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Colon Flashcards

1
Q

Peutz-Jeger syndrome;

A

GI polyps

Muco-cutaneous pigmentations

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2
Q

Gardner syndrome>

A

Epidermoid cysts
Osteomas
Mesenteric desmoid tumors

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3
Q

Who gets adjuvant chemotherapy for colon Ca?

A

All stage III, IV

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4
Q

Recurrent c. Diff colitis treatment?

A

Oral fidaxomicin with IV bezlotuxumab as adjunct

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5
Q

Impediments to spontaneous closure of a fistula?

A

FRIEND

Foreign body
Radiation
Infection/inflammation
Epithelialization
Neoplasia
Distal obstruction

<2 cm short segment, >500 output also risk of non-spontaneous closure

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6
Q

First line therapy for mild cases of desmoid tumors?

A

NSAIDs + Tamoxifen with MRI every 3-6 months

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7
Q

First line tx for initial c diff colitis or recurrence?

A

Fidoxomicin now recommended over Vanco’

200 mg BID for ten days

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8
Q

Coloplasty?

A

Creating a longitudinal colotomy and closing it tranversely

Allows creation of a colonic reservoir when you can’t create a J pouch

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9
Q

Angiography can localize bleeds at a rate of?

A

0.5 ml/min

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10
Q

Tagged RBC scans can localize bleeds at a rate of?

A

0.1 ml/min

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11
Q

Mutation of APC on 5q21?

A

FAP

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12
Q

When do we screen pts with upper endoscopy with FAP?

A

Starting at 20-25 y/o or when colonic polyps first appear

Pts w/FAP are at risk of duodenal adenomas; can develop into duodenal ca in 10% of pts

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13
Q

Screening in FAP?

A

Colonoscopy every 1-2 years starting at 10-15

EGD starting at 20-25 or when colonic polyps first appear

Thyroid US every 2-3 years starting in late teenage years (screen for papillary thyroid ca)

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14
Q

Most common genetic defect seen in colon cancer?

A

APC gene on chromosome 5

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15
Q

Therapeutic strategy for rectal Ca:

A

Stage I: T1, T2 and no nodal involvement —-> Resect

Stage II and above: T3 +/- nodes—-> neoadjuvant chemotherapy followed by surgery

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16
Q

Indications for radical resection of rectal carcinoid?

A

> 2 cm

Invasion into or thru muscularis propria (T2 dx)
Lymphovascular invasion

elevated mitotic rate

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17
Q

Carcinoids stain positive for?

A

Chromogranin

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18
Q

Imaging test of choice to diagnose a colo-vesicle fistula?

A

CT with oral or rectal contrast (No IV)

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19
Q

Difference in anal fissure presentation in someone with Crohns vs an anal fissure that’s idiopathic?

A

Crohns fissures tend to be in the lateral position; mainstay is usually medical

Non-Crohn’s fissures tend to be posterior midline; treatment usually conservative first then lateral internal sphincterotomy

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20
Q

B/l injury to the b/l S1-S3 nerve roots during a difficult pelvic dissection will result in what?

A

Fecal incontinence (S1-S3 nerve roots are branches of pudendal nerve)

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21
Q

HPV strains:

A

6/11 being anal warts; condyloma acuminata

16/18; high grade dysplasia and anal cancer

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22
Q

Office based procedures for hemorrhoids grade I- III?

A

Rubber band ligation most commonly performed

In pts with high bleeding risk (DAPT after coronary event); sclerotherapy recommended (less risk of post-procedure bleeding)

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23
Q

Intraepithelial adenocarcinoma that arises from apocrine sweat glands:

A

Pagets dx

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24
Q

Most sensitive and specific test for anal intrapeithealial neoplasia?

A

High Resolution anoscopy

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25
Q

Large cauliflower like anal mass:

A

Verrucous Ca

Wide local excision is tx of choice

Can include an APR if sphincter complex involved

26
Q

Verrucous carcinoma features:

A

See mild cellular atypical and pushing margins

Locally invasive, slow growing

Tx; wide local excision, APR if sphincter complex involved

27
Q

MC complication after rubber band ligation is?

A

Bleeding

28
Q

External anal sphincter is under somatic innervation by what?

A

Inferior rectal branch of pudendal nerve

29
Q

Usual location of anal fissure?

A

Posterior midline

30
Q

Tx of low grade mucinous appendiceal neoplasm?

A

Cytoreductive surgery with heated intraperitoneal chemotherapy

31
Q

Hagitt classification of colonic polyps;

A

1; limited to head
2: limited to neck
3; limited to stalk
4; invades wall of bowel but limited to submucosa

32
Q

Primary tx of colonic lymphoma?

A

Surgery + R-CHOP

33
Q

Rectal leiyomyomas;

A

Rare; benign tumors of smooth muscle origin
Desmin positive
Spindle cell histology

EUS is primary mode of detecting depth of invasion

34
Q

Which HPV assc w/ squamous anal ca?

A

16»>18

35
Q

Treatment for Lynch syndrome?

A

Need total colectomy with ileo-rectal anastomosis

40% chance of finding a metachronous lesion during colonoscopy so take the whole colon

Annual proctoscopy needed to monitor rectum for Ca

36
Q

Most sensitive radiographic test for GI bleeding;

A

Radionucleotide tagged RBC test

Detection rate 0.1- 0.5 ml/min

37
Q

Lap appt compared to open is associated with increased rates of?

A

Organ space infection vs open

38
Q

Mutated mismatch repair genes in Lynch syndrome; AD;

A

MLH1
MSH2
MSH6
PMS2

39
Q

MC extra colonic Ca seen in lynch syndrome?

A

Endometrial Ca

40
Q

Amsterdam criteria for lynch syndrome:

A

3 affected family members
2 generations
1 before age 50

41
Q

Best test to diagnose a colo-vesicular fistula;

A

Ct abdomen/pelvis

42
Q

IPAA?

A

Potentially done for pts with UC

NOT DONE FOR CROHNs pt

43
Q

Hamartomatous polyps throughout the body, with increased risk of thyroid, endometrial, colon cancer;

A

Cowden syndrome; PTEN mutation (AD)

44
Q

APC gene mutation?

A

FAP

100% risk of colon cancer, duodenal ca, desmoid tumors

45
Q

What’s an ontological resection for colon cancer?

A

Margins 2-5 cm and at least 12 lymph nodes

46
Q

When do we perform LAR?

A

Appropriate for sigmoid and proximal rectal Ca tumors

7-9 cm above anal verge

47
Q

When do we perform APR?

A

When sphincter complex involved

48
Q

Nigro protocol”:

A

5 FU, mitomycin c, external radiation therapy 50 Gy

49
Q

MC genetic defect in colon Ca;

A

APC

50
Q

Most common colonic bacteria is;

A

B. Fragilis

51
Q

NET AKA Carcinoids > 2 cm, what do we do?

A

Need radical resection
High risk of mets

52
Q

Salvage APR for SCC of rectum after nigro protocol?

A

Usually wait 6 months for the tumor to regress after Nigro protocol

If still present at 6 months, can proceed with salvage APR

During this time period, the tumor can regress slowly

53
Q

What’s a sentinel pile?

A

Hypertrophic skin tag that has formed from chronic anal fissure

Helps distinguish from acute anal fissure

54
Q

Tx for intersphincteric fistulas?

A

Draining seton

55
Q

An anal fistula with <30% sphincter involvement can be treated with?

A

Fistulotomy

56
Q

Common types of anal fistulas:

A
  1. Intersphincteric- most common
    2; transphincteric; next most common
  2. Suprasphincteric
  3. Extrasphincteric
57
Q

What type of Cancer do we use the Nigro protocol on?

A

SCC of anus

NOT adenocarcinoma

58
Q

Tx of adenocarcinoma of anal canal:

A

Transanal excision if; <3 cm, limited to submucosa, occupy less than 40% of lumen,

Larger lesions require an APR

59
Q

Delorme procedure for rectal prolapse:

A

Used if prolapse <5 cm

Ircumferential mucosal incision made 1 cm above dentate line

Strip the mucosa to proximal extent of prolapse; followed by longitudinal plication of muscularis propria

60
Q

ALtemier procedure:

A

For rectal prolapse >5 cm

Prolapse is exteriorized, full thickness circumferential incision made 1 cm above dentate line
Redundant sigmoid is pulled transanally and resected
Stapled or hand sewn anastomosis created

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