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Colorectal Flashcards

1
Q

Impediments to spontaneous closure of fistulas

A

Foreign body, radiation, inflammation/infection, epithelialization, neoplasia, distal obstruction

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2
Q

Highest risk factor for post op anastomotic leak

A

Fecal contamination. Also, intraop blood loss

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3
Q

Management of fistula in Crohn’s disease

A

Infliximab

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4
Q

Most sensitive step during colonoscopy to rule out GI bleed

A

Intubated the TI

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5
Q

Rx for early return of bowel function after colon surgery

A

12mg Alvimopan preop continued 7 days postop

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6
Q

Haggitt classification

A

0 - superficial to muscularis mucosa
1 - submucosal invasion head of polyp
2 - neck
3 - stalk
4 - below stalk or sessile polyp

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7
Q

Kikuchi classification

A

Sm1 - Upper 1/3 submucosa
Sm2 - Upper 2/3
Sm3 - Lower 1/3

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8
Q

Operative planning rectal cancer

A

CT CAP
MRI pelvis
Rigid proctoscopy

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9
Q

Preop study prior to repair of bladder/rectum prolapse

A

Colonoscopy and urodynamic studies

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10
Q

Best surgical treatment for constipation

A

Total abdominal Colectomy with ileorectal anastomosis

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11
Q

Best diagnostic test for colonic inertia

A

Sitz marker study

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12
Q

UC extraintestinal conditions (which does not resolve with Colectomy)

A

Arthritis, ankylosing spondylitis, erythema nodosum, pyoderma gangrenosum, PSC*

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13
Q

Site of colon and rectum with greatest absorptive capacity

A

Ascending colon

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14
Q

DVT ppx s/p abdominal/pelvic cancer operations

A

28 days LMWH

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15
Q

T3/4 rectal cancer; tx

A

Neoadjuvant chemorads, surgery, adjuvant

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16
Q

Surveillance following endoscopic resection colon cancer

A

Scope 3month, 1 year, 3 years, 5 years

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17
Q

Correct ostomy placement

A

Summit of infraumbilical fold in rectus

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18
Q

Massive GI bleed; surgical tx

A

TAC with end ileostomy

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19
Q

Gold standard for dx of colonic pseudoobstruction

A

CT

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20
Q

Postop surveillance s/p colorectal cancer surgery

A

Clinical exam and CEA 3-6mo for 2, 6mo for 5
CT every 6-12mo for 5 if high risk for recurrence
Colonoscopy 1 yr, 3 then 5

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21
Q

IBS criteria

A

Rome IV; recurrent abdominal pain (at least 1 day/week in the last 3 months) associated with 2 or more:
Related to defecation
Change in stool frequency
Change in stool form

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22
Q

Criteria for transanal endoscopic microsurgery (TEM)

A

T1 without high risk features, <3cm, <30% circumference, 5-15cm from anal verge

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23
Q

Transvaginal repair of rectocele; Critical step

A

Plication of the vaginal muscularis and rectovaginal tissues

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24
Q

Polyp invading submucosa at splenic flexure; tx

A

Extended left hemicolectomy

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25
Sigmoid volvulus; tx
Colonic decompression, but needs resection same admission due to high recurrence risk
26
UC with visible high grade dysplasia; next step
Repeat endoscopy with bx 3-6months
27
New diagnosis of UC; next screening colonoscopy
8 years
28
High risk based on fm hx for colon cancer; screening colonoscopy
Age 40 or 10 yrs earlier than relative's age at dx
29
Rectal carcinoid <1cm; tx
Endoscopic or local excision alone
30
Indications for total proctocolectomy in patients with UC
Invisible multifocal low grade dysplasia, invisible high grade dysplasia
31
WHO classification polyps
Epithelial (adenoma, carcinoma, carcinoids, mixed) Non-epithelial (lipoma, leiomyoma, GIST, angiosarcoma, melanoma, Kaposi's sarcoma) Polyps (hyperplastic, PJ, juvenile) Secondary tumors
32
Rectal bleeding s/p AAA repair; next step
Sigmoidoscopy
33
Cefoxitin redosing intraop
2hrs
34
Endometrial, thyroid, breast, renal, colon cancer; syndrome and gene
Cowden syndrome, PTEN May have hamartomas and skin lesions as well
35
FAP s/p TAC with IRA; surveillance
yearly endoscopy
36
Amsterdam II Criteria; dx, genes and criteria
HNPP or Lynch syndrome (MLH1, MSH2/6, PMS2) At least 3 relatives with colorectal, endometrial, SB, ureter or renal pelvis cancer At least 2 successive generations affected At lest 1 before age 50
37
Gastric, pancreatic, SB cancer, cardiovascular defects; syndrome and gene
Juvenile polyposis syndrome, SMAD4 and BMPR1A
38
Gastric, panc, SB cancer with peri oral pigmentation; syndrome and gene
Peutz-Jegher, STK11
39
Gastric, duodenal, bladder, breast, ovarian cancer; syndrome and gene
MUTYH-asociated polyposis
40
Duodenal, gastric, pancreatic multiple polyps; syndrome and gene
Familial adenomatous polyposis, APC
41
Risks of colon radiation
Radiation colitis; ulcers, telangiectasias, fistulas
42
Bowel obstruction with pigmented mucosal lesions; dx
PJ, hamartomatous polyp causing intussusception
43
Post-strictureplasty hemorrhage; tx
Observe
44
Lower GI bleed stable after transfusion/resuscitation; next step
Prep -> colonoscopy
45
Colon cancer margin and nodes
2-5cm at least 12 nodes
46
Candidates for primary surgical therapy in rectal cancer
T1 or T2 (invade submucosa or muscular propria) without clinical nodes
47
Acute diverticulitis failed non-op management; tx
Sigmoidectomy with primary anastomosis with diversion vs end-colostomy
48
Ascending colon cancer; tx
Right colectomy
49
Hepatic flexure cancer; tx
Extended right colectomy
50
No prior colon evaluation now s/p colon resection for obstructing lesion; surveillance
3-6months post-op
51
Colonic lipoma; tx
Observe, if >2cm can be endoscopically resected
52
Hinchey Classification
Ia - pericolic inflammation/phlegmon Ib - pericolic abscess II - pelvic/distant abscess III - purulent peritonitis IV - feculent peritonitis
53
Normal colonoscopy polyps (10yr f/u)
20 or less hyperplastic polyps <1cm
54
3-4 tubular adenomas <1cm or greater 1cm hyperplastic polyp; surveillance interval
3-5yrs
55
5-10 adenomas Sessile polyp > 1 cm High-risk polyp (TV or Villous >1cm, high grade dysplasia; surveillance interval
3years
56
>10adenomas; surveillence interval
1yr
57
Adenoma removed piecemeal; surveillance interval
3-6months
58
Appendiceal neuroendocrine tumors requiring staging workup and right hemicolectomy
>2cm Poor prog features (high mitotic or Ki67) Involve base Positive nodes/margins Goblet cell histology
58
Appendiceal neuroendocrine tumors requiring staging workup and right hemicolectomy
>2cm Poor prog features (high mitotic or Ki67) Involve base Positive nodes/margins Goblet cell histology
59
Antibiotic bowel prep prior to colon surgery
Neomycin 1g + Erythromycin 1g or Neomycin 1g + Metronidazole 1g (3 doses over 10hrs afternoon and evening before operation)
60
Preop IV abxs prior to colon surgery
Cephalosporin 2g + Flagyl 500mg IV OR Clinda 900mg + Levoflxacin 500mg (1hr prior)
61
Colon cancer preop workup
CT CAP, colonoscopy, CEA, labs

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