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P & P II > Chapter 33 WS > Flashcards

Chapter 33 WS Flashcards

1
Q

two types of polyps found in the colon

A

Villous adenomas and Tubular adenomas

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2
Q

which type is most likely to become malignant? (Villous adenomas or Tubular adenomas)

A

villous adenomas

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3
Q

what is FAP and how is it treated?

A

The studding of the entire large bowel wall by thousands of polyps.

Treated by completely removing the colon and rectum.

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4
Q

what is HNPCC?

A

Hereditary nonpolyposis colorectal syndrome (Lynch syndrome).

Inherited disorder that greatly increases the risk of colorectal cancers due to repair gene mutations.

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5
Q

What are symptoms/clinical presentations of rectal cancer.

A
  • Rectal bleeding
  • change in bowel habits
  • diarrhea versus constipation
  • change in stool caliber
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6
Q

Distinguish between symptoms/clinical presentation of cancers of the left side of the colon versus the right

A

Left Side of Colon: blood in stool, change in stool caliber, obstructive symptoms, and abdominal pain

Right Side of Colon: abdominal pain often accompanied with an abdominal mass, nausea, vomiting, occult blood in stool.

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7
Q

an anterior extrarectal mass may be indicative of _______

A

peritoneal seeding

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8
Q

how do colorectal cancers spread to the supraclavicular lymph nodes

A

As a result of spread from metastatically involved paraaortic nodes via the thoracic duct.

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9
Q

What imaging studies are performed in the staging workup for colorectal cancer.

A
  • Chest x-ray to detect mets to lungs,
  • CT scan or MRI of pelvis to determine if tumor extends into other pelvic organs or lymph nodes,
  • CT scan of abdomen to see if liver involved,
  • PET to determine mets.
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10
Q

ascending colon: intraperitoneal or retroperitoneal?

A

retroperitoneal

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11
Q

descending colon: intraperitoneal or retroperitoneal?

A

retroperitoneal

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12
Q

cecum: intraperitoneal or retroperitoneal?

A

intraperitoneal

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13
Q

transverse colon: intraperitoneal or retroperitoneal?

A

intraperitoneal

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14
Q

sigmoid colon: intraperitoneal or retroperitoneal?

A

intraperitoneal

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15
Q

hepatic flexure: intraperitoneal or retroperitoneal?

A

retroperitoneal

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16
Q

splenic flexure: intraperitoneal or retroperitoneal?

A

retroperitoneal

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17
Q

define peritoneal seeding

A

Tumor cells break off and shed into the abdominal cavity then take up residence on another surface.

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18
Q

Tumor cells break off and shed into the abdominal cavity then take up residence on another surface.

A

peritoneal seeding

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19
Q

what is the main dose limiting structure when treating colorectal cancer

A

Small bowel

If treating the ascending or descending colon, then kidney is also a dose-limiting structure.

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20
Q

acute side effects of radiation to the colon

A
  • diarrhea
  • abdominal cramps and bloating
  • proctitis
  • bloody or mucus discharge
  • dysuria

Also, leukopenia and thrombocytopenia. Chemoradiation increases gastrointestinal and hematologic toxicities. If perineum treated then moist desquamation can occur to this area.

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21
Q

chronic side effects of radiation to the colon

A
  • Persistant diarrhea
  • increased bowel frequency
  • proctitis
  • fistula
  • urinary incontinence
  • bladder atrophy.

Most common is enteritis, adhesions, and obstruction caused by damage to the small bowel.

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22
Q

What is the purpose of the surgeon placing clips during surgery for colorectal cancer.

A

To demarcate the tumor bed so radiation oncologist can more precisely outline the area at risk, thus using smaller treatment volumes

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23
Q

how does a full bladder change the location of the small bowel

A

pushes the small bowel more superiorly

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24
Q

What foods should patients avoid eating when being treated with radiation for colon cancer.

A
  • whole grain breads or cereals
  • fried or fatty foods
  • milk and milk products
  • raw vegetables
  • fresh fruit.
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25
what foods are recommended for patient being treated to the colon
- White bread, - meat baked, broiled, or roasted until tender, - macaroni, - cooked vegetables - peeled apples and bananas.
26
define dentate line of rectum
Also known as pectinate line. Divides the upper 2/3 and lower 1/3 of the anal canal. Line at which the cells transition from stratified squamous epithelium to columnar epithelium (cuboidal at dentate line)
27
define anal verge
The surface of the ringed opening of the anus. It is the lower edge of the anal canal that marks the junction of the anal canal and the external hair-bearing skin.
28
what are OARs
organs at risk
29
What are the OAR in the treatment for anal cancer.
- Femoral heads and neck, - genitalia/perineum, - small bowel, - bladder.
30
define unresectable
tumor cannot be surgically removed
31
What are the two most important etiologic factors in the development of squamous cell carcinoma of the esophagus in Western countries.
excessive alcohol and tobacco use
32
At what vertebral body does the esophagus start and when does it terminate
starts at C6 and ends at T10/11
33
define barrett esophagus
A condition in which the distal esophagus is line with a columnar epithelium rather than a stratified squamous epithelium, usually due to gastroesophageal reflux. The cells undergo metaplasia.
34
A condition in which the distal esophagus is line with a columnar epithelium rather than a stratified squamous epithelium, usually due to gastroesophageal reflux. The cells undergo metaplasia.
barretts esophagus
35
define achalasia
A disorder in which the lower 2/3 region of the esophagus loses its normal peristaltic activity and prohibits the passage of food into the stomach
36
A disorder in which the lower 2/3 region of the esophagus loses its normal peristaltic activity and prohibits the passage of food into the stomach
achalasia
37
define tylosis
Inherited disorder (rare). Mutation on Chromosome 17 is thought to be the reason for the disorder. Results in excessive skin growth on palms of hands and soles of feet.
38
Inherited disorder (rare). Mutation on Chromosome 17 is thought to be the reason for the disorder. Results in excessive skin growth on palms of hands and soles of feet.
tylosis
39
List the layers of the wall of the esophagus
Mucosa, submucosa, muscular, adventitia(instead of serosal layer
40
What layer is lacking in the wall of the esophagus that is found in the bowel wall.
serosa
41
List the nodes that the upper 1/3 of the esophagus drain into.
- Internal jugular, cervical - paraesophageal - supraclavicular lymph nodes.
42
List the nodes that the thoracic portion of the esophagus drain into.
- Paratracheal - hilar - subcarinal - paraesophageal - paracardial lymph nodes.
43
List the nodes that the lower third (distal) of the esophagus drain into.
- Celiac - axis - left gastric nodes - nodes of the lesser curvature of the stomach.
44
What foods should patients avoid eating when being treated with radiation to the thoracic area.
- Hot and spicy foods, - dry to coarse foods, - crackers, nuts, and potato chips, - raw vegetables, - citrus fruits, - juices, - alcoholic beverages
45
what foods are recommended for patients being treated with radiation therapy to the thoracic area
- Cottage cheese, - yogurt, and milkshakes, - puddings, - casseroles, - scrambled eggs, - meats and vegetable in sauces or gravies
46
List the main lymph nodes that drain the pancreas.
- Superior and inferior pancreaticoduodenal nodes, - porta hepatis, - suprapancreatic nodes, - par-aortic nodes.
47
three parts of the pancreas
head, body, & tail
48
what are the four most common presenting symptoms of pancreatic cancer.
- Jaundice, - abdominal pain, - anorexia, - weight loss.
49
most common tumor marker associated with pancreatic cancer
CA-19 serum carbohydrate antigen
50
define residual disease as it relates to cancer
Small number of cancer cells that remain in body after treatment
51
explain the whipple procedure
A resection of the head of the pancreas, entire duodenum, distal stomach, gallbladder, and common bile duct. Reconstruction follows with the remaining pancreas, bile ducts, and stomach anastomosed into various sites of the jejunum.
52
what organs are removed during a whipple procedure
- head of the pancreas, - entire duodenum, - distal stomach, - gallbladder, - common bile duct.
53
A surgical connection of two vessels or tubes
anastomosis
54
anastomosis
A surgical connection of two vessels or tubes
55
tenesmus
spasms of rectum accompained by a desire to empty the bowel
56
spasms of rectum accompained by a desire to empty the bowel
tenesmus
57
colostomy
Surgical creation of an artificial opening from the colon onto the abdominal surface
58
Surgical creation of an artificial opening from the colon onto the abdominal surface
colostomy
59
colonscopy
medical examination of the colon using an endoscope
60
medical examination of the colon using an endoscope
colonscopy
61
retroperitoneal
behind the peritoneal membrane against the abdominal wall
62
behind the peritoneal membrane against the abdominal wall
retroperitoneal
63
mesentery
A double layer of peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine.
64
A double layer of peritoneum that supports the intestines and conveys blood vessels and nerves to supply the wall of the intestine.
mesentery
65
Identify the level of vertebral body associated with the umbilicus
L3/4
66
Identify the level of vertebral body associated with the cecum
L4
67
Identify the level of vertebral body associated with the bifurcation of abdominal aorta
L4
68
Identify the level of vertebral body associated with the common iliac nodes
L4
69
Identify the level of vertebral body associated with the iliac crest
L4/5
70
Identify the level of vertebral body associated with the start of the rectum
S3
71
Identify the level of vertebral body associated with the spleen
T10/11
72
what is cisterna chyli
A dilated sac at the lower end (beginning) of the thoracic duct into which lymph from the intestinal trunk and lumbar lymphatic trunks flow.
73
A dilated sac at the lower end (beginning) of the thoracic duct into which lymph from the intestinal trunk and lumbar lymphatic trunks flow.
cisterna chyli
74
the internal iliac nodes are also known as the _____ nodes
hypogastic
75
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): kidney
2300 cGy clinical nephritis
76
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): bladder
6500 cGy symptomatic bladder contracture and volume loss
77
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): femoral head
5200 cGy necrosis
78
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): rectum
6000 cGy severe proctisis/necrosis/fistula/stenosis
79
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): prostate
8000 cGy incontinence
80
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): small bowel
4000 cGy obstruction, perforation, fistula
81
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): esophagus
5500 cGy clinical stricutre, perforation
82
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): colon
4500 cGy obstruction, perforation, fistula
83
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): liver
3000 cGy liver failure
84
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): testes
100 cGy hormonal imbalances, sexual dysfuction, infertility
85
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): stomach
5000 cGy ulceration, perforation
86
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): uterus
10000 cGy necrosis, perforation
87
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): vagina
9000 cGy ulcer, fistula
88
Indicate the TD 5/5 (in cGy) for each of the following and the injury that occurs if exceeded (3/3): ovaries
200 cGy sterility
89
Tumors in the tail of the pancreas drain to the
splenic hilar nodes

P & P II (34 decks)

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