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Rosalynn's ABSITE > colon/rectum > Flashcards

colon/rectum Flashcards

1
Q

Treatment for severe UC is NEVER?

A

surgery

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2
Q

Extraintestinal manifestations of Crohn’s disease most commonly occur in those with what?

A

ileal disease

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3
Q

extra intestinal manifestations of Crohn’s disease most likely to resolve with medical/surgical therapy?

A

Erythema nodosum

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4
Q

extra intestinal manifestations of Crohn’s disease most likely NOT to resolve with medical/surgical therapy?

A

ankylosing spondylitis
pyoderma gangrenosum
uveitis
primary sclerosis

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5
Q

best way to diagnose a fistula from diverticulitis

A

CT abd/pelvis

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6
Q

indications for adjuvant chemo in stage II cancer

A

T4 disease
lymph-vascular or perineurial invasion
insufficient lymph node sample
poor differentiation
elevated CEA levels
Proficient MMR

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7
Q

MC complication after proctocolectomy and pouch for IBD?

A

Pouchitis
treat with IV abx first not surgery

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8
Q

screening colonoscopy for UC starts when?

A

10 years after disease dx regardless of age

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9
Q

when do patients with FAP get prophylactic proctocolectomy?

A

20 years old

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10
Q

when should FAP get screening EGD?

A

25 years old

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11
Q

when should FAP get screening flex sig?

A

teenager

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12
Q

For Crohn’s disease, infliximab is good for

A

perianal fistula

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13
Q

treatment of Crohn’s disease with strictures

A

resection (first)
stricturoplasty with recurrence to save on bowel length

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14
Q

the most common cause of severe GI bleeding in older patients

A

diverticular disease
usually self resolving

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15
Q

MC viral sexually transmitted infection in US

A

condylomata acuminata

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16
Q

pre op albumin less than what is risk for anastomotic leak

A

less than 3.5

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17
Q

MC genetic defect involved with colon cancer

A

APC gene

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18
Q

For SCC of the anus local regional recurrent/persistence after chemoradiation is

A

20%

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19
Q

anal melanoma express

A

s-100
HMB-45
Melan A

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20
Q

important prognostic factor of anal melanoma

A

perineurial invasion

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21
Q

treatment for recurrent anal SCC after chemorads

A

salvage APR

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22
Q

treatment for anal melanoma

A

local excision

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23
Q

treatment for anal adenocarcinoma

A

APR with adjuvant chemorads

24
Q

HIV patient with large soft cauliflower like mass

A

verrucous carcinoma treat with WLE

25
Q

Which anorectal abscesses will need REUA?

A

complex abscesses: intersphincteric, supralevator, horseshoe abscesses

26
Q

what is the greatest risk to I&D of perirectal abscess?

A

recurrent abscess, 40% within first year

27
Q

most common cause of I&D failure of perirectal abscess

A

incomplete drainage or unidentified fistula

28
Q

where is a perianal abscess

A

in the perianal space, superficially at the anal verge and continuous with the ischioanal fossa laterally

29
Q

where is an ischioanal abscess

A

in the ischioanal space with a superior boundary of the elevator ani muscle, medial boundary of the external anal sphincter, and laterally of the pelvic side wall

(may communicate bilaterally via the deep postnatal space resulting in horseshoe abscess)

30
Q

Where is an intersphincteric abscess

A

in the intersphincteric place between the internal and external sphincter muscles

31
Q

where is a supralevator abscess?

A

in the extraperitoneal supralevator space bounded medially by the rectum and laterally by the pelvic side wall

require imaging

32
Q

how do you drain a horseshoe abscess

A

modified Haney procedure

opening the deep postanal space with sphincter sparing posterior midline incision, placement of seton via the internal opening, make bilateral counter incisions to drain the ischioanal fossae with setons

33
Q

T/F: abscess drainage with concomitant fistulotomy may be performed with caution for simple anal fistulas

A

true

34
Q

what kind of abscess is number 1?

A

supralevator

35
Q

what kind of abscess is number 2?

A

horse shoe

36
Q

what kind of abscess is number 3?

A

ischiorectal

37
Q

what kind of abscess is number 4?

A

intersphincteric

38
Q

what kind of abscess is number 5?

A

perianal abscess

39
Q

the dentate line represents the border between, what?

A

embryonic endoderm and ectoderm

40
Q

at the dentate line there are columns of ?

A

Morgagni that contain anal crypts at their bases

41
Q

the anoderm is the border between the?

A

anoderm and skin (has hair, sweat glands, sebaceous glands

42
Q

the internal anal sphincter is a continuation of the?

A

rectal circular smooth muscle

43
Q

the external anal sphincter is a continuation of?

A

levator ani muscles

44
Q

what are the most common anorectal abscess?

A

perianal abscess

located just beneath the skin of the anal canal and do not transverse the external anal sphincter

45
Q

what are the parks classification of anal fistulas?

A

Types 1-4

46
Q

what are complex fistulas?

A

fistulas involving more than 30% of the external anal sphincter with multiple tracts, fistulas involved with Crohn’s disease, malignancy, or radiation

usually cannot be managed with fistulotomy

47
Q

which anorectal abscesses can be drained in clinic?

A

superficial perianal and simple ischiorectal abscesses with an elliptical or cruciate incision

48
Q

when is a seton usually used for fistulas?

A

high transsphincteric fistula, supersphincteric fistula, female patients with anterior fistulas, advanced Crohn’s disease

49
Q

what is the LIFT procedure?

A

ligation of intershpincteric fistula tract - tract is identified in the plane between the internal and external sphincter and ligated

50
Q

what is an endoanal advancement flap?

A

used to obstruct the internal opening of the fistula to eliminate the source of fistula drainage

51
Q

when are antibiotics used for perirectal abscess/fistula

A

immunosuppressed, signs of infection, signs of cellulitis, prosthetic valves, heart transplant patients, prior endocarditis

52
Q

how do you do an internal sphincterotomy?

A

place a small scalpel into the intersphincteric groove and divide the internal sphincter by turning the scalpel medially

53
Q

what is the most accurate imaging study to order for patient with complex fistula?

A

MRI

54
Q

when is a rigid proctoscopy used?

A

accurate measurement of the distance from anal verge and exact location of a rectal tumor

55
Q

colon anastomotic leaks are most likely to happen after which POD?

A

afer POD 3: dip in anastomotic strength due to collagen degradation coupled with lower level of tensile strength which scar is still maturing

Rosalynn's ABSITE (33 decks)

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