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Surgery > Colon, Rectum, Anus > Flashcards

Colon, Rectum, Anus Flashcards

1
Q

Goals for short term follow-up after bariatric surgery?

A
  1. Maximize care of the patient in the post-operative period.
  2. Assist in the adjustment to new eating , exercise, and lifestyle patterns.
  3. Be on alert for and treat postoperative complications.
  4. Recommend measures to limit such complications.
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2
Q

Goals of long- term follow up after bariatric surgery?

A
  1. Weight gain
  2. Management of comorbid condition relapse
  3. Emergence of recurrent depression, substance and alcohol misuse and nutritional complications.
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3
Q

Most common omental neoplasms?

A

Metastatic disease

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4
Q

Blood vessels involved in rectus sheath hematoma?

A

Inferior epigastric artery

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5
Q

Most common cause of small bowel obstruction ?

A

Adhesions

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6
Q

Rare disease defined as compression of the third portion of the duodenum between the abdominal aorta and the superior mesenteric artery.

A

Superior Mesenteric Artery Syndrome / Wilkie’s Syndrome

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7
Q

Second cancer diagnosed more than 6 months after the diagnosis of the first primary cancer

A

Metachronous colorectal cancer

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8
Q

Grade of hemorrhoids for which infrared photocoagulation may be used?

A

Grade I & II

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9
Q

Nonbilious vomiting that becomes increasingly projectile , inability to tolerate feeds and sometimes associated with jaundice?

A

Hypertrophic pyloric stenosis

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10
Q

Surgical management of infant with low type imperforate anus?

A

Perineal operation (Anoplasty) without a colostomy

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11
Q

Goals for post-bariatric surgery?

A
  1. Hemoperitoneum
  2. Adjusting to eating patterns
  3. Early identification of post-operative complications and preventive measures
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12
Q

Contributory factors to the development of GERD?

A
  1. Defective lower esophageal sphincter tone
  2. Degree of hiatal herniation
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13
Q

Important lab test for pre-op management of patient with acute abdomen?

A

Specimen of blood for cross matching should be sent whenever urgent surgery is anticipated

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14
Q

Signs of acute abdomen requiring urgent surgery

A
  1. Bleeding
  2. Ischemic bowel
  3. Perforated viscus
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15
Q

Best approach for vertical band gastroplasty in bariatric surgery?

A

Laparoscopic

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16
Q

Clinical features of acute abdomen?

A
  1. Washboard abdomen
  2. Absent bowel sounds
  3. Involuntary guarding
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17
Q

Surgical objectives for resection of gastric carcinoma?

A
  1. Tumor with adjacent uninvolved stomach
  2. Duodenum
  3. Regional lymph node
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18
Q

Management of paralytic ileus ?

A

Conservative with clinical and pharmacological management

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19
Q

Bowel preparation prior to surgical resection of bowel?

A
  1. Antibiotics
  2. Enema
  3. Laxatives
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20
Q

Risk factors for the development of colon cancer?

A
  1. Ulcerative colitis
  2. Crohn’s colitis
  3. Inflammatory Bowel diseases
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21
Q

Most common cause of mechanical bowel obstruction for post hysterectomy patients?

A

Adhesion

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22
Q

Condition associated with synchronous GIT adenocarcinoma?

A

Extramammary perianal paget’s disease

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23
Q

Laxative that produces hydrogen and methane gases that can explode with electrocautery?

A

Mannitol

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24
Q

Management for complete small bowel obstruction?

A

Expeditious surgery

“ the sun should never rise or set on a complete bowel obstruction “

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25
Q

Watershed area of the colon supplied by SMA & IMA?

A

Splenic flexure

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26
Q

After massive bowel resection due to mesenteric vascular occlusion resulting in short gut syndrome, A 55 yo M is started with TPN. Which of the ff electrolyte abnormalities characterizes re-feeding syndrome?

A
  1. Hypokalemia
  2. Hypomagnesemia
  3. Hypophosphatemia
  4. Hypocalcemia
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27
Q

Prolonged post-operative ileus is defined as that which is seen beyond how many days after surgery?

A

5 days

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28
Q

After colonoscopic polypectomy a 2cm polyp, 4 cm from the anal verge turned out to be an adenomatous polyp. The most appropriate step to do next is?

A

Abdomino-perineal resection

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29
Q

Colonic pseudo-obstruction is also known as?

A

Ogilvie’s Syndrome

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30
Q

Massive dilatation of the colon in the absence of mechanical obstruction?

A

Colonic pseudo-obstruction ( Ogilvie Syndrome)

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31
Q

Pre-op bowel preparation is not done in which case?

A

Complete intestinal obstruction

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32
Q

The development of rectus sheath hematoma after a prolonged labor is usually due to a break in which vessel?

A

Inferior epigastric artery

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33
Q

The most common tumor of the omentum is?

A

Lipoma

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34
Q

Hepatic resection is most commonly considered for localized metastatic spread from which of the following primary site?

A

Colorectal

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35
Q

A 50 yo / F complains of constipation and anal pain with a MRI finding of posterior extra rectal mass that is adherent to the sacrum. What is most likely the diagnosis?

A

Chordoma

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36
Q

Which of the following is true regarding mesh hernia repair?

A

Must be done for recurrent hernias

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37
Q

The most common content of a complete indirect inguinal hernia is?

A

Small intestine

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38
Q

Which of these abdominal wall hernias arise from the arcuate line?

A

Spigelian

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39
Q

The life-threatening complication of obstructive hydrocephalus is ?

A

Herniation

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40
Q

Through a McBurney incision, the appendix and the rest of the visible / palpable structures were normal. Which of the following is true?

A

The normal appendix should be removed

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41
Q

Layer of the abdominal wall that does not have a corresponding layer in the scrotum ?

A

Transversus abdominis

Doesn’t reach the scrotum

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42
Q

Anatomic areas of interest seen in laparoscopic hernia repair?

A
  1. Triangle of doom
  2. Triangle of pain
  3. Circle of death
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43
Q

Borders of the inguinal triangle of Hasselbach?

A
  1. Rectus abdominis muscle (medial)
  2. Inferior epigastric vessels (superolateral)
  3. Inguinal ligament (inferolateral)
44
Q

Most common subtype of groin hernia in women?

A

Indirect inguinal hernia

45
Q

Location of direct inguinal hernia in relation to the epigastric vessels?

A

Medial or inferior to the inferior epigastric vessels

46
Q

Location of indirect inguinal hernia in relation to the epigastric vessels?

A

Lateral or superior to the inferior epigastric artery

(ILSI)

47
Q

Gold standard for the diagnosis of inguinal hernias?

A

History & PE

48
Q

Findings of trans illumination test for cystic and solid testicular masses?

A

Cystic- light shines through
Solid- light blocked by mass

49
Q

Location of the neck of a femoral hernia in relation to the pubic tubercle?

A

Above and Medial to the Public tubercle

50
Q

Location of the indirect inguinal hernia in relation to the pubic tubercle?

A

Below and lateral to the pubic tubercle

IBL

FAM : Femoral Above & Middle

51
Q

Operative technique for primary unilateral inguinal hernias in males?

A

Mesh repair

Either Litchenstein or Laparoscopic repair

52
Q

Type of SBO where the bowel is occluded at two points such that the proximal and distal loops and mesentery are entrapped in a single constrictive lesion?

A

Closed-loop obstruction

53
Q

Parameters used to assess bowel viability during surgery? (5)

A
  1. Color
  2. Peristalsis
  3. Marginal arterial pulsations
  4. Necrosis
  5. Perforations
54
Q

Temporal sequence of normal gastrointestinal motility?

A
  1. Small intestinal : 24 hrs
  2. Gastric: 24-48 hrs
  3. Colonic: 2-5 days

Its in reverse alphabetical order
( S - G- C )

55
Q

Factors that inhibit spontaneous closure of intestinal fistulas?

A

FRIEND
1. Foreign body
2. Radiation enteritis
3. Infection or Inflammation at the fistula origin
4. Epithelialization of the fistula tract
5. Neoplasm at the fistula origin
6. Distal obstruction of the intestine

56
Q

Anatomic definition of short bowel syndrome?

A

<200cm of residual bowel in adults

57
Q

Meeting points of the 3 taenia coli?

A

Base of the appendix and rectosigmoid junction

58
Q

Location of the appendix when abdominal findings are less striking and flank maybe the most tender part?

A

Retrocecal

59
Q

Ultrasound findings in appendicitis?

A
  1. Wall thickening
  2. Periappendiceal fluid
60
Q

Imaging of choice for appendicitis in pregnancy?

A

Ultrasonography

61
Q

Standard care of presumed uncomplicated appendicitis?

A

Operative treatment

62
Q

Management of an appendiceal carcinoid 1.5 cm in size located at the base of the appendix?

A

Right hemicolectomy

63
Q

Tumors that may present with diffuse collection of gelatinous fluid and mucinous implants on peritoneal surfaces and omentum?

A

Appendiceal and Ovarian tumors

This case is Pseudomyxoma peritonei

64
Q

Finding seen in water-soluble contrast enema in sigmoid volvulus ?

A

Birds beak deformity

65
Q

Timing of contrast (barium) enema or colonoscopy in diverticulitis?

A

6 weeks after an attack

These may cause perforation during an acute attack. They are one to rule out malignancy.

66
Q

Indications for surgery of Crohn’s disease?

A

Management of complications

Note:
Not a cure for disease since recurrence is common vs Ulcerative colitis where total protocolectomy can be curative

67
Q

Genes linked to hereditary nonpolyposis colorectal cancer (HNPCC) or Lynch Syndrome.

A

DNA mismatch repair (MMR) Genes

68
Q

Location of colon cancer associated with changes in bowel habits and hematochezia?

A

Left sided lesions

69
Q

Location of colon cancer where there is postprandial discomfort , weakness , occult bleeding , anemia, melena.

A

Right sided lesions

70
Q

Starting age for colorectal cancer screening in average risks individuals?

A

50 years old

71
Q

Glycoprotein absent from normal adult intestinal mucosa but present in primitive endoderm?

A

Carcinoembryonic antigen (CEA)

Cannot be used as screening test but useful in treatment monitoring after apparently successful surgical treatment

72
Q

Second cancer diagnosed more than 6 months after diagnosis of first primary?

A

Metachronous

Note:
Synchronous : if second cancer was diagnosed within 6 months of the primary cancer

73
Q

8-14 longitudinal mucosal folds present in the anus?

A

Columns of Morgagni

74
Q

Surgery correlated with lower recurrence rates among patients with rectal cancer due to the mesorectum being a site for matastasis of rectal cancer.

A

Total Mesorectal Excision (TME)

75
Q

Another name for parasympathetic fibers originating from S2-S4 that innervate the anoderm?

A

Nervi erigentes

76
Q

Tissue fold configuration in rectal prolapse vs hemorrhoids?

A

Rectal prolapse: Circumferential
Hemorrhoids: Radial

77
Q

Internal hemorrhoid grades where infrared photocoagulation is an acceptable procedure?

A

Grade I & Grade II

78
Q

Tear in the anoderm just distal to the dentate line ?

A

Anal fissure

79
Q

Suprasphincteric fistula that encompasses the entire sphincter apparatus?

A

Type 3 Fistula in ano

80
Q

Absent in Hirschsprung’s disease resulting in functional obstruction?

A

Auerbach plexus = Myenteric plexus

81
Q

Condition resulting from the failure of the rectum to descend through the external sphincter complex?

A

Imperforate anus

82
Q

Hernia that occurs superior or lateral to the Inferior Epigastric vessels.

A

Indirect Inguinal Hernia

ISLI ( Indirect Superior Lateral Inferior epigastric vessels)

83
Q

Hernia that occurs inferior or medial to the Inferior Epigastric vessels.

A

Direct Inguinal Hernia

DIMI ( Direct Inferior / Medial Inferior epigastric vessels)

84
Q

What type of Hernia where its neck located above and medial to the pubic tubercle.

A

Inguinal Hernia

IAM

85
Q

What type of Hernia where its neck located below and lateral to the pubic tubercle.

A

Femoral Hernia

BeLat ( Below & Lat = MC in Females - Femoral)

86
Q

Examination technique used in hernia where the index finger is placed at the deep inguinal ring, middle finger at the superficial ring, and ring finger at the saphenous opening.

A

Three Finger Test / Zeimans Technique

87
Q

Zeiman’s technique: What Type of Hernia?
Impulse Felt at deep inguinal ring

A

Indirect Hernia

88
Q

Zeiman’s technique: What Type of Hernia?
Impulse Felt at superficial ring

A

Direct Hernia

89
Q

Zeiman’s technique: What Type of Hernia?
Impulse Felt at saphenous opening

A

Femoral Hernia

90
Q

What type of Hernia?
Ring Occlusion Test : No bulging

A

Indirect Hernia

91
Q

What type of Hernia?
Ring Occlusion Test : Bulging

A

Direct Hernia

Rationale: you occlude the inguinal ring so Indirect hernia will have no bulging. Direct hernia doesn’t pass to the inguinal ring that’s why there’s bulging.

92
Q

Hernia located in the superior lumbar triangle.

A

Grynfeltt’s Hernia

93
Q

Hernia located in the inferior lumbar triangle.

A

Petit’s Hernia

94
Q

Hernia eponyms:
Ritcher’s Hernia

A

Only antimesenteric part

95
Q

Hernia eponyms:
Littre’s Hernia

A

Meckel’s Diverticulum

96
Q

Hernia eponyms:
Mickel’s diverticulum

A

Littre’s Hernia

97
Q

Hernia eponyms:
Direct + Indirect Hernia

A

Pantaloon Hernia

98
Q

Hernia eponyms:
Two loops in the same ring ( W Shaped)

A

Maydl’s Hernia

99
Q

Hernia eponyms:
Appendix

A

Amyand’s Hernia

100
Q

Hernia eponyms:
Anterior diaphragm

A

Morgagni’s Hernia

101
Q

Hernia eponyms:
Posterior Diaphragm Hernia

A

Bochdaleck’s Hernia

102
Q

Hernia eponyms:
Lateral to rectus muscle Hernia

A

Spigelian Hernia

103
Q

Hernia eponyms:
Hernia found only in antimesenteric part

A

Ritcher’s Hernia

104
Q

Which type of hernia does the fundus of the stomach herniate?

A

Type II ( Rolling)

Type I : cardia
Type II - fundus
Type III: cardia + fundus
Type IV: Intestine

105
Q

Fistulas with an external opening located anteriorly 2.75 cm from the anal margin connect to the internal opening by what direction?

A

Short, radial tract to the anterior midline.

Goodsall’s rule dictates that fistulas with an external opening ** anteriorly** connect to the internal opening by short, radial tract. Fistulas with an external opening posteriorly track in a curvilinear fashion to posterior midline. However if the anterior external opening is >3cm from the anal margin, such fistulas tract to the posterior midline.

Surgery (14 decks)

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