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ABSITE > Colorectal > Flashcards

Colorectal Flashcards

1
Q

Colon secretes______ and absorbs____

A

Potassium and reabsorbs sodium and water

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2
Q

Layers of colon

A

Mucosa
submucosa
muscularis propria
serosa

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3
Q

Which parts of colon are retroperitoneal

A

Ascending, descending and sigmoid

Anterior upper and middle 1/3rd of rectum

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4
Q 
vascular supply
Ascending:
Transverse
Descending
Sigmoid
Rectum
A

Ascending: SMA(Ileocolic and Right colic)
Transverse (proximal 2/3 by SMA. Distal 1/3 by IMA. Middle colic)
Descending: IMA Left colic
Sigmoid IMA: Sigmoid
Rectum Upper: IMA Superior rectal
Lower: internal Iliac: Middle rectal; internal Iliac to internal pudendal to inferior rectal.
Marignal artery of drummond: Connects SMA to IMA

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5
Q

Venous supply of colon

A

Follows arterial. SMV joins IMV to form portal vein behind pancreas
Rectum: Inferior rectal vein to internal iliac veins.
Superior and middle drain to IMV to portal.
Lymph nodes are similar

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6
Q

Watershed areas

A

Griffiths point: Splenic flexure at SMA and IMA junction and
Sudaks Point at rectum at superior and middle rectal junction

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7
Q

External sphincter: Which muscle. Controlled by?

A

Puborectalis, extension of levator Ani, controlled by CNS: Inferior rectal branch of internal pudendal nerve

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8
Q

Internal Sphincter: which muscles and Control

A

Extension of muscularis propria

Involuntary bypelvic splanchnic nerves

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9
Q

Meissner and auerbach

A

INNER plexus

Auerbach: Outer

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10
Q

distance from anal verge:
Anal canal
Rectum
Rectosigmoid junction

A

5cm
5-15
15-18

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11
Q

main nutrient of colonocytes

A

Short chain fatty acids

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12
Q

tx of stump pouchitis

A

Short chain fatty acid enema

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13
Q

Tx of infectious pouchitis

A

Flagyl

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14
Q

Denonvilliers fascia and waldeyers fascia

A

Rectovesicular and rectoprostatic (denon)

waldeyers: Retrosacral fascia

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15
Q

most common polyp

A

Hyperplastic

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16
Q

Most common neoplastic

A

Tubular adenoma most are pedunculated

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17
Q

Most likely polyp to cause symptoms

A

Villous adenoma. Likely sessile

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18
Q

Polyp characteristics likely to cause ca:

A

> 2cm, sessile, villous

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19
Q

polypectomy vs segmental resection. When is polypectomy sufficient

A

If margin >2mm, not poorly differentiated and no evidence of lymphovascular involvement.

20
Q

high grade dysplasia vs intramucosal vs invasive ca

A

in first two, basement membrane remains intact, in invasive ca, submucosa involved

21
Q

false positive guaic fobt causes

A

beef, vitamin c, iron, cimetidine

22
Q

contraindications to colonoscopy

A

recent MI, splenomegaly, pregnancy(if fluoro)

23
Q

tx of extensive low rectal villous adenomas with atypia

A

trans anal excision ( NO APR unless cancer

24
Q

transanal exsion shows T1 cancer. Further tx needed?

A

No. If margins are adequate(2mm), no lymphovascular invasion and well differentiated.

25
Q

Transanal excision shows T2: further Tx needed?

A

APR or LAR needed.

26
Q

symptoms of colorectal ca;

A

anemia, bleeding constipation

27
Q

colon ca a/w which infxn?

A

clostridium septicum.

28
Q

main mutations in colon ca

A

p53, DCC, KRAS, APC

29
Q

Most common site

A

Sigmoid

30
Q

Mets to

A

liver(via portal vein) and lung(via iliac vein)

31
Q

5 year survival in liver mets?

A

35% if resectable with adequate liver fxn

32
Q

5 YS in lung mets

A

25% after resection

33
Q

rectal ca mets to spine via?

A

Batsons plexus(venous)

34
Q

prognosis with lymphocytic penetration? Mucoepidermoid ca?

A

LC: improved prognosis
ME: Worse

35
Q

TRUS

A

BEST test of assesing T and N status

36
Q

Goals of resection

A

EN bloc resection with adequate margins, mesocolon, regional adenectomy
2cm margins

37
Q

best way to pick intrahepatic mets

A

intraop u/s. 3-5mm resolution vs conventionu/s 10mm vs ct/mri (5-10)

38
Q

APR Indications

A

Malignant lesions only, not amenable to LAR.

Lesions with <2cm margin from levator ani

39
Q

Criteria for transanal excision of low rectal T1 lesions

A

<4cm. Negative margins, well differentiated, no lymhovascular involvement.
T2 or higher: APR/LAR

40
Q

Chemo.
colon: Stage III and IV
rectal stage II and III
rectal IV

A

colon: Stage III and IV: postop
rectal stage II and III neoadjuvant
rectal IV chemo +radio possibly surgery
chemo regimen: 5FU leucovorin, oxaliplatin

41
Q

XRT. damage, advantage

A

Can cause vasculitis, thrombosis, ulcers, strictures, bleeding
can allow downstaging, helping avoid morbid operations

42
Q 
FAP
gene? when do polyps form
age of prophylactic colectomy
other common cancer
surgery
A

AD
APC gene, chromosome 5
20y. prophylactic colectomy, rectal mucosectomy, ileoanal pouch
periampullary duodenal tumors.

43
Q

Other APC gene associated tumors:

A

Gardners: FAP and desmoid tumors/osteomas
turcot: Colon ca and brain ca

44
Q 
Lynch syndrome
Gene
Lynch 1 vs 2
Amsterdam criteria
when to start screening.
A

AD DNA mismatch repair genes.
1: just colon ca. 2: increase risk of ovarian, endometrial, bladder and stomach.
Amsterdam: 3-2-1. 3 first degree relatives, 2 generations, 1 cancer before 50.
screen at 25 or 10 years before
total proctocolectomy

45
Q

cecal vs sigmoid volvulu

A

age. cecal in young, 20-30s, sig in old, psych patients, neuro dysfxn, laxative abuse,

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