectal fascia (rectosacral)
Waldeyer's fascia
28
Most common colon polyp
Hyperplastic polyp
29
Most common neoplastic intestinal polyp
Tubular adenoma
30
Most likely to produce sxs, more often cancerous (50%0
Villous adenoma
31
Indications for increased cancer risk of intestinal polyps (3)
>2cm, sessile, villous
32
Screening age for colon cancer, normal risk and family hx
``` Normal risk - 50yo Intermediate risk (fam hx) - 40yo or 10 yrs before youngest fam member ```
33
Screening options for colon cancer
1. Colonoscopy q10 yrs 2. Fecal occult blood testing (FOBT) q3yrs AND flex sigmoidoscopy q 5yrs 3. FOBT annually
34
Definition of invasive cancer (T1) lesion in colorectal
Invasion INTO submucosa (past basement membrane)
35
Indications for adequate resection with polypectomy of T1 lesion (3)
Negative margins (2mm) Well differentiated No lymphovascular invasion
36
Low rectal villous adenoma with atypia tx with T1 vs T2 rectal lesion
T1 - transanal excision (2mm margins, no lymph/vasc invasion, well diff) T2 - APR/LAR
37
2nd leading cause of Ca death
Colorectal cancer
38
Gene mutations for colon cancer (4)
APC p53 DCC k-ras
39
Most common site of colon cancer primary
Sigmoid
40
Most important prognostic factor colon cancer
Nodal status
41
Most common sites of colon cancer metastasis (1 & 2)
1 - Liver | 2 - Lung
42
Colon cancer metastasizes to liver via _, and lung via _
Liver via portal vein | Lung via iliac vein
43
5yr survival rate of colon cancer with liver metastasis and lung metastasis, respectively
35% - liver | 25% - lung
44
Rectal cancer can metastasize to spine via
Batson's plexus
45
Worst prognosis colorectal cancer
Mucoepidermoid
46
Best test for T and N status; assessing depth of invasion
Transrectal ultrasound
47
Margins for colorectal cancer resection
2cm
48
Best method for picking up intrahepatic metastasis
Intraoperative ultrasound
49
Indication for APR vs LAR
Need 2cm margin from levator ani muscles for LAR, otherwise need APR
50
T staging for colorectal cancer
1 - into submucosa 2 - into muscularis propria 3 - into subserosa or through muscularis propria 4 - through serosa, into adjacent organs/peritoneal space
51
N staging for colorectal cancer
0 - nodes negative 1 - 1-3 regional nodes 2 - >/= 4 regional nodes 3 - central nodes
52
Chemo regimen for colorectal cancer
FOLFOX (5FU, Leucovorin (folic acid), Oxaliplatin
53
Colon cancer stage getting postop chemo
Stage 3-4 (no XRT in colon)
54
Rectal cancer stage getting neoadjuvant chemo-XRT
Stage 2-3
55
Rectal cancer stage getting chemo-XRT, +/- surgery
Stage 4 (avoid APR with pts with mets)
56
Most common site of damage from XRT
Rectum
57
Rate of recurrence of rectal cancer within first yr
20%
58
FAP inheritance and gene mutation (+ chromosome)
Autosomal dominant; APC gene (chromosome 5)
59
Age for total colectomy (prophylactically)
20yo
60
Surgical procedure for FAP
Proctocolectomy, rectal mucosectomy, ileoanal pouch | Alternate is total proctocolectomy with end ileostomy
61
MCC death in FAP after colectomy
Duodenal tumors (periampullary)
62
Gardner's syndrome
Colon ca + intra-abd desmoid tumors
63
Turcot's syndrome
Colon ca + brain tumors
64
Inheritance and gene with Lynch syndrome (HNPCC)
Autosomal dominant; DNA mismatch repair gene
65
Lynch 1 vs lynch 2 risks
1 - just colon cancer risk | 2 - also at risk for ovarian, endometrial, bladder, stomach
66
Amsterdam criteria for Lynch syndrome
3, 2, 1 - 3 first degree relatives - over 2 generations - 1 person w/ cancer before 50yo
67
Surveillance colonoscopy time-frame for lynch syndrome
25yo or 10 yrs before primary relative
68
Tx for sigmoid volvulus
Colonoscopic decompression -> bowel prep/rectal tube -> sigmoidectomy same admission
69
Tx for cecal volvulus
Right hemicolectomy
70
Tx for maintenance vs acute UC
acute - steroids | maintenance - 5-ASA (mesalazine)/sulfasalazinea and loperamide
71
Most common site of perforation for UC
Transverse colon
72
Most common site of perforation for Crohn's
Distal ileum
73
Cancer risk for UC pts with pancolitis
1% per yr starting 10yrs after initial dx with pancolotis
74
Most common extraintestinal manifestation of UC requiring total colectomy
Failure to thrive in children
75
Which conditions (2) do NOT improve with colectomy in UC
Primary sclerosing cholangitis, ankylosing spondilitis
76
Which conditions (3-4) improve with colectomy in UC
Ocular problems, arthritis and anemia/(50% pyoderma gangranosum)
77
HLA B27 associated with
UC, ankylosing spondylitis, sacroiliitis
78
Tx for pyoderma gangrenosum
Steroids
79
Most common location of colon perf 2/2 obstruction
cecum
80
MCC of colonic obstruction 1 & 2
1 - cancer | 2 - diverticulitis
81
Tx for amoebic colitis
Flagyl
82
Yellow-white sulfur granule pathology of colonic mass/abscess; tx
Actinomyces; tx - penicillin
83
Most common presentation of right sided and left sided diverticula, respectively
Right - Bleeding | Left - Diverticulitis
84
Bleeding amount for arteriography to pick up in GI bleed
>/= 0.5cc/min
85
Bleeding amount for tagged RBC scan to pick up in GI bleed
>/= 0.1cc/min
86
Best dx test for colovesicular fistula
cystoscopy

Fiser Absite (14 decks)

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