COLON Flashcards
What branches are taking in a right hemicolectomy
Ileocolic
Right colic
Right branch of the middle colic
Pitfalls to mention with right hemicolectomy
Identify the ureter
gonadal vessels
Watch out for the duodenum
Surgery performed for right hepatic flexure or proximal transverse colon cancer
Extended right hand selected
Ileocolic
Right colic
Middle colic
Inferior mesenteric bang!
Watch out for
The pancreas
The duodenum
the spleen
Transverse colectomy
Middle colic vessel
Possibly inferior mesenteric vien
Mobilize both hepatic and splenic lectures to have enough life
Left hemicolectomy vessels and key piont
Left branch of the middle colic
Left colic
Inferior mesenteric vein
Mobilize splenic flexure
Sigmoidectomy vessels in key points
Inferior mesenteric artery
(this is why the sigmoid dies after AAA)
Watch out for the ureter
Watch out for gonadal vessels
Workout for Ogilvy’s syndrome
Rule out distal extraction with Gastrografin enema!
Cardiac monitor
Neostigmine
Hinche class
I Micro perf
II abscess near sigmoid perf
III permanent peritonitis (eg, pelvic abscess large)
IV feculent peritonitis
Cecal cancer resection
Right hemicolectomy
If ANY other previous bal surgery subtotal colectomy
Medication for diarrhea
Cholestyramine
paregoric
List blood supply today:
Ilioinguinal -distal ilium, cecum, ascending
Right colic - ascending, hepatic flexion
Middle colic - transverse colon
Left colic - splenic flexure descendingcolon
Inferior mesenteric artery - sigmoid
Management of colon metastasis to the long
Resect
major Family cancer syndromes
Gardener syndrome
Peutz jegher
HNPCC
FAP
HNPCC history and screening
Amsterdam criteria:
Three relatives with colorectal cancer (endometrial, small bowel, GU cancers)
Over two generations
One primary relative under the age of 50 at time of Dx
Age 25:
first scope
screen endometrial
Treatment of FAP
PROCTOcolectomy wiht IPAA during teenage years
colon cancer screening lab
CEA
when does polypectomy needed a cancer operation
Invading submucosa - haggitt level 4
Sessile
Lymphovascular invasion
Poorly differentiated
management of small adenoma
repeat scope in 3 years
Screening options for colon cancer
age 50
I. felx sig q 5 yrs and yearly FOBT
II. Double contrast barium enema q 5 yrs
positive contrast: barium or barium-like agent, e.g. Gastrograffin ®
negative contrast: air or CO2
C scope q 10
Lynch syndrome
What is the treatment
If found to have colorectal cancer
Total abdominal colectomy with ileorectal anastomosis
and
With post op ANNUAL
endoscopic surveillance of the remaining rectum
Females after children
get TAH BSOO
(40 – 60% chance of endometrial cancer)
If there is any previous colon resection what is needed for further procedure
Total colectomy
What is the Niagara protocol
5-FU because everyone gets this
Mitomycin-c
mity mouse will see if chemo works
5-FU
Mitomycin C
45 gy (uptodate)
Treatment of carcinoid in the appendix at the base known preoperatively what medication should you prepare the patient with set timer for 15 minutes
If known cancer:
Give octreotide preoperatively
Right hemicolectomy
What extra colonic cancer do patients get with FAP
And what is the treatment
Periampullary adenocarcinoma
Whipple
FOLFOX
Fu L Ox
Fluorouracil
Leucovorin
Oxaliplatin
Management of carcinoma in a polyp
can be effectively managed by endoscopic removal (polypectomy) alone as long as the resection margins are free of cancer for:
severe dysplasia
or
carcinoma in situ (no evidence of invasive cancer),
The presence of any of the following factors should prompt consideration of radical surgery:
●Poorly-differentiated histology
●Lymphovascular invasion
●Cancer at the resection or stalk margin
●Invasion into the muscularis propria of the bowel wall (T2 lesion)
●Invasive carcinoma arising in a sessile (flat) polyp with unfavorable features (eg, lower third submucosal penetration, lymphovascular invasion, poorly differentiated)
If the patient is seen with a painful thrombosis within 24 to 48 hours, the treatment of choice is
immediate excision of the hemorrhoid
(not evacuation of the clot) under local anesthesia.
The patient who presents later: treated with Sitz baths; stool softeners; topical anesthetics, astringents, steroids
to aid in rapid resolution of symptoms
since natural reabsorption of the clot has started
If an outside provider has done the scope to diagnose calling cancer what needs to be done for preoperative arrangements
Tattoo colon cancer sight
Consider Re-scope to get distance measurements.
After Acute appy with IR drain draining feculent material
DDX:
Drain may have been put through the bowel
This may be a fistula from Cecal stump leak
Tx:
TPN
