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*OldSurgery > Colon and Rectum > Flashcards

Colon and Rectum Flashcards

1
Q

what supplies the right colon and hepatic flexure?

A

SMA

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2
Q

What supplies the left colon?

A

IMA

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3
Q

Layers of the colon

A 
inner circular
outer longitudinal (tinea coli- 3)
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4
Q

what does the colon have that the small intestine doesn’t?

A

haustral markings

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5
Q

Functions of the colon

A

absorption
storage
propulsion
some digestion

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6
Q

are adhesions common in the large bowel?

A

No, rare to cause an obstruction

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7
Q

most common cause of large bowel obstruction

A

carcinoma

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8
Q

2 other common causes of large bowel obstruction

A

diverticulitis (20%)

volvulus (5%)

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9
Q

what area of the large bowel is most likely perforate?

A

cecum (thinnest part) perf at 10-12 cm

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10
Q

symptoms of large bowel obstruction

A

constipation or obstipation
abdominal pain and distention
blood per rectum

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11
Q

when does N/V occur w/ LBO?

A

if ileocecal valve is incompetent

vomitus looks and smells like stool

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12
Q

how do you differ SBO from LBO

A

plain films show distented LB w/ normal SB (can be dilated if IC valve incompetent)

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13
Q

if gangrene or perf is suspectted what type contrast should you use?

A

water solubule

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14
Q

should you do a colonoscopy if a perf is supected

A

No, can make it worse

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15
Q

what is the primary goal w/ a LBO?

A

decompression

removal of obstruction is secondary

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16
Q

a twisting of the large bowel on its mesentery of at least 180 degrees

A

volvulus

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16
Q

what type obstruction is there w/ a volvulus?

A

closed loop obstruction and progressive stangulation of teh bowel

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16
Q

most common sites of a volvulus

A

sigmoid
cecal
transverse colon

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16
Q

what are most patients w/ a sigmoid volvulus like?

A

mostly >65 in a nursing home
abdominal pain and distention
obstipation

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16
Q

where do you see a sigmoid volvulus

A

right quadrant
look likes a coffee bean, with inside of bean pointing toward RQ
sigmoid has flipped onto itself
bird’s beak appearance

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16
Q

tx w/ sigmoid volvulus w/ potentially strangulated bowel

A

emergent resection w/ colostomy

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16
Q

Tx w/ sigmoid volvulus w/ no signs of strangulation

A

endoscopic reduction- if successful do a
rectal tube
bowel prep
semi-elective resection (after 50% decompression)

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16
Q

how can you tell if a sigmoid volvulus is strangulated

A

abdomen becomes tender

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16
Q

If a sigmoid volvulus can’t be reduced what needs to be done?

A

emergent operation (sigmoid resection)

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16
Q

what do patients w/ a cecal volvulus tend to present?

A

younger and female

similar to SBO

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16
Q

How does a cecal volvulus point?

A

Coffee bean point to left quadrant

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16
Q

tx for cecal volvulus

A

surgery

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16
Q

what is a sign of diverticulitis

A

thickened bowel wall

fat stranding, inflammation in pericolonic fat

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17
Q

Massive colonic distention without a mechanical obstruction often in
Bed ridden patients with comorbid diseases

A

COLONIC PSUEDO-OBSTUCTION – OGILVIE’S SYNDROME

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17
Q

how do you diagnose colonic pseudo-obstruction- ogilive syndrome

A

contrast enema and sigmoidoscopy

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17
Q

surgery for diverticulitis if they aren’t getting better (immediate/ emergent/ urgent)

A

sigmoidectomy with end colostomy with Hartman’s pouch

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17
Q

who can have elective sx for diverticulitis

A

recurrent diverticulitis
complicated diverticulitis that was tx w/ abx
age less than 50

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18
Q

what is tx of uncomplication diverticuli?

A

high fiber diet

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19
Q

with delayed or elective surgery for sigmoid diverticulitis what do they get?

A

sigmoidectomy w/ colorectal anastamosis (no colostomy)

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20
Q

Caused by a ruptured diverticulum

90% occur in patients older than 50

A

Diverticulitis

21
Q

95% of diverticulitis have involvement where?

A

sigmoid colon

22
Q

is it common to have bleeding diverticitulitis?

A

No, usually have bleeding diverticuli or diverticulitis

23
Q

Presentation of diverticulitis

A 
Grandual onset LLQ pain
Fever, anorexia, nausea or vomiting 
constipation
UTI symptoms
Pneumaturia (fistula)
24
Q

what is an indication for surgery w/ diverticular bleeding?

A

> 4 units pRBC in 24 hours

25
Q

tx for mild diverticulitis

A

clear liquid diet (must be able to tolerate this)
oral abx for 7-10 days (broad spectrum)
follow up in 58-72 hours

26
Q

must have active arterial bleeding at time of study (0.5 – 1 mL/min)

A

angiography

27
Q

if there is a perf diverticulitits what needs to happen?

A

surgery- laporotomy

28
Q

what needs to happen after someone has healed from diverticulitis?

A

colonscopy to r/o cancer

29
Q

complications of diverticulitis

A

Abscess/ Phelgmon
perforation w/ peritonitis
fistula (may need sx)

30
Q

what is the second leading cause of cancer death?

A

colorectal cancer

31
Q

Need for immediate surgery w/ diverticulitis

A

free perf
lack of improvement w/ conservative therapy
obstruction

32
Q

with delayed or elective surgery for sigmoid diverticulitis what do they get?

A

sigmoidectomy w/ colorectal anastamosis (no colostomy)

33
Q

Most common cause of LGI bleed

A

Diverticular bleeding

34
Q

How does someone w/ diverticular bleed present?

A

BRBPR

hemodynamic instability- need iV fluids

35
Q

for localized diverticular bleeding what procedure is done?

A

segmental colectomy

36
Q

for non-localized diverticular bleeding what is needed?

A

total colectomy

37
Q

what rule out rectal source of bleeding

A

rigid protoscope

38
Q

can dectect at slower rate of bleeding than angiography (0.1 mL/min)

A

bleeding scan

39
Q

what s a premalignant lesion, type of colon polyps

A

adenomas

40
Q

most colorectal cancers arise from what?

A

adenomas

41
Q

a colon polyp bigger than what has malignant potential?

A

> 1cm

42
Q

should all colon polyps be removed?

A

yes

43
Q

what is the second leading cause of cancer death?

A

colorectal cancer

44
Q

what drug may be protective for colorectal cancer?

A

NSAIDs

45
Q

Colon cancer develops in nearly all untreated patients by age 40
Genetic testing in at risk patients
Colectomy

A

Familial adenomatous polyposis (FAP)

46
Q

what type polyps is FAP associated with?

A

Associated with duodenal/periampullary adenomatous polyps

47
Q

earlier average age of onset of cancer

need to look for cancer at multiple spots

A

Hereditary nonpolyposis colorectal cancer (aka Lynch syndrome)

48
Q

screening for colorectal cancer

A

Flexible Sigmoidoscopy every 5 years

Colonoscopy every 10 years

49
Q

when should someone w/ a family hx of colon cancer be tested?

A

age 40 or ten years prior to youngest person in family presentation

50
Q

presentation of colorectal cancer?

A

asymptomatic - found on screening

51
Q

how many stool cultures do you get for C Diff?

A

3

52
Q

tx for C Diff

A

D/C abx
metronidazole (better PO)
oral vancomycin is 2nd line

53
Q

what is the only chance for cure of early colorectal cancer?

A

surgical resection

also remove a lot of messentery (lymph nodes)

54
Q

Inflammation in GI tract is confined to colon and rectum

A

ulcerative colitis

55
Q

age distribution w/ UC

A

20 - 29 years

60 - 70 years

56
Q

where is UC always found?

A

Rectum, then works its way proximal

57
Q

diagnosis for UC?

A

sigmoidoscopy for active dz
colonoscopy
biopsy

58
Q

do people with Crohn’s or UC bleeding more?

A

UC

59
Q

what will UC look like on a barium enema?

A

lead pipe appearance

60
Q

people w/ UC are at high risk of what type cancer?

A

carcinoma of the colon or rectum

61
Q

tx for UC

A

antidiarrheal and bulking meds
mesalazine
corticosteroids (acute attacks)

62
Q

drug for maintenance w/ UC

A

Oral aminosalicylates

63
Q

surgical therapy for UC (fulminant colitis)

A

total abdominal colectomy w/ ileostomy

64
Q

what is resection of the rectum?

A

proctectomy

65
Q 
Antibiotic associated colitis
Occurs during or after antibiotic treatment
Diarrhea
Abdominal cramping
Vomiting
Fever
Leukocytosis
A

Clostridium difficile colitis

66
Q

tx for C Diff

A

D/C abx
metronidazole (better PO)
oral vancomycin is 2nd line

67
Q

complications of severe C Diff

A

Toxic Megacolon
Perforation
Septic shock

68
Q

what may C Diff colitis require?

A

subtotal colectomy

69
Q

Caused by mesenteric vascular occlusion or nonocclusive mechanisms
Often occurs in patients with multiple comorbidities and/or the elderly
may be due to thrombosis, emboli, low flow state, venous occlusion

A

ischemic colitis

70
Q

what do you get for dx for ischemic colitis

A

Luekocytosis
CT scan- thickened large bowel
sigmoidoscopy/ colonoscopy

71
Q

tx of ischemic colitis

A

volume resuscitation
borad spectrum ABX
NPO
surgery if med management fails

*OldSurgery (22 decks)

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