Colorectal Review Flashcards
How do you perform an extended left hemicolectomy?
Colonic resection between the left third of the transverse colon and the colorectal junction. The inferior mesenteric vessel and the left middle colic vessel are ligated at their origin in combination with a regional lymphadenectomy.
What features of a colonic polyp biopsy would necessitate oncologic resection?
- poor differentiation
- vascular or lymphatic invasion
- invasion below the submucosa
- positive resection margin
- cancer within 2mm of resection margin
- involvement at the base of the polyp
- incomplete resection of polyp
Which Haggitt Classification necessitates oncologic resection?
level 4 - invading the submucosa, below the stalk of the polyp
Surveillance recommendation for the follow:
- normal colonoscopy
- <20 hyperplastic polyps < 1cm
Routine colonoscopy in 10 years, this is a normal colonoscopy
Surveillance recommendation for the follow:
- 3-4 adenomas < 1cm in size
- 1 Hyperplastic polyp > 1cm in size
Follow up colonoscopy in 3-5 years
- unlikely to be tested given the gray area of recommendation
Surveillance recommendation for following:
- 5-10 adenomas found on colonoscopy
Follow up colonoscopy in 3 years
Surveillance recommendation for following:
- Sessile polyp > 1cm
follow up colonoscopy in 3 years
Surveillance recommendation for following:
- Polyp with tubulovillous/villous features
follow up colonoscopy in 3 years
Surveillance recommendation for following:
- polyp with high grade dysplasia
follow up colonoscopy in 3 years
Surveillance recommendation for following:
- > 10 adenomas found on colonoscopy
repeat colonoscopy in 1 year
Surveillance recommendation for following:
- adenoma removed piecemeal on colonoscopy
repeat colonoscopy in 3-6 months
treatment for pseudomyxoma peritonitis
- Cytoreductive surgery
- Hyperthermic intraperitoneal chemotherapy
What is cytoreductive surgery?
- for treatment of PMP it is defined as having no gross disease greater than 2mm in size
Preferred treatment for anal squamous cell carcinoma
- radiation and chemotherapy upfront
- salvage APR for recurrences
Preferred treatment for anal melanoma
- wide local excision
Preferred treatment for anal adenocarcinoma
- APR followed by adjuvant chemotherapy
most common small bowel malignancy
- metastatic lesion
small bowel tumor found to be a metastatic lesion…most likely source is?
melanoma
Patient with chronic lower right quadrant pain, presumed appendicitis. In OR normal appendix with inflamed cecum and/or terminal ileum…what do you do?
- take out appendix even if grossly normal
- patient likely has Chron’s and is presenting with terminal ileitis
Peutz-Jeghers syndrome is characterized by what
- hamartomatous polyps throughout GI
- hyperpigmented macules on the buccal mucosa, lips, and digits
Peutz-Jeghers increases the risk of what?
- GI malignancy
- extraintestinal malignancy (breast, uterus, cervix, testes, pancreas, lung)
How do you diagnose Chronic Appendicitis
its a diagnosis of exclusion, must rule out everything else
patient with protocolectomy with J-pouch anastomosis, presenting with pouchitis…what is the treatment?
- Antibiotic treatment with metronidazole or a fluoroquinolone
- 5-ASA can be used for refractory cases
how do you close a previous ostomy site?
purse string closure…has lowest complication rate of any closure method
What does Toxin A from Clostridium Difficile result in?
Intestinal necrosis
How much invasion in a T1 colorectal adenocarcinoma lesion?
to but not through the muscularis mucosa
How much invasion in a T2 colorectal adenocarcinoma lesion?
invades into muscularis propria