colon/rectum Flashcards
Treatment for severe UC is NEVER?
surgery
Extraintestinal manifestations of Crohn’s disease most commonly occur in those with what?
ileal disease
extra intestinal manifestations of Crohn’s disease most likely to resolve with medical/surgical therapy?
Erythema nodosum
extra intestinal manifestations of Crohn’s disease most likely NOT to resolve with medical/surgical therapy?
ankylosing spondylitis
pyoderma gangrenosum
uveitis
primary sclerosis
best way to diagnose a fistula from diverticulitis
CT abd/pelvis
indications for adjuvant chemo in stage II cancer
T4 disease
lymph-vascular or perineurial invasion
insufficient lymph node sample
poor differentiation
elevated CEA levels
Proficient MMR
MC complication after proctocolectomy and pouch for IBD?
Pouchitis
treat with IV abx first not surgery
screening colonoscopy for UC starts when?
10 years after disease dx regardless of age
when do patients with FAP get prophylactic proctocolectomy?
20 years old
when should FAP get screening EGD?
25 years old
when should FAP get screening flex sig?
teenager
For Crohn’s disease, infliximab is good for
perianal fistula
treatment of Crohn’s disease with strictures
resection (first)
stricturoplasty with recurrence to save on bowel length
the most common cause of severe GI bleeding in older patients
diverticular disease
usually self resolving
MC viral sexually transmitted infection in US
condylomata acuminata
pre op albumin less than what is risk for anastomotic leak
less than 3.5
MC genetic defect involved with colon cancer
APC gene
For SCC of the anus local regional recurrent/persistence after chemoradiation is
20%
anal melanoma express
s-100
HMB-45
Melan A
important prognostic factor of anal melanoma
perineurial invasion
treatment for recurrent anal SCC after chemorads
salvage APR
treatment for anal melanoma
local excision
treatment for anal adenocarcinoma
APR with adjuvant chemorads
HIV patient with large soft cauliflower like mass
verrucous carcinoma treat with WLE
Which anorectal abscesses will need REUA?
complex abscesses: intersphincteric, supralevator, horseshoe abscesses
what is the greatest risk to I&D of perirectal abscess?
recurrent abscess, 40% within first year
most common cause of I&D failure of perirectal abscess
incomplete drainage or unidentified fistula
where is a perianal abscess
in the perianal space, superficially at the anal verge and continuous with the ischioanal fossa laterally
where is an ischioanal abscess
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)
Where is an intersphincteric abscess
in the intersphincteric place between the internal and external sphincter muscles
where is a supralevator abscess?
in the extraperitoneal supralevator space bounded medially by the rectum and laterally by the pelvic side wall
require imaging
how do you drain a horseshoe abscess
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
T/F: abscess drainage with concomitant fistulotomy may be performed with caution for simple anal fistulas
true
what kind of abscess is number 1?
supralevator
what kind of abscess is number 2?
horse shoe
what kind of abscess is number 3?
ischiorectal
what kind of abscess is number 4?
intersphincteric
what kind of abscess is number 5?
perianal abscess
the dentate line represents the border between, what?
embryonic endoderm and ectoderm
at the dentate line there are columns of ?
Morgagni that contain anal crypts at their bases
the anoderm is the border between the?
anoderm and skin (has hair, sweat glands, sebaceous glands
the internal anal sphincter is a continuation of the?
rectal circular smooth muscle
the external anal sphincter is a continuation of?
levator ani muscles
what are the most common anorectal abscess?
perianal abscess
located just beneath the skin of the anal canal and do not transverse the external anal sphincter
what are the parks classification of anal fistulas?
Types 1-4
what are complex fistulas?
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
which anorectal abscesses can be drained in clinic?
superficial perianal and simple ischiorectal abscesses with an elliptical or cruciate incision
when is a seton usually used for fistulas?
high transsphincteric fistula, supersphincteric fistula, female patients with anterior fistulas, advanced Crohn’s disease
what is the LIFT procedure?
ligation of intershpincteric fistula tract - tract is identified in the plane between the internal and external sphincter and ligated
what is an endoanal advancement flap?
used to obstruct the internal opening of the fistula to eliminate the source of fistula drainage
when are antibiotics used for perirectal abscess/fistula
immunosuppressed, signs of infection, signs of cellulitis, prosthetic valves, heart transplant patients, prior endocarditis
how do you do an internal sphincterotomy?
place a small scalpel into the intersphincteric groove and divide the internal sphincter by turning the scalpel medially
what is the most accurate imaging study to order for patient with complex fistula?
MRI
when is a rigid proctoscopy used?
accurate measurement of the distance from anal verge and exact location of a rectal tumor
colon anastomotic leaks are most likely to happen after which POD?
afer POD 3: dip in anastomotic strength due to collagen degradation coupled with lower level of tensile strength which scar is still maturing
