COLON Flashcards

1
Q

What branches are taking in a right hemicolectomy

A

Ileocolic
Right colic
Right branch of the middle colic

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2
Q

Pitfalls to mention with right hemicolectomy

A

Identify the ureter
gonadal vessels
Watch out for the duodenum

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3
Q

Surgery performed for right hepatic flexure or proximal transverse colon cancer

A

Extended right hand selected

Ileocolic
Right colic
Middle colic

Inferior mesenteric bang!

Watch out for
The pancreas
The duodenum
the spleen

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4
Q

Transverse colectomy

A

Middle colic vessel

Possibly inferior mesenteric vien

Mobilize both hepatic and splenic lectures to have enough life

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5
Q

Left hemicolectomy vessels and key piont

A

Left branch of the middle colic

Left colic

Inferior mesenteric vein

Mobilize splenic flexure

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6
Q

Sigmoidectomy vessels in key points

A

Inferior mesenteric artery
(this is why the sigmoid dies after AAA)

Watch out for the ureter
Watch out for gonadal vessels

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7
Q

Workout for Ogilvy’s syndrome

A

Rule out distal extraction with Gastrografin enema!

Cardiac monitor

Neostigmine

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8
Q

Hinche class

A

I Micro perf

II abscess near sigmoid perf

III permanent peritonitis (eg, pelvic abscess large)

IV feculent peritonitis

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9
Q

Cecal cancer resection

A

Right hemicolectomy

If ANY other previous bal surgery subtotal colectomy

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10
Q

Medication for diarrhea

A

Cholestyramine

paregoric

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11
Q

List blood supply today:

A

Ilioinguinal -distal ilium, cecum, ascending

Right colic - ascending, hepatic flexion

Middle colic - transverse colon

Left colic - splenic flexure descendingcolon

Inferior mesenteric artery - sigmoid

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12
Q

Management of colon metastasis to the long

A

Resect

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13
Q

major Family cancer syndromes

A

Gardener syndrome
Peutz jegher
HNPCC
FAP

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14
Q

HNPCC history and screening

A

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

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15
Q

Treatment of FAP

A

PROCTOcolectomy wiht IPAA during teenage years

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16
Q

colon cancer screening lab

17
Q

when does polypectomy needed a cancer operation

A

Invading submucosa - haggitt level 4

Sessile

Lymphovascular invasion

Poorly differentiated

18
Q

management of small adenoma

A

repeat scope in 3 years

19
Q

Screening options for colon cancer

A

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

20
Q

Lynch syndrome

What is the treatment

A

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)

21
Q

If there is any previous colon resection what is needed for further procedure

A

Total colectomy

22
Q

What is the Niagara protocol

A

5-FU because everyone gets this

Mitomycin-c

mity mouse will see if chemo works

5-FU

Mitomycin C

45 gy (uptodate)

23
Q

Treatment of carcinoid in the appendix at the base known preoperatively what medication should you prepare the patient with set timer for 15 minutes

A

If known cancer:
Give octreotide preoperatively

Right hemicolectomy

24
Q

What extra colonic cancer do patients get with FAP

And what is the treatment

A

Periampullary adenocarcinoma

Whipple

25
FOLFOX
Fu L Ox Fluorouracil Leucovorin Oxaliplatin
26
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)
27
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
28
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.
29
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