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ABSITE > Colorectal > Flashcards

Colorectal Flashcards

1
Q

4 layers of the colon

A

mucosa–> submucosa –> muscularis propria –> serosa

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2
Q

retorperitoneal components of colon

A

ascending, descending, and sigmoid are all retroperitonel

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3
Q

peritoneum

A

covers anterior upper and middle 1/3 of the rectum

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4
Q

muscularis mucosa

A

circular/longitudinal interwoven inner layer

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5
Q

muscularis propria

A

circular layer of muscle

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6
Q

plicae semilinaris

A

transverse bands that from haustra

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7
Q

bands that run longitudinally along the colon

A

taenia coli

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8
Q

superior mesenteric artery

A

ascending and 2/3 transverse colon

ileocolic, right and middle colic arteries

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9
Q

inferior mesenteic artery

A

1/2 transverse colon, descending colon, sigmoid colon, and upper portion of rectum
left colic, sigmoid branches, superior rectal artery

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10
Q

marginal artery

A

runs along colon margin, connecting SMA to IMA

collateral flow

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11
Q

arc of Riolan

A

short direct connection between IMA and SMA

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12
Q

venous drainage of the colon

A

follows arterial supply ,

except IMV –> goes to splenic vein, joins SMV to form portal vein

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13
Q

superior rectal artery

A

branch of IMA

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14
Q

middle rectal artery

A

branch of internal iliac

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15
Q

inferior rectal artery

A

branch of internal pudendal (which is a branch of the internal iliac)

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16
Q

lymphatic drainage from superior and middle rectum

A

drain to IMA nodal lymphatics

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17
Q

lymphatic drainage from lower rectum

A

IMA nodes, internal iliac nodes

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18
Q

watershed area of the colon

A 
splenic flexure ( Griffiths point) (SMA and IMA junction)
rectum (Sudaks point) superior rectal and inferior rectal artery junction
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19
Q

external sphincter

A

puborectalis muscle- under CNS control (voluntary)

a continuation of levator ani muscle

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20
Q

nerve supply to the external sphincter

A

pudendal nerve, perineal branch of S4

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21
Q

internal sphincter

A

involuntary control

continuation of the circular band of colon muscle (smooth)

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22
Q

transition between anal canal and rectum

A

levator ani

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23
Q

mucus secreting goblet cells

A

crypts of lieberkuhn

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24
Q

source of nutrients for colonocytes

A

short chain fatty acids

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25
Q

stump pouchitis

A

TX: short chain fatty acids

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26
Q

infectious pouchitis

A

TX metronidazole

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27
Q

denovilliers fascia

A

rectovesicular fascia in men

rectovaginal fascia in women

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28
Q

waldeyers fascia

A

rectosacral fascia

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29
Q

most common colon polyp

A

hyperplastic polyps

30
Q

most common neoplastic intersitnal poly

A

tubular adenoma

31
Q

villious adenoma

A

50 % cancerous

> 2 cm, sessile , increased cancer risk

32
Q

high grade dysplasia

A

basement membrane intact (insitu)

33
Q

gene mutations in colon cancer

A

APC, DCC, p53, k-ras

34
Q

most important prognostic factor in colorectal cancer

A

nodal status

35
Q

1 site of colorectal mets

A

liver

lung #2 (via iliac vein)

36
Q

batsons plexus

A

venous drainage from rectum to spine

allows direct spread of mets to spine

37
Q

abdominoperitoneal resection

A

permamneny colostomy

anal canal excised along with rectum

38
Q

T1

A

into submucosa

39
Q

T2

A

into muscularis propria

40
Q

T3

A

serosa or through muscularis propria

41
Q

T4

A

through serosa into fre peritonel cavity

42
Q

N1

A

1-3 postive nodes

43
Q

N2

A

> 4 positive nodes

44
Q

N3

A

central nodes

45
Q

Stage I

A

T1-T2, No, Mo

46
Q

Stage II

A

T3-T4, N0, M0

chemo and XRT

47
Q

Stage III

A

And N1 disease

chemo and XRT

48
Q

Stage IV

A

any M1 disease

49
Q

follow up for colorectal cancer

A

H&P, CEA, stool guaiac every 6 months for 3 years, then annually
yearly LFTs, abdominal CT, colonoscopy, CXR

50
Q

Familial Adenomtous polyposis

A

APC gene, autosomal dominant
prophylactic total colectomy @ age 20
esophagogastroduodenoscopy q 2 yrs for duodenal polyp check (periampullar tumors of duodenum)

51
Q

Gardners syndrome

A

patients get colon CA and desmoid tumors/osteomas

52
Q

Turcots syndrome

A

colon cancer, brain tumors

53
Q

lynch syndrome (HNPCC)

A

DNA mismatch repair genes
Lynch 1- colon ca
Lynch 2 ,increased risk for ovarian, endometrial =, bladder, and stomach cancer

54
Q

Amsterdam criteria

A 
3,2,1 -->
at least 3 first degree relatives
over 2 generations
1 with cancer before age 50
--> need surveillance colonoscopy 10 yrs starting at age 25 or 10 yrs before 1st relative got cancer
55
Q

Juvenile polyposis

A

hamartomatous polyps
anemia, decreased energy, failure to thrive
increased cancer risk but polyps themselves no malignant potential

56
Q

peutz-jeghers syndrome

A

gastrointestinal hamartoma polyposis and dark pigmentation around mucus membranse
increased risk of other cancers

57
Q

cronkite - canada syndrome

A

hamartomatous poyps, atrophy of hair and nails, hypopigmentation

58
Q

sigmoid volvulus

A

causes closed loop obstruction
bent inner tube sign on xray
TX: decompression with colonoscopy, bowel prep, sigmoid colectomy under same admission unles peritonitic –> straight to OR

59
Q

cecal volvulus

A

SBO with dilated cecum in RLQ

TX: OR right hemicolectomy, or cecopexy

60
Q

ulcerative colitis

A

Sx: bloody diarrhea, abdominal pain, fever, weight loss
involves mucosa and submucosa
spares anus

61
Q

Toxix megacolon

A

can occur in UC

fever, Increased HR, steroids, bowel rest, TPN, abx

62
Q

perforation with ulcerative colitis

A

transverse colon

63
Q

perforation with chrons disease

A

distal ileum

64
Q

most common major morbidity after surgery

A

leak - can lead to sepsis

65
Q

HLA B27

A

sacroilitis and ankylosing spondylitis

66
Q

olgivies

A

pseudoobstructin of colon
associated with opiate use, bedridden or older patients recent surgery, infection
TX: colonsocopy, neostigimine, cecostomy if that fails

67
Q

amoebic colitis

A 
entamoeba histolytica
primary infection in colon
secondary infection i lover
Sx: dysentery 
DX; endoscopy--> ulceration, trophozites, 90% antiamebic antibodies
TX: flagyl, diiodohydroxyquin
68
Q

lymphogranuloma venereum

A

chlamydia, homosexulas
causes proctatits, tenesmus, bleeding, may produce fistulas
TX: doxycylcine, hydrocortisone

69
Q

DIVERTICULA

A

herniation of mucosa through the colon walla t sites where artereis enter the muscular wall
caused by straining increased luminal pressure
diverticulitis usually left side
bleeding usually right

70
Q

azotemia after GI bleed

A

caused by production of urea from bacterial action

on intraluminal blood (increased BU, total bilirubin)

71
Q

angiodysplasia bleeding

A

associated aortic stenosis

72
Q

yersinia

A

can mimic appendicitis

TX: tetracylcine, bactrim

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