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Surgery > Chapter 12, part 4 > Flashcards

Chapter 12, part 4 Flashcards

1
Q

Familial adenomatous polyposis

A

Development of numerous colonic polyps >100

Autosomal dominant mutation of APC tumor suppressor gene located on chromosome 5q

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2
Q

Gardner syndrome

A

Polyposis and osteomas, sarcomas, and epidermoid inclusion cysts

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3
Q

Turcot syndrome

A

Polyposis and brain tumors

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4
Q

When to screen for familial adenomatous polyposis

A

Starting for high risk ppl at 10 yo
If + for mutation: total proctocolectomy and permanent end ileostomy, total proctocolectomy with IPAA or total abdominal colectomy and ileorectal anastamosis

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5
Q

What is the MCC of hereditary colon cancer?

A

Hereditary nonpolyposis colorectal cancer or Lynch syndrome

Defects in DNA mismatch repair genes

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6
Q

When does hereditary nonpolyposis colorectal cancer (Lynch syndrome) usually become colon CA?

A

Around 44 yo

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7
Q

What is recommended for women with hereditary nonpolyposis colorectal cancer (Lynch syndrome)?

A

Prophylactic total ab hysterectomy and bilateral salpingo-oophorectomy

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8
Q

Amsterdam criteria

A

Three affected relatives, with 2 consecutive generations, and with at least 1 family member diagnosed before age 50
If identified via criteria, need colonoscopy q2yrs starting between 20-35, and then yearly after 35

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9
Q

Multiple polyposis coli or juvenile polyposis coli

A

Autosomal dominant syndrome associated with SMAD4 gene

Hamartomas and bleeding

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10
Q

Dx and tx of multiple polyposis coli or juvenile polyposis coli

A

Upper and lower endoscopy starting at 15-25

Endoscopic polypectomy

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11
Q

Peutz-Jeghers syndrome

A

Autosomal dominant dz associated with mutations in STK11

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12
Q

Presentation of Peutz-Jeghers syndrome

A

Multiple GI hamartomatous polyps and hyperpigmentation of lips, buccal mucosa, and digits

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13
Q

Dx of Peutz-Jeghers syndrome

A

Endoscopy with polypectomy as indicated q2yrs

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14
Q

Screening for cancer

A

Colonoscopy starting at 50 and q5-10 yrs: for no risk
Moderate risk (CA in 1st degree relative >60): start at 40 and do q5-10yrs
High risk (sigmoidoscopy): FAP-10 yo and yearly until 40
High risk-Lynch syndrome- 20 yo and q2yrs until 35, then yearly
High risk- IBD- 10 yr after start of colitis, then q1-2y

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15
Q

Dx and staging of CA

A

Start with colonoscopy and then do radiographic exam to check for mets
MC site of mets= liver (need to do CT of abdomen)
CEA (food for surveillance after curative therapy)
PET
Cancers in mid and upper rectum- rigid proctoscopy

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16
Q

How to treat a resectable tumor without mets in colon cancer

A

Segmental colectomy
Margins greater than or equal to 5 cm
Need minimum of 12 lymph nodes in specimen

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17
Q

How to treat tumors adherent to adjacent organs in colon cancer

A

Resected en bloc

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18
Q

What is offered to any pt with evidence of spread in colon cancer?

A

Chemo

5-FU or leucovorin with either oxaliplatin or irinotecan

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19
Q

How to treat locally advanced rectal cancer

A

Neoadjuvant chemo

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20
Q

How to treat total mesorectal excision in rectal cancer

A

Complete removal of rectal tumor and regional lymph nodes

2 cm distal margin

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21
Q

How to treat tumor in mid/upper rectum

A

Low anterior resection (LAR) with colorectal anastamosis

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22
Q

How to treat preexisting fecal incontinence or with very low rectal cancer

A

Abdominoperineal resection (APR)

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23
Q

How to treat metastatic dz

A

Asymptomatic primary colon tumor and unresectable metastatic disease: chemo

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24
Q

What is considered lower GI bleeding?

A

Bleeding distal to ligament of Treitz

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25
Q

What is the MCC of lower GI bleeding?

2nd MCC?

A

1/2 occur from diverticular dz

Arteriovenous malformations

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26
Q

Dx of lower GI bleed

A

Find the bleed
NG tube lavage to r/o upper GI bleed
Proctoscopy to r/o anorectal cause
Need large-bore IV access and fluid resuscitation

27
Q

Labs/rads for lower GI bleed

A

CBC and coag studies
Type and cross
Colonoscopy would not be good if a ton of blood
Could do radionuclide scan and inject tagged RBCs (but need to be actively bleeding)
Selective visceral angiography- better info and can offer therapeutic options

28
Q

Tx of lower GI bleed

A

Surgery may be needed if ongoing transfusion requirement (6 L over 24 hrs)

29
Q

What cancers are MC found in the appendix?

A

Carcinoid tumors

30
Q

When is carcinoid syndrome caused?

A

When carcinoid tumors get to the base of the appendix

31
Q

Presentation of carcinoid syndrome

A

Cutaneous flushing
Bronchospasm
Secretory diarrhea
Cardiac valvular lesions

32
Q

Mucocele

A

Accumulation of mucin within the lumen d/t proximal obstruction

33
Q

Mucinous crystadenomas

A

Benign lesions associated with dilated mucin filled appendix and adenomatous epithelium

34
Q

Mucinous crystadenocarcinoma

A

Malignant
Can cause pseudomyxoma peritonei- peritoneal cancer becomes seeded by cancer cells that continue to secrete mucin- treat with surgical debulking

35
Q

Abscess or fistula-in-ano

A

Obstruction of anal glands can lead to infection and if they track down toward anal orifice, perianal abscess
MC type of anorectal abscess

36
Q

Intersphincteric abscess

A

Infection can remain in intersphincteric plane

37
Q

Ischiorectal abscess

A

Can penetrate laterally through the external sphincter

38
Q

Supralevator abscess

A

Can track superiorly above levator ani

39
Q

Horseshoes

A

Infection starts in postnatal space and spread bilaterally

40
Q

What are 50% of anal abascesses?

A

Fistula in ano

41
Q

How can the general course of tract of fistulas in ano be predicted?

A

On the basis of site of external opening using Goodsall’s rule

42
Q

Presentation of abscess or fistula in ano

A

Anal pain
Swelling
Fever
Tender mass

43
Q

Dx of abscess or fistula in ano

A

CT or MRI

44
Q

Tx of abscess or fistula in ano

A

Incised and drained
External opening should be made on the anal side of the abscess
Intershpincteric- drain into anal canal via sphincterotomy
Postnatal- incising between the coccyx and anus
Horseshoe- Hanley technique

45
Q

Tx of fistula in ano

A

If identified with abscess: seton should be placed
Then staged procedure 8 wks later
Intersphincteric and superficial transphincteric fistulas: open and close by secondary intent= fistulotomy

46
Q

Types of hemorrhoids

A

Right anterior
Right posterior
Left lateral

47
Q

Internal hemorrhoids

A

Above dentate line- BRB and prolapse

48
Q

1st degree internal hemorrhoids

A

Bulging within lumen without prolapse

49
Q

2nd degree internal hemorrhoids

A

Prolapse with straining but reduces

50
Q

3rd degree internal hemorrhoids

A

Prolapse that reduces only with digital manipulation

51
Q

4th degree internal hemorrhoids

A

Irreducible prolapse

52
Q

External hemorrhoids

A

Below dentate line

Acute discomfort

53
Q

Dx of hemorrhoids

A

Anoscopy

54
Q

Tx of hemorrhoids

A

1st and 2nd: nonsurgical therapy: rubber band ligation
Symptomatic 2nd, 3rd, and 4th: surgical tx
Hemorrhoidectomy: prone jackknife position

55
Q

Pilonidal dz

A

Episodic infection of subcutaneous tissues of the superior gluteal cleft
Subcutaneous abscess that drains spontaneously or requires surgical drainage

56
Q

What leads to recurring infections in pilonidal dz

A

Complex tunneling sinuses

57
Q

Tx of pilonidal dz

A

Need surgical resection
MIdline excision
with/without primary closure of the defect
Marsupialization: skin at wound edge can be sutured to the base to eliminate overhang and make the wound smaller

58
Q

Anal fissue

A

Linear tears in the andoderm distal to the dentate line

59
Q

Where do most anal fissures occur?

A

Posterior midline

60
Q

Presentation of anal fissure

A

Constipation or intense pain with defecation is a common complaint
Chronic fissure is classically associated with heaped up epidermis (sentinel tag), which is a marker of chronic inflammation

61
Q

Tx of anal fissue

A

Conservative- fiber supplements and sitz bath

Refractory cases: lateral internal sphincterotomy

62
Q

When is rectal prolapse most common?

A

Women > 50 yo

63
Q

Presentation of rectal prolapse

A

Extrusion of rectal mucosa from the anus when a pt bears down

64
Q

Tx of rectal prolapse

A

Rectoplexy with or without resection of the redudant sigmoid colon
Altemeir procedure- most common perineal approach

Surgery (30 decks)

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