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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
what do patients w/ a cecal volvulus tend to present?
younger and female | similar to SBO
16
How does a cecal volvulus point?
Coffee bean point to left quadrant
16
tx for cecal volvulus
surgery
16
what is a sign of diverticulitis
thickened bowel wall | fat stranding, inflammation in pericolonic fat
17
Massive colonic distention without a mechanical obstruction often in Bed ridden patients with comorbid diseases
COLONIC PSUEDO-OBSTUCTION – OGILVIE’S SYNDROME
17
how do you diagnose colonic pseudo-obstruction- ogilive syndrome
contrast enema and sigmoidoscopy
17
surgery for diverticulitis if they aren't getting better (immediate/ emergent/ urgent)
sigmoidectomy with end colostomy with Hartman’s pouch
17
who can have elective sx for diverticulitis
recurrent diverticulitis complicated diverticulitis that was tx w/ abx age less than 50
18
what is tx of uncomplication diverticuli?
high fiber diet
19
with delayed or elective surgery for sigmoid diverticulitis what do they get?
sigmoidectomy w/ colorectal anastamosis (no colostomy)
20
Caused by a ruptured diverticulum | 90% occur in patients older than 50
Diverticulitis
21
95% of diverticulitis have involvement where?
sigmoid colon
22
is it common to have bleeding diverticitulitis?
No, usually have bleeding diverticuli or diverticulitis
23
Presentation of diverticulitis
``` Grandual onset LLQ pain Fever, anorexia, nausea or vomiting constipation UTI symptoms Pneumaturia (fistula) ```
24
what is an indication for surgery w/ diverticular bleeding?
>4 units pRBC in 24 hours
25
tx for mild diverticulitis
clear liquid diet (must be able to tolerate this) oral abx for 7-10 days (broad spectrum) follow up in 58-72 hours
26
must have active arterial bleeding at time of study (0.5 – 1 mL/min)
angiography
27
if there is a perf diverticulitits what needs to happen?
surgery- laporotomy
28
what needs to happen after someone has healed from diverticulitis?
colonscopy to r/o cancer
29
complications of diverticulitis
Abscess/ Phelgmon perforation w/ peritonitis fistula (may need sx)
30
what is the second leading cause of cancer death?
colorectal cancer
31
Need for immediate surgery w/ diverticulitis
free perf lack of improvement w/ conservative therapy obstruction
32
with delayed or elective surgery for sigmoid diverticulitis what do they get?
sigmoidectomy w/ colorectal anastamosis (no colostomy)
33
Most common cause of LGI bleed
Diverticular bleeding
34
How does someone w/ diverticular bleed present?
BRBPR | hemodynamic instability- need iV fluids
35
for localized diverticular bleeding what procedure is done?
segmental colectomy
36
for non-localized diverticular bleeding what is needed?
total colectomy
37
what rule out rectal source of bleeding
rigid protoscope
38
can dectect at slower rate of bleeding than angiography (0.1 mL/min)
bleeding scan
39
what s a premalignant lesion, type of colon polyps
adenomas
40
most colorectal cancers arise from what?
adenomas
41
a colon polyp bigger than what has malignant potential?
>1cm
42
should all colon polyps be removed?
yes
43
what is the second leading cause of cancer death?
colorectal cancer
44
what drug may be protective for colorectal cancer?
NSAIDs
45
Colon cancer develops in nearly all untreated patients by age 40 Genetic testing in at risk patients Colectomy
Familial adenomatous polyposis (FAP)
46
what type polyps is FAP associated with?
Associated with duodenal/periampullary adenomatous polyps
47
earlier average age of onset of cancer | need to look for cancer at multiple spots
Hereditary nonpolyposis colorectal cancer (aka Lynch syndrome)
48
screening for colorectal cancer
Flexible Sigmoidoscopy every 5 years | Colonoscopy every 10 years
49
when should someone w/ a family hx of colon cancer be tested?
age 40 or ten years prior to youngest person in family presentation
50
presentation of colorectal cancer?
asymptomatic - found on screening
51
how many stool cultures do you get for C Diff?
3
52
tx for C Diff
D/C abx metronidazole (better PO) oral vancomycin is 2nd line
53
what is the only chance for cure of early colorectal cancer?
surgical resection | also remove a lot of messentery (lymph nodes)
54
Inflammation in GI tract is confined to colon and rectum
ulcerative colitis
55
age distribution w/ UC
20 - 29 years | 60 - 70 years
56
where is UC always found?
Rectum, then works its way proximal
57
diagnosis for UC?
sigmoidoscopy for active dz colonoscopy biopsy
58
do people with Crohn's or UC bleeding more?
UC
59
what will UC look like on a barium enema?
lead pipe appearance
60
people w/ UC are at high risk of what type cancer?
carcinoma of the colon or rectum
61
tx for UC
antidiarrheal and bulking meds mesalazine corticosteroids (acute attacks)
62
drug for maintenance w/ UC
Oral aminosalicylates
63
surgical therapy for UC (fulminant colitis)
total abdominal colectomy w/ ileostomy
64
what is resection of the rectum?
proctectomy
65
``` Antibiotic associated colitis Occurs during or after antibiotic treatment Diarrhea Abdominal cramping Vomiting Fever Leukocytosis ```
Clostridium difficile colitis
66
tx for C Diff
D/C abx metronidazole (better PO) oral vancomycin is 2nd line
67
complications of severe C Diff
Toxic Megacolon Perforation Septic shock
68
what may C Diff colitis require?
subtotal colectomy
69
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
ischemic colitis
70
what do you get for dx for ischemic colitis
Luekocytosis CT scan- thickened large bowel sigmoidoscopy/ colonoscopy
71
tx of ischemic colitis
volume resuscitation borad spectrum ABX NPO surgery if med management fails

*OldSurgery (22 decks)

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