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ABSITE > Colorectal > Flashcards

Colorectal Flashcards

1
Q

Colon secretes ___ and re-absorbs ____; mostly in the R colon and cecum

A

Secretes K; reasorbs Na and water

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2
Q

4 layers of colon mucosa

A

Mucosa (columnar epithelium); submucosa, muclaris propria, serosa

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3
Q

Asc/Dec, sigmoid colon are – intra/retroperit

A

Retroperitoneal

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4
Q

Ascending and 2/3 of transverse colon are supplied by…

A

SMA (ileocolic, right and middle colic arteries)

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5
Q

1/3 of transverse, descending colon, sigmoid colon and upper rectum are supplied by…

A

IMA

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6
Q

What is arc of Riolan

A

Short direct connection between SMA and IMA

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7
Q

80% of blood flow in colon goes to which bowel layers?

A

Mucosa, submucosa

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8
Q

Splenic vein joins the ***

A

SMV to form the portal vein behind the pancreas

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9
Q

IMV drains into…

A

Splenic vein

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10
Q

The superior / middle / inferior rectal arteries

A

Superior: branch of IMA
Middle: branch of II (lateral stalks during LAR or APR contain middle rectal arteries)
Inferior: branch of internal pudendal – branch of II

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11
Q

Where do the superior and middle rectal veins drain? What about inferior?

A

IMV –> portal vein

Inferior: internal iliac, caval

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12
Q

Watershed areas of colon

A

Splenic flexure (Griffith’s point) – SMA/IMA junction

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13
Q

What is Sudak’s point?

A

Rectum – superior and middle rectal junction

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14
Q

Is colon or small bowel more sensitive to ischema/low-flow states?

A

Colon; fewer collaterals

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15
Q

External sphincter

A

Inferior rectal branch of internal puddendal nerve (continuation of levator ani muscle)

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16
Q

Internal sphincter

A

Involuntary / pelvic splanchnic nerves; continuation of muscularis propria; normally contracted

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17
Q

Meissner’s vs. Auerbach’s plexus

A

Meissners: inner nerve plexux
Auerbach: Outer nerve plexus

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18
Q

Pelvic splanchnic: sympa or para

A

Para

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19
Q

Distance from anal verge to anal canal, rectum, recto-sigmoid junction

A

Anal canal: 0-5 cm
Rectum: 5-15 cm
Recto-sigmoid: 15-18cm

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20
Q

Transition between anal canal and rectum

A

Levator ani

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21
Q

What are crypts of Lieberkuhn?

A

Mucin-secreting goblet cells

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22
Q

Treatment of colonic intertia

A

Subtotal colectomy

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23
Q

Main nutrient of colonocyte

A

SCFA

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24
Q

What is treatment for stump pouchitis

A

SCFA enema

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25
Q

Treatment of infectious pouchitis

A

Flagyl

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26
Q

Denovilliers vs Waldeyers fasica

A

Anterior/Posterior

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27
Q

MC colon polyp

A

Hyperplastic; no cancer risk

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28
Q

MC neoplastic polyp in colon

A

Tubular adenoma

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29
Q

MC colon polyp to produce symptoms

A

Villious adenoma; 50% have cancer

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30
Q

Characteristics of colon polyps with increased cancer risk

A

> 2cm, sessile, villous

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31
Q

If a polyp cannot be resected endoscopically, how do you get rid of it?

A

Segmental resection

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32
Q

Invasive colon cancer has eroded into…

A

Submucosa

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33
Q

Normal age for colon cancer screening

A

50 at normal risk; 40, or 10 years before youngest case

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34
Q

Colon cancer screening

A

q 10 year cscope
high-sensitivity FOBT q 3 years and flex sig q 5
Q annual fecal occult blood

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35
Q

When is a polypectomy sufficient treatment?

A

t1; clear margins 2mm, well-differentiated, no vasc/lymphatic invasion; otherwise formal resection

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36
Q

T/F Red meat and fat are risk factors for colon cancer

A

True / oxygen radicals

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37
Q

Main genetic mutations of colon cancer

A

APC, DCC, p53, k-ras

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38
Q

Most common site of colon cancer

A

Sigmoid colon

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39
Q

Where does colon cancer spread first?

A

Nodes

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40
Q

1 site of colon cancer mets

A

Liver; Number 2 is lung

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41
Q

How does colon cancer get to liver, lung?

A

Liver: PV
Lung: Iliac vein

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42
Q

T/F isolated liver, lung mets can be resected for colon ca

A

True

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43
Q

How does rectal cancer mets to the spine?

A

Batson’s venous plexus

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44
Q

Can colon cancer be resected en bloc?

A

Yes

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45
Q

T/F Mucoepidermoid colon cancer has worst prognosis

A

True

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46
Q

Best test for depth, invasion; recurrence, nodes

A

Trans-rectal ultrasound

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47
Q

For rectal pain with rectal cancer — treatment

A

APR

48
Q

What size margins for colon cancer

A

2cm

49
Q

Best method of picking up intra-hepatic mets

A

Intra-operative ultrasound (3-5 mm)

50
Q

What is an APR

A

Permanent colostomy; anal canal is excised with the rectum

- Impotence, bladder dysfunction (injured pudendal nerves)

51
Q

If you cannot get 2cm margins with an LAR, the treatment is…

A

APR

52
Q

Neoadjuvant Chemo-RT for rectal cancer

A

Can produce complete response, preserve sphincter function

53
Q

t1 vs t2 vs t3 vs t4 colon ca

A

submucosa, muscularis propria, subserosa, through serosa

54
Q

Can low recta T1’s be excised transanally

A

Yes; negative margins, well-differentiated

55
Q

Who gets NAC/RT colon cancer

A

Stage 2, 3

56
Q

Chemo for colon cancer

A

FOLFOX (5-FU, leucovorin, oxaliplatin)

57
Q

Most common site of injury in colon cancer RT

A

Rectum; vasculitis, thrombosis, ulcers, strictures, bleeding

58
Q

Is FAP AD?

A

Yes

59
Q

When are polyps present in FAP?

A

Puberty

60
Q

When do you get a total colectomy in FAP?

A

Age 20

61
Q

Where else can you get polyps in FAP?

A

Duodenum

62
Q

MCC death in patients with FAP who have undergone colectomy?

A

Peri-ampullary tumors of duodenum

63
Q

What is Gardner’s syndrome?

A

Colon Cancer (a/w APC gene) and intra-abdominal desmoid tumors/osteomas

64
Q

What is Turcot’s syndrome?

A

APC gene, brain tumors

65
Q

Lynch syndrome

A

5% population; AD

- A/W DNA MMR gene

66
Q

Lynch II syndrome also increases risk of…

A

Ovarian, endometrial, bladder, stomach

67
Q

What operation do you need for Lynch syndrome?

A

Total proctocolectomy with first cancer operation

68
Q

Lynch L or R sided cancer

A

R

69
Q

When does surveillance colonoscopy begin for Lynch?

A

25 or 10 years before primary relative

70
Q

For HNPCC, do you need colonoscopy?

A

No; flex sig

71
Q

Sigmoid volvulus is more common with low or high fiber diet

A

High fiber

72
Q

In what types of patients is sigmoid voluvlus more common

A

Psychiatric, neurologic dysfunction, laxitive absue

73
Q

Treatment for sigmoid voluvlus

A

Decompress with colonscopy; bowel prep, and perform sigmoid colectomy during same admission

74
Q

Cecal volvulus

A

Can appear as SBO; R hemi colectomy; can try cecopexy is colon is viable and patient is frail

75
Q

UC involves which bowel layers

A

Mucosa and submucosa

76
Q

Does UC spare anus?

A

Yes

77
Q

Crypt abscess in UC or Crohn’s

A

UC

78
Q

Pseudo-polyps UC or Crohn’s

A

UC

79
Q

Cobblestoning in UC vs. Crohn’s

A

Crohn’s

80
Q

In UC, bleeding is universal and has mucosal friability with pseudopolyps

A

True

81
Q

Medical treatment of UC

A

Salfasalazine, Liperamide

82
Q

For acute flares of UC

A

Steroids; Cipro/Flagyl

83
Q

Indications for surgery with toxic colitis and toxic megacolon

A

Pneumoperitoneum, diffuse peritonitis; uncontrolled sepsis, major hemorrhage

84
Q

Perforation with UC vs. Crohn’s

A

Transverse colon: UC

Crohn’s distal ileum

85
Q

Risk of cancer in UC

A

1%/year starting 10 years after initial diagnosis

86
Q

MC extra0intestinal manifestation in children

A

FTT

87
Q

Treatment poyderma gangrenosusm

A

Steroids

88
Q

< 2 cm low rectal carcinoid

A

WLE with negative margins

89
Q

> 2 cm rectal carcinod or invasion into muscularis propria

A

APR

90
Q

Most likley location colon perf with obstruction

A

Cecum

91
Q

Number 1 and 2 cause of colonic obstruction

A

Cancer, diverticulitis

92
Q

What is Ogilvie’s syndrome

A

Massively dilated colon which can perforatea

93
Q

Treatment Ogilvie’s syndrome

A

Replace electrolytes, discontinue anti-motility agents, i.e. Morphine; NGT, neostigmine

94
Q

If colon > 10 cm in Ogilbie’s syndrome

A

Decompression with colonscopy and neostigmine, cecostomy if that fails

95
Q

Treatment of amoebic colitis

A

Flagyl (colon –> liver)

* Mexico, fecal-oral

96
Q

Actinomyces most common location

A

Cecum

97
Q

Yellow-white sulfer granules

A

Actinomces – penicillin

98
Q

Tagged RBC scan vs. arteriography for LGI bleed

A

> 0.1 cc/min; >0.5cc/min

99
Q

MCC complication following diverticulitis

A

Abscess

100
Q

Need to resect all of sigmoid colon down to superior rectum for diverticulitis

A

True

101
Q

MCC colo-vesicular fistula

A

Diverticulitis

102
Q

Best test of colo-vesicular fistula

A

Cystoscopy

103
Q

Vessels that bleed in diverticulosis

A

Vasa rectum; arterial bleeding

104
Q

Usual first step for diverticular bleed

A

Colonoscopy

105
Q

If massive LGI bleed

A

Angiography; to localize area for surgery; or highly selective coil embolization

106
Q

Most sensitive test for LGI bleed

A

Tagged RBC scan

107
Q

Angiodysplasia bleeding is typically on L or R colon

A

R; venous bleeds

108
Q

T/F 20% patients with angiodysplasia have AS

A

True

109
Q

Usually ischemic colitis involves R or L colon

A

L

110
Q

SMA/IMA junction

A

Grifftith’s point

111
Q

When to perform a colon resection for ischemic colitis

A

Gangrenous colitis; peritonitisl black bowel; sepsis; perforation
* Otherwise NPO/ABX/IVF

112
Q

Key histologic finding for C. diff colitis

A

PMN inflammation of mucosa and submucosa

113
Q

Neutropenic typhlitis (enterocolitics)

A

Follows CTX with WBC low (nadir); can mimic surgical disease; can see pneumatosis intestinalis; surgery only for free perforation. Treatment is abx

114
Q

Can Yersinia mimic appendicitis

A

Yes

115
Q

MCC of acquired megacolon?

A

Trypanosoma cruzi (2/2 destruction of nerves)

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