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Surgery > Colon > Flashcards

Colon Flashcards

1
Q

The parts that are covered by Serosa (peritoneum):

A 
Cecum 
Transverse 
Sigmoid 
Ant. Ascending 
Ant. Descending 
Rectosigmoid 
Upper 3rd and ant. Wall of middle third of rectum
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2
Q

Parts without serosa :

A

Post. Ascending
Post. Descending
Lower 3rd of rectum

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3
Q

IBD - inflamatory bowel disease

2 major disorders :

A

1) ulcerative colitis ( uc)

2) cronh’s disease

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4
Q

Crohn’s disease :

A

Causes inflammation of the digestive system
-Can affect any area from the mouth to the anus , it often affects the ileum.
Its aspect feature is cobblestones , and it does not affect in a continuous way
-Smoking worsen the disease
-crohns disease usually affects the entire thickness
-bowel obstruction, fistulas can appear

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5
Q

Etiologic theories of IBD:

A
  • genetic predisposition
  • mucosal immune system
  • enviromental triggers (bacteria , infection, NSAID, smoking)
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6
Q

Sympts. Of ulcerative colitis ;

A 
- altered bowel movements: 
⬆️stool frequency 
⬇️stool cosistency 
-abdominal pain: 
LLQ cramping , relieved with defecation 
Tenesmus ( the feeling of the need to pass stool even if its empty)
-blood 🩸 in stool
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7
Q

Sympts. Of Crohn’s disease :

A
  • chronic or nocturnal diarrhea
  • abd. Pain
  • distension and postprandial RLQ abd. Pain
  • weight loss
  • fever
  • rectal bleeding
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8
Q

Risk factors for a more severe Crohn’s disease:

A
  • early age at diagnosis <40
  • perisnal involvment
  • severe deep ulceration on endoscopy
  • multiple areas of involvement
  • current tabacco use
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9
Q

Risk factors for severe ulcerative colitis:

A
  • early age at diagnosis <40
  • early steroid treatment
  • extensive colitis
  • hospitalization
  • elevated inflammatory markers ( CRP, ESR)
  • low serum albumin
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10
Q

Anti- TNF agents are:

A 
✅Infliximab
✅Adalimumab
Golimumab(uc)
Gertolizumab (cd)
Pegol (cd)
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11
Q

Anti- integin Agents:

A

✅Vedolizumab

Natalizumab (cd)

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12
Q

Medications for active disease (UC):

A

1) 5-Aminosalicylic acid derivatives:
Sulfasalazine, mesalamine, balsalazide, olsalazine
2) ANTBX: metronidazole, ciprofloxaxin,rifaximin
3)corticosteroids:
Hydrocortisone, prednisone, methylprednisolone, predinsolone , budesonide, dexamethasone
4)immunomodulators:
Azathioprine, 6-mercaptopurine, methotrexate, cyclosporine
5) TNF inhibitors:
Infliximab, adalimumab , certolizumab pegol , golimumab
6)anti-integrin agents:
Natalizumab, vedolizumab
7) Anti-IL12/23 agents:
Ustekinumab

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13
Q

Drugs for sympt, relief :

A

-antidiarrheal : diphenoxylate and atropine, loperamide, cholysteramine
-Anticholinergic antispasmodic agents:
Dicyclomine, hyocyamine

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14
Q

Dermatological manifestation in IBD:

A

▪️erythema nodosum:
CD>UC, most common manifes.
▪️skin cancer
▪️pyoderma gangrenosum: most common site is legs
▪️psoriasis, sweet’s syndrome, metastatic croh’s disease

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15
Q

Musculoskeletal manifestations of IBD:

A

▪️peripheral arthritis
▪️spondylitis
▪️sacroilitis

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16
Q

Ocular manifestation in IBD:

A

▪️Episcleritis (ant. Chamber)
▪️post chamber: uveitis
▪️cataract ( from steroid treatment

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17
Q

Other manifestations in IBD:

A

▪️thrombosis (hypercoagulable state)
▪️primary sclerosing cholangitis , fatty liver , gallstones
▪️Aphthous stomatitis ( repeated formation of benign and non contagious mouth ulcers
▪️Nephrolithiasis , obst. Uropathy , urinary tract fistulization
▪️colorectal cancer risk ( >8 years duration of disease , family history of CRC, psc

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18
Q

Toxic megacolon:
Ineffective peristalsis (paralysis of myenteric plexus)
Distention leads to perforation
Sepsis and death

A

-dilatation >5.5cm on roentgenography

+3/4 of : fever , tachcard, leukocytosis , anemia

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19
Q

Management of toxic megacolon:

A

*iv fluid support
*correcting electrolyte abnormalities
*complete bowel rest
*rule out infectious etiology
▪️decompression:
Rectal tube , nasogastric tube , repositioning maneuvers
▪️medical care:
Tr. for infections , iv corticosteroids (3-5 days) , broad spec. ANTBX
▪️radiology: assessment with plain films , CT scanning
▪️surgical intervention: signs of perforation, medical care failure

20
Q

Predictors for colectomy:

A

🔸 >8 stools per day
🔸increased CRP
🔸>3 stools per day after the 3rd day of admission

21
Q

Complications of colon surgery:

A

-UTI/ retention
-significant hypokalemia
-ileus
-GIT( abscess , leak , SBO)
-cardiac
-atelecstasis
Pneumonia

22
Q

Tru diverticulum vs pseudo:

*diverticula commonly affect the sigmoid

A

True-> is sacklike herniation of the entire bowel wall

Pseudo-> involves only a protrusion of mucosa through the muscularis propria of the colon

23
Q

Complications of diverticular disease :

A
  • diverticulitis
  • perforation or bleeding
  • > diverticula commonly affect the sigmoid
24
Q

The most common cause of hatochezia in pts >60 is :

A

Colonic diverticulum

25
Q

Acute uncomplicated Diverticulitis:

A 
Fever 
Anorexia 
LLQ abd. Pain
Obstipation
Localized or generalized peritonitis
26
Q

Complicated diverticular disease :

A

Perforation
Abscess
Stricture
Fistula

27
Q

Following findings on CT of Diverticulitis :

A

Sigmoid diverticula
Thickened colonic wall >4mm
Inflammation within the pericolic fat -+the collection of contrast material or fluid

28
Q

DDX with diverticulitis:

A

Ovarian cyst
Endometriosis
Acute appendicitis
Pelvic inflammatory disease

29
Q

Treatment of diverticular disease :

A

Asympt.: managed by fiber inriched diet , **avoid nuts and popcorn
Sympt.: should be treated initially with antbx and bowel rest
TRIMETHOPRIM/ SULFAMETHOXAZOLE
or
Ciprofloxacin +metronidazole
*addition of ampicillin to nonresponders
*IV piperacillin or oral penicillin /cluvanic acid
*rifixamin with fiber
(7-10days)

30
Q

Surgical treatment of Div. Disease :

A

Goals :
Controls sepsis , eliminating complications, removing the diseased colonic segment , restoring intestinal continuity
Options :
-ileostomy or colostomy and sutured omental patch with drainage
-resection with colostomy
-resection with anastomosis
-resection with anastomosis and diversion

31
Q

Contraindication to percutaneous drainage :

A

No percutaneous access route
Pneumoperitoneum
Fecal peritonitis

32
Q

Stage 3 of diverticular disease is managed by :

A

HARTMAN’s procedure
Or
Primary anastomosis and proximal diversion

33
Q

No anastomosis of any type should be attempted in stage :

A

Stage 4/ Hinchey stage of diverticular disease

34
Q

Etiology of colon cancer :

A 
Heridetary: 
FAP (familial adenomatous polyposis) 
HNPCC (heridetary non polyposis colorectal cancer ) 
Sporadic : 
Environmental factors
35
Q

Risk factors of colon cancer :

A 
🔸Age ( >50)
🔸previous polyp or bowel cancer 
🔸chronic bowel inflamm.: uc or CD 
🔸diet and exercise 
🔸obesity
🔸smoking and alcohol 
🔸family history
36
Q

Sympts. Of colorectal cancer :

A 
Ascending: 
Anemia , tumor , mass , fever 
Descending: 
Obstruction, altered bowel habit 
Tenesmus (feeling the need to pass stool although its empty) , pain
37
Q

Examination for colorectal cancer :

A

*general appearance :
Anemia , jaundice , weight loss , cachexia
*abd.:
Mass , hepatomegaly , ascitis , signs of obstruction or peritonitis
*rectal examination

38
Q

Investigation and staging of colorectal cancer :

A 
Colonoscopy +biopsy
Blood samples
CXR
Barium enema 
US , CT, MRI
CEA
39
Q

FAP:

A
  • long arm of chromosome 5
  • > 100 adenomas
  • clectomy and IRA( ileorectal anastomosis
  • IAP( ileoand pouch )
  • ileostomy
40
Q

Colon cancer treatment :

A

🔸surgery is the only way to cure
🔸chemotherapy
🔸immunotherapy and other treatments
🔸support

41
Q

Staging of colon cancer :

A

▪️Duke’s A : confined to the bowel wall
▪️Duke’s B: through the wall
▪️Duke’s C : spread to LNs
▪️Dukes D : spread to liver

42
Q

Pathways for colon metastasis dissemination:

A

🔸direct invasion through the wall
🔸LN metastasis
🔸portal vein metastasis
🔸intraluminal seeding

43
Q

Colon cancer surgeries:

A 
▪️radical - resections 
▪️palliative- stomas , internal by pass 
Standard operations : 
🔸right hemicolectomy
🔸extended right hemicolectomy
🔸left hemicolectomy 
🔸high ant. Resection
🔸segmental resection
44
Q

Treatment of advanced colon cancer disease :

A
  • quality of life
  • effective palliation
  • chemo/radiotherapy
  • palliative care unit
  • hepatic resection in selected pts
  • palliative surgical resection
45
Q

In obstructed colon cancer we can use as treatment:

A

Self expanding stent

46
Q

Clinical features of CD:

A

1) Any segment
2) Rectal sparing
3) Skip lesions
4) Transmural
5) Fistulas
6) Garnulomas
7) Smoking

Surgery (8 decks)

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