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Surgery > Colon, Rectum, Anus > Flashcards

Colon, Rectum, Anus Flashcards

1
Q

What are the special features of the colon?

A
  1. Haustrations
  2. Appendices epiploicae
  3. Taenia coli
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2
Q

What are the components of taenia coli

A
  1. Taenia libera
  2. Taenia mesocolica
  3. Taenia omentalis
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3
Q

[Segment of the colon]

widest, least likely to obstruct

A

cecum

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4
Q

[Segment of the colon]

thinnest wall, most common site of perforation

A

cecum

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5
Q

[Segment of the colon]

what is the length of the ascending colon?

A

13cm

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6
Q

[Segment of the colon]

Which is higher, the left or right colic flexure?

A

left

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7
Q

[Segment of the colon]

what is the narrowest portion, most common site of obstruction

A

sigmoid colin

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8
Q

[Segment of the colon]

most common site of volvulus

A

sigmoid colon

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9
Q

[Segment of the colon]

Extremely mobile segment

A

sigmoid

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10
Q

What is the embryologic origin of transverse colon?

A
  1. Proximal - midgut

2. Distal - hindgut

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11
Q

[Segment of the colon]

long straight “tunnel view”

A

Descending colon

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12
Q

[Segment of the colon]

external bulging bluish mass indenting the colon, descending with respiration

A

splenic flexure

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13
Q

[Segment of the colon]

“cathedral ceiling” appearance

A

Transverse colon

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14
Q

[Segment of the colon]

“fool’s cecum”

A

Hepatic flexure

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15
Q

[Segment of the colon]

spiral configuration which can cause the taenia to approximate each other

A

Hepatic flexure

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16
Q

[Segment of the colon]

mercedes benz sign

A

cecum

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17
Q

[Segment of the colon]

pouting lips sign

A

ileocecal valve

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18
Q

[Segment of the colon]

bow and arrow sign

A

appendiceal orifice

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19
Q

What are the branches of your SMA that supplies the colon?

A
  1. Ileocolic
  2. Right colic
  3. Middle colic
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20
Q

What are the branches of your IMA that supplies the colon?

A
  1. Left colic
  2. Sigmoidal branches
  3. Superior rectal
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21
Q

What are the arteries that anastomose in marginal artery of Drummond?

A

Terminal branches of the SMA and IMA

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22
Q

What do you call the anastomosis between the middle colic artery and the SMA and the ascending branch of the left colic artery of the IMA?

A

Arc of Riolan or meandering artery of Moskowitz

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23
Q

The inferior mesenteric vein joins this vein before draining to the portal vein

A

Splenic vein

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24
Q

What are the foregut derivatives of the GIT?

A
  1. Esophagus
  2. Stomach
  3. Pancreas
  4. Liver
  5. Duodenum
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25
Q

What are the midgut derivatives of the GIT?

A
  1. Small intestine
  2. Ascending colon
  3. Proximal colon
  4. Transverse colon
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26
Q

What are the hindgut derivatives of the GIT?

A
  1. Distal transverse
  2. Descending
  3. Rectum
  4. Proximal anus
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27
Q

what do you see in the water soluble contrast enema in patients with Sigmoid volvulus?

A

birds beak deformity

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28
Q

What are the plain abdomen radiographs findings in patients with sigmoid volvulus?

A
  1. Inverted U shaped
  2. Sausage loop
  3. Omega sign
  4. Coffee bean sign
  5. Bent inner tube sign
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29
Q

What is the surgical management for strangulation/unprepared bowel in patients with sigmoid volvulus?

A

Construction of colostomy Hartmann’s pouch

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30
Q

What is the surgical management for patients with cecal volvulus?

A

Right hemicolectomy with primary ileotransverse anastomosis

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31
Q

[Diagnosis]

loop extending from the RLQ to LUQ

A

Cecal volvulus

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32
Q

[Diagnosis]

loop extending from the LLQ to the RUQ

A

Sigmoid volvulus

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33
Q

What is the standard initial therapy for acute sigmoid volvulus?

A

Endoscopic Detorsion / rigid proctosigmoidoscopy

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34
Q

What is the treatment for failed sigmoid volvulus decompression?

A

Emergency Laparotomy

and those with peritonitis too

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35
Q

What are the Abdominal CT scan findings in patients with diverticulitis?

A
  1. Sigmoid diverticula
  2. Thickened colonic wall >4mm
  3. Inflammation with pericolic fat with or without collection of contrast material or fluid
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36
Q

In patients with uncomplicated diverticulitis, how long will you administer a clear liquid diet and broad spectrum antibiotics?

A

7-10 days

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37
Q

What is the surgical management for patients with diverticulitis with abscess

A

drainage

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38
Q

What are the criteria for admission in patients with uncomplicated diverticulitis?

A
  1. High documented fever
  2. Immunocompromised status
  3. Severe abdominal pain
  4. Significant or unstable comorbid conditions
  5. Inability to tolerate oral intake
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39
Q

[Determine the hinchey Stage]

Diverticulitis with a pericolic abscess

A

Stage I

Tx: Percutaneous drainage of abscess, resection with primary anastomosis without diverting stoma

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40
Q

[Determine the hinchey Stage]

diverticulitis with a distant abscess (retroperitoneal, pelvic)

A

Stage II

Tx: percutaneous drainage of abscess, resection with primary anastomosis

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41
Q

[Determine the hinchey Stage]

Purulent peritonitis

A

Stage III

Tx: Hartmann procedure, Diverting colostomy plus percutaneous draninage

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42
Q

[Determine the hinchey Stage]

fecal peritonitis

A

Stage IV

Tx: hartman procedure plus diverting colostomy plus percutaneous drainage

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43
Q

What is the preferred surgical treatment for patients with right sided diverticulitis?

A

Segmental ileocecal resection

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44
Q

What is the anatomic marker to distinguish LGIB from UGIB

A

Ligament of treitz

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45
Q

[Location of LGIB]

Hematochezia

A

LGIB from left side of colon

Rule out massive UGIB

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46
Q

[Location of LGIB]

Maroon-colored stools

A

LGIB from right side of colon

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47
Q

[Location of LGIB]

melena

A

Cecal bleeding

BUT TYPICALLY SEEN IN UGIB

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48
Q

What is the rationale behind doing NGT aspiration in patients with suspected LGIB?

A

Determine the presence or absence of blood proximal to the ligament of treitz

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49
Q

What is the test of choice to identify site of LGIB (which can also be therapeutic)

A

Colonoscopy

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50
Q

What are the drug choices for vasoconstricting agents in patients with LGIB?

A
  1. Vasopressin
  2. Alcohol
  3. Morrhuate sodium or Sodium tetradecyl sulfate
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51
Q

[Inflammatory bowel disease]

Appendectomy is protective

A

ulcerative colitis

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52
Q

[Inflammatory bowel disease]

smoking may prevent disease

A

ulcerative colitis

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53
Q

[Inflammatory bowel disease]

affects any part of the GIT, cobblestone appearance, transmural

A

Crohn Disease

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54
Q

What is the pathognomonic feature of Crohn Disease?

A

Granulomas

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55
Q

[Inflammatory bowel disease]

megacolon is frequent

A

ulcerative colitis

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56
Q

What are the indications for surgery in patients with ulcerative colitis?

A
  1. Active disease unresponsive to medical therapy
  2. Risk of CA
  3. Severe bleeding
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57
Q

What are the indications for surgery in patients with crohn disease?

A
  1. Management of complications

2. Resect a segment that is grossly involved with the disease

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58
Q

[Colorectal CA Pathogenesis: Gene involved]

Normal epithelium to Dysplastic epithelium

A

APC

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59
Q

[Colorectal CA Pathogenesis: Gene involved]

Early adenoma to intermediate adenoma

A

KRAS

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60
Q

[Colorectal CA Pathogenesis: Gene involved]

Late adenoma to CA

A

p53

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61
Q

[Colorectal CA Pathogenesis: Genetic pathways]

chromosomal deletions and aneuploidy; tumors occur in the more distal colon, associated with a poorer prognosis

A

LOJ

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62
Q

[Colorectal CA Pathogenesis: Genetic pathways]

results from errors in mismatch repair and microsatellite instability; tumors are more likely right sided with diploid DNA; better prognosis

A

Replication error pathway

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63
Q

[Colorectal CA Pathogenesis: Genetic pathways]

Also called serrated methylated pathway, epigenetic alterations caused by hypo or hypermethylation of a promoter region resulting to either gene activation or silencing; observed in serrated type of polyps

A

CpG island methylation pathway

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64
Q

Most common location of colorectal polyp?

A

rectosigmoid area

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65
Q

What is the most common histologic type of colorectal polyp?

A

Hyperplastic polyp

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66
Q

Hyperplastic colorectal polyp are considered pre-malignant is its size becomes _____

A

> 2cm

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67
Q

What is the histologic type of colorectal polyp that is asociated with UC and CD?

A

Inflammatory or pseudopolyp

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68
Q

Which histologic type of colorectal polyp is considered premalignant and is treated like an adenomatous polyp?

A

Serrated polyp

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69
Q

____ classification is a clinical tool used to describe the degree of invasion into a pedunculated polyp

A

Haggitt

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70
Q

[Neoplastic Polyp]

Most common type

A

Tubular adenoma

CA risk <5%

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71
Q

[Neoplastic Polyp]

Seen throughout the large intestine

A

Tubulovillous adenoma

CA risk 25%

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72
Q

[Neoplastic Polyp]

predominantly in the rectum

A

Villous adenoma

CA risk 40%

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73
Q

[Neoplastic Polyp]

sessile, velvety, cauliflowerlike grossly

A

Villous adenoma

CA risk 40%

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74
Q

What is the clinical classification used only for sessile colorectal polyp?

A

Kikuchi Classification

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75
Q

[Haggitt Classification]

CA invading though the muscularis mucosa but limited to the head of a peduculated polyp

A

Level 1

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76
Q

[Haggitt Classification]

CA invading the neck of a pedunculated polyp

A

Level 2

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77
Q

[Haggitt Classification]

CA invading the stalk of a pedunculated polyp

A

Level 3

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78
Q

[Haggitt Classification]

CA invading into the submucosa of the bowel wall below the stalk of a pedunculated polyp

A

Level 4

Risk of LN metastasis: 12 to 25%

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79
Q

Oncologic resection is warranted for what Kikuchi or Haggitt Grade

A

Kikuchi SM 3

Haggitt 4

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80
Q

[Kikuchi Classification]

Superficial 1/3 of the submucosa is involved

A

SM 1

Nodal mets = 2%

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81
Q

[Kikuchi Classification]

Superficial 2/3 of the submucosa is involved

A

SM 2

Nodal mets = 8%

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82
Q

[Kikuchi Classification]

deep 1/3 of the submucosa is involved

A

SM 3

Nodal mets = 23%

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83
Q

Early onset colorectal CA due to HNPCC are predominantly seen in which side of the colon? (Right or left)

A

Right

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84
Q

What are the components of your Amsterdam Criteria for diagnosis of HNPCC?

A

3-2-1 rule

3 relatives have histologically verified colorectal CA (one must be first degree relative)

2 successive generations

1 relative must have received a diagnosis before age 50

Exclude FAP

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85
Q

What variant of HNPCC wherein there is an isolated early onset colorectal CA?

A

Lynch Syndrome 1

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86
Q

What variant of HNPCC wherein the colorectal CA and tumors of the endometrium, ovary, stomach, small bowel, hepatobiliary tract, pancreas, ureter, renal pelvis?

A

Lynch Syndrome II

87
Q

____ refers to a rare hereditary, autosomal dominant cancer, affected genes are MLH1, MSH2, MSH6

A

Muir-Torre Syndrome

88
Q

What are the findings consistent with Peutz-Jegher Syndrome?

A

Hamartomas

89
Q

[Diagnosis]

rectal bleeding, IDA, change in bowel habits, abdominal pain, intestinal obstruction

A

Colorectal CA

90
Q

[Right or left sided colorectal CA]

occult bleeding, anemia, melena, postprandial discomfort, weakness

A

Right side

since it has large lumen, tumor must attain a large size before causing symptoms

91
Q

[Right or left sided colorectal CA]

goat-stool-like stools, colicky pain, alternating diarrhea, constipation, bloody stools, tenesmus

A

Left side

Since it has a smaller lumen, symptoms can present earlier

92
Q

[Colorectal CA Early Detection]

When will you begin screening men an women who are at average risk for developing colorectal CA?

A

50 years old

93
Q

[Colorectal CA Early Detection]

FOBT or FIT should be done every __

94
Q

[Colorectal CA Early Detection]

Flexible sigmoidoscopy should be done every

95
Q

[Colorectal CA Early Detection]

FOBT or FIT + Flexible Sigmoidoscopy should be done every

96
Q

[Colorectal CA Early Detection]

Double contrast barium enema should be done every

97
Q

[Colorectal CA Early Detection]

Colorectal CA should be done every ____

98
Q

[Colorectal CA Early Detection]

What is the best screening tool for Colorectal CA?

A

Colonoscopy

99
Q

What screening test for colorectal CA what is both diagnostic and therapeutic?

A

Colonoscopy

100
Q

What tumors of the colon can be reached via Digital Rectal Exam and Anoscopy?

A

Only mid and distal rectum

101
Q

A rigid proctoscopy can only cover what length of the colon?

102
Q

What is the preferred method in evaluating the rectum? (Rigid or flexible instrument)

A

Rigid or Flexible

Fexible sigmoidoscopy gives inaccurate measurements if used at the rectum

103
Q

What are the advantages of using flexible sigmoidoscopy?

A
  1. Reaches the proximal left colon

2. Reaches the splenic flexure

104
Q

What is the role of imaging techniques like contrast enema, CT, MRI, transrectal UTZ in colorectal CA?

A

Important in the evaluation, staging, follow-up

105
Q

CEA as a marker for colorectal CA is produced by what cells in the intestinal mucosa?

A

Cells originating from the primitive endoderm

106
Q

What is the role of CEA monitoring in Colorectal CA?

A

used for treatment monitoring

Its rise after successful surgical resection suggests recurrence

107
Q

[Rectal UTZ finding]

UT1 means that the mass invades the ___

108
Q

[Rectal UTZ finding]

UT2 means that the mass invades the ___

A

Muscularis propria

109
Q

[Rectal UTZ finding]

UT3 means that the mass invades the ___

A

Perirectal Fat

110
Q

[Rectal UTZ finding]

UT4 means that the mass invades the ___

A

Adjacent organs

111
Q

[Colorectal CA Stage]

Tumor in the submucosa
Node involvement
No metastasis

A

Stage III

ANT tumor, with LN involvement, stage 3 agad

112
Q

What is used in mechanical cleansing lavage solution prior to colorectal CA surgical treatment?

A

Polyethelyne glycol in a balanced salt solution

4 liters in 4 hours

113
Q

What are the antibiotic of choice for bowel preparation prior to colorectal CA surgery?

A

Neomycin + erythromycin one day beofre the operation

1pm, 2pm and 11pm

114
Q

[Surgical Management]

If the tumor is located in the cecum

A

Right hemicolectomy

Extent: Terminal ileum to mid transverse colon

115
Q

[Surgical Management]

If the tumor is located in the ascending colon

A

Right hemicolectomy

Extent: Terminal ileum to mid transverse colon

116
Q

[Surgical Management]

If the tumor is located in the hepatic flexure

A

extended right hemicolectomy

Extent: Terminal ileum to distal transverse colon

117
Q

[Surgical Management]

If the tumor is located in the splenic flexure

A

Extended left hemicolectomy

Extent: splenic flexure to rectosigmoid junction

118
Q

[Surgical Management]

If the tumor is located in the descending colon

A

left hemicolectomy

Extent: splenic flexure to rectosigmoid junction

119
Q

[Surgical Management]

If the tumor is located in the sigmoid colon

A

rectosigmoid resection

Extent: distal descending colon to rectosigmoid junction

120
Q

What are the indications for total or subtotal colectomy with ileorectal anastomosis?

A
  1. HNPCC
  2. Attenuated FAP
  3. Synchronous CA in separate colon segments
  4. Acute malignant distal colon obstructions with unknown status of proximal bowel
121
Q

What are the post-operative components ERAS protocol for elective colorectal surgery?

A
  1. Early oral nutrition
  2. Early ambulation
  3. Early catheter removal
  4. Use of chewing gum
  5. Defined discharge criteria
122
Q

What are the intra-operative components ERAS protocol for elective colorectal surgery?

A
  1. Active warming
  2. Use of multi-modal pain management
  3. Surgical techniques
  4. Avoidance or prophylactic NG tubes and drains
123
Q

What are the ERAS protocol components for elective colorectal surgery that are applicable to both intra-and post-operative??

A
  1. Use of multi-modal anti-emetic prophylaxis

2. Use of goal directed peri-operative fluid therapy

124
Q

What are the major blood vessels (artery) affected in right hemicolectomy?

A
  1. Ileocolic
  2. Right colic
  3. Right branch of middle colic
125
Q

What are the major blood vessels (artery) affected in extended right hemicolectomy?

A
  1. Ileocolic
  2. Right colic
  3. Root of middle colic
126
Q

What are the major blood vessels (artery) affected in extended left hemicolectomy?

A
  1. Left branch middle colic
  2. Left colic
  3. Inferior mesenteric
127
Q

What are the major blood vessels (artery) affected in left hemicolectomy?

A
  1. Inferior mesenteric

2. Left colic

128
Q

What are the major blood vessels (artery) affected in rectosigmoid resection?

A
  1. Inferior mesenteric

2. Superior rectal

129
Q

At what vertebral level where the sigmoid loses its mesentery and gradually becomes the rectum?

A

Mid sacral level

130
Q

Which part of the valve of houston wherein the convexity is to the left

131
Q

Which of the valve od houston wherein the convexity is to the left

A

upper and middle

132
Q

What is the eponym of the middle valve of rectum

A

Kohlrausch valve

133
Q

What is the level corresponding the kohlraush valve?

A

anterior peritoneal reflection

134
Q

What is the most consistent valve of the rectum

A

Middle valve (Kohlraush valve)

135
Q

What is the anatomic landmark of proximal rectum?

A

Third Sacral Vertebra (S3)

136
Q

What is the anatomic landmark of distal rectum?

A

Dentate line

137
Q

What is the Surgical landmark of proximal rectum?

A

Sacral promontory

138
Q

What is the surgical landmark of proximal rectum?

A

anorectal ring

139
Q

What do you call the part of the anal canal that remains closed when the buttocks are gently retracted

A

Anal verge

140
Q

What do you call the perianal skin overlying outside the anal verge?

A

anal margin

141
Q

What do you call the longitudinal mucosal folds of the anus?

A

Columns of morgagni

8-14 longitudinal muscle folds

142
Q

What are the borders of the anatomic canal of the rectum?

A

Anal verge to Dentate line

Length: 1 to 1.5cm

143
Q

What are the borders of the surgical canal of the rectum?

A

Anal verge and Anorectal line

Length: 2 to 2.5cm

144
Q

The external anal sphincter is a continuation of what muscle?

A

Puborectalis

145
Q

Muscle of the anal canal that represents the distal condensation of the circular muscle layer

A

Internal sphincter

146
Q

The conjoined longitudinal muscle of the anal canal is composed of ____

A
  1. Outer longitudinal layer of the rectum

2. Fibers of the levator ani muscle

147
Q

What are the functions of the conjoined longitudinal muscle?

A
  1. Attach the anorectum to the pelvis
  2. Skeleton that supports and binds the internal and external sphincter complex
  3. Acts as a support to prevent hemorrhoidal and rectal prolapse
  4. Potentialization effect in maintaining an anal seal
148
Q

What are the components of levator ani muscle?

A

1 .Pubococcygeus

  1. Iliococcygeus
  2. Puborectalis
149
Q

[Fascial Layers of the anorectal region]

lines the rectum, part of the visceral layer of the endopelvic fascia

A

Fascia propria

150
Q

[Fascial Layers of the anorectal region]

separates the anterior rectum from the vagina in females and prostate and seminal vesicle from males

A

Denonvilliers fascia

151
Q

[Fascial Layers of the anorectal region]

fascial condensation between the fascia propria and the presacral fascia at the level of S4

A

Waldeyer fascia (Rectosacral fascia)

152
Q

[Fascial Layers of the anorectal region]

separates the posterior rectum from the sacral vessels and pelvic nerves

A

Presacral fascia

153
Q

[Arterial supply of the rectum]

From the terminal branch of the IMA

A

Superior rectal

154
Q

[Arterial supply of the rectum]

From the internal iliac artery

A

Middle rectal

155
Q

[Arterial supply of the rectum]

from the internal pudendal artery

A

Inferior rectal artery

156
Q

What is the venous drainage of the structures above dentate line

A

Inferior mesenteric vein then to the portal vein

157
Q

What is the venous drainage of the structures below the dentate line

A

Drains to the internal pudendal vein then to the internal iliac vein

158
Q

[Lymphatic drainage of the rectum and anus]

The upper and middle rectum

A

Pararectal nodes then to inferior mesenteric node

159
Q

[Lymphatic drainage of the rectum and anus]

lower rectum

A

para rectal nodes then to inferior mesenteric and internal iloac nodes

160
Q

[Lymphatic drainage of the rectum and anus]

anal canal above the dentate line

A

inferior mesenteric and internal iliac nodes

161
Q

[Lymphatic drainage of the rectum and anus]

anal canal below the dentate line

A

primarily into the medial group of superficial inguinal nodes

162
Q

What is the importance of the mesorectum?

A

can be a metastatic site for rectal CA

163
Q

What are the indications of low anterior resection?

A
  1. Lesions in the middle and upper third of the rectum
164
Q

___ is also called an anal-sparing procedure for tumors in the middle and upper third of the rectum

A

LAR

Temporary colostomy or ileostomy might be necessary to protect anastomosis

165
Q

What structures are removed in the abdominoperineal resection of Rectal tumors?

A
  1. Sigmoid colon
  2. Rectum
  3. Anus

APR: permanent colostomy cinstruction

166
Q

What are the indcations for APR?

A
  1. Perianal skin involvement
  2. Puborectalis and sphincter involvement
  3. Fecal incontinence
167
Q

[Diagnosis]

Abdominal discomfort, incomplete bowel evacuation, straining due to difficult defecation, digital maneuvers to help defecation, long term laxative use

A

Rectal proplapse

Hemorrhoids has no associated SSx

168
Q

[Rectal prolapse or Hemorrhoids]

double rectal wall on palpation/DRE

A

Rectal prolapse

In hemorrhoids, hemorrhoidal plexus are palpated

169
Q

[Rectal prolapse or Hemorrhoids]

tissue folds are radial

A

hemorrhoids

in Rectal prolapse, the tissue folds are circumferential

170
Q

What is the preferred surgical procedure for an elderly patient with multiple comorbidities with rectal prolapse?

A

Transperineal approach

171
Q

What are examples of your transperineal approach for rectal prolapse management?

A
  1. Anal encirclement (thiersh wire procedure)
  2. Mucosal sleeve resection (delorme)
  3. Perineal rectosigmoidoscopy (altemeier procedure)
172
Q

What are the main hemorrhoidal complexes that traverse the anal canal

A

3-7-11

  1. Left lateral (3 o’clock)
  2. Right posterior (7 o’clock)
  3. Right anterior (11 o’clock)
173
Q

[External or internal hemorrhoids]

itching, pain, thrombosed

A

External hemorrhouds

174
Q

What is the most effective topical treatment for relief of symptoms of patients with hemorrhoids

A

Warm Sitz Bath

40 degC, soak for 15 mins

175
Q

What will be the effect to the patient if the rubber band ligation for an internal hemorrhoid is done close to the dentate line?

A

Intense pain post procedure

176
Q

What will you do if a patient with external hemorrhoid presents with intense pain <72 hours onset?

A

Offer excision

177
Q

[management of choice: Internal Hemorrhoids]

Protruding through the anal canal but not beyond the anal verge

A

This is Grade I

Offer medical, sclerotherapy, RBL

178
Q

[management of choice: Internal Hemorrhoids]

protrusion but with spontaneous reduction

A

This is Grade II

Offer medical, sclerotherapy and RBL

179
Q

[management of choice: Internal Hemorrhoids]

protrusion requiring manual reduction

A

This is grade 3

offer medical and surgical.

in selected cases, sclerotherapy and RBL

180
Q

[management of choice: Internal Hemorrhoids]

protrusion that cannot be reduced

A

Medical and surgical.

You cannot do sclerotherapy or RBL

181
Q

What do you call (eponym) a hemorrhoidectomy technique wherein you close the dfect first after hemorrhoidectomy

A

Parks-Ferguson hemorrhoidectomy

182
Q

What is the preferred surgical technique for patients with thrombosed hemorrhoids?

A

Milligan-Morgan Method

DO NOT SUTURE THE DEFECT

183
Q

Where is the tear located in patients with anal fissure?

A

distal to the dentate line

184
Q

How will you drain a supralevator abscess that is a result from an upward extension of an inter-sphincteric abscess?

A

Drain transrectally

Remember: intersphincteric between sphincters

185
Q

Why will you not do a transperineal drainage for a supralevator abscess from an upward extension of an intersphincteric abscess?

A

It can cause a suprasphincteric fistula

Remember: intersphincteric = between 2 sphincters

186
Q

How will you drain a supralevator abscess that is a result of upward extension of a trans-sphincteric fistula or an ischiorectal abscess?

A

Drain transperineally

If drained transrectally, extra sphincteric fistula will be the result

187
Q

What is the surgical treatment of choice for superficial fistula-in-ano?

A

Fistulotomy

188
Q

What is the surgical treatment of choice for intersphincteric tract?

A

Ligation of intersphincteric fistula tract

189
Q

A fistula that originates anterior to the tranverse line will course ____

A

Anteriorly in a direct or radial route

Except if the anterior fistula lies more than 3cm from the anus can have a curvilinear tract draining to the posterior midline

190
Q

A fistula that originate posterior to the transverse line will have a ))))

A

curved path; the internal opening is at the posterior midline

191
Q

[Crohn or UC]

which is associated with perianal fistula?

192
Q

[Anal canal/anal margin tumors]

lesions that cannot be visualized at all while gentle traction is placed on the buttocks

A

Anal canal tumor

above the dentate line

193
Q

[Anal canal/anal margin tumors]

lesion completely visible when gentle traction is placed in the buttocks

A

Anal margin tumors

below the dentate line

194
Q

Tumors that fall more than 5cm from the radius of the anal opening is classified as?

A

skin tumor

not anal canal/margin tumor

195
Q

Where is the usual location of more advance anal region neoplasm?

A

distal anal canal

196
Q

What are the components of staging workup for anal CA?

A
  1. CT of the chest, abdomen, pelvis

2. Trans anal UTZ to assess depth of invasion and establish size of tumor

197
Q

What is the medical management for anal canal CA?

A

Nigro Protocol

5FU, Mitomycin C, Radiotherapy

198
Q

What is the surgical management of choice for patients with <1cm, well differentiated anal canal SCCA?

A

1Wide local excision

199
Q

What is the surgical management of choice for anal SCCA sessile lesions?

A

Remove via piecemeal tecnhique

200
Q

What is the surgical management for an anal margin SCC with no sphincter invasion?

A

Wide local excision to negative margins

201
Q

What is the surgical management for an anal margin SCC with sphincter invasion or a significantly large mass?

A

Chemotherapy + radiotherapy

202
Q

What is the surgical management for an anal margin SCC that is <2cm, well-differentiated, without evidence of nodal spread

A

Anal margin SCC

203
Q

What is the surgical management for an anal margin SCC if adequate excision compromises sphincter?

204
Q

In patients with Hirschsprung disease, what will be the use of doing Barium enema?

A

Demonstrate transition zone

205
Q

What will be demonstrated in suction rectal biopsy for patients with hirschsprung disease>

A
  1. Absence of ganglion cells in the myenteric and submucosal plexus
  2. Increased acetylcholinesterase positive nerve fibers
  3. Hypertrophied nerve bundles
206
Q

[Surgical Options for hirschsprung]

side to side anastomosis; residual pouch of aganglionic bowel left intact with the ganglionic bowel attached behind

A

Duhamel

Duha = side to side

207
Q

[Surgical Options for hirschsprung]

Resection of aganglionic segment with end to end anastomosis

A

Swenson

simple connection lang

208
Q

[Surgical Options for hirschsprung]

mucosa of aganglionic segment stripped but the outer muscular cuff is left, and anastomosis is done

A

Soave

strip aganglionic segment

209
Q

What is the anatomic marker to distinguish a high vs low type imperforate anus?

A

Levator ani

210
Q

What do you call an x-ray imaging technique specifically used to assess imperforate anus?

A

Rice Wangensteen X-ray Cross table lateral

211
Q

What is the surgical management for low type imperforate anus?

A

Perineal approach without colostomy

212
Q

What will be the surgical technique for a high type imperforate anus?

A

Colostomy then pull-through

213
Q

What are the anatomic markers seen in rice wangensteen x-ray that used to classify imporforate anus

A

Pubococcygeus (PC)
Ischial Spine (I line)
M line

214
Q

[Classify the imperforate anus]

gas bubble is above the PC line

A

High anomaly imperforate anus

Surgery (19 decks)

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