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True Learn Studying 2021 > Colorectal Review > Flashcards

Colorectal Review Flashcards

1
Q

How do you perform an extended left hemicolectomy?

A

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.

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2
Q

What features of a colonic polyp biopsy would necessitate oncologic resection?

A
  1. poor differentiation
  2. vascular or lymphatic invasion
  3. invasion below the submucosa
  4. positive resection margin
  5. cancer within 2mm of resection margin
  6. involvement at the base of the polyp
  7. incomplete resection of polyp
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3
Q

Which Haggitt Classification necessitates oncologic resection?

A

level 4 - invading the submucosa, below the stalk of the polyp

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4
Q

Surveillance recommendation for the follow:

  • normal colonoscopy
  • <20 hyperplastic polyps < 1cm
A

Routine colonoscopy in 10 years, this is a normal colonoscopy

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5
Q

Surveillance recommendation for the follow:

  • 3-4 adenomas < 1cm in size
  • 1 Hyperplastic polyp > 1cm in size
A

Follow up colonoscopy in 3-5 years

  • unlikely to be tested given the gray area of recommendation
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6
Q

Surveillance recommendation for following:

- 5-10 adenomas found on colonoscopy

A

Follow up colonoscopy in 3 years

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7
Q

Surveillance recommendation for following:

- Sessile polyp > 1cm

A

follow up colonoscopy in 3 years

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8
Q

Surveillance recommendation for following:

- Polyp with tubulovillous/villous features

A

follow up colonoscopy in 3 years

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9
Q

Surveillance recommendation for following:

- polyp with high grade dysplasia

A

follow up colonoscopy in 3 years

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10
Q

Surveillance recommendation for following:

- > 10 adenomas found on colonoscopy

A

repeat colonoscopy in 1 year

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11
Q

Surveillance recommendation for following:

- adenoma removed piecemeal on colonoscopy

A

repeat colonoscopy in 3-6 months

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12
Q

treatment for pseudomyxoma peritonitis

A
  • Cytoreductive surgery

- Hyperthermic intraperitoneal chemotherapy

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13
Q

What is cytoreductive surgery?

A
  • for treatment of PMP it is defined as having no gross disease greater than 2mm in size
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14
Q

Preferred treatment for anal squamous cell carcinoma

A
  • radiation and chemotherapy upfront

- salvage APR for recurrences

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15
Q

Preferred treatment for anal melanoma

A
  • wide local excision
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16
Q

Preferred treatment for anal adenocarcinoma

A
  • APR followed by adjuvant chemotherapy
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17
Q

most common small bowel malignancy

A
  • metastatic lesion
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18
Q

small bowel tumor found to be a metastatic lesion…most likely source is?

A

melanoma

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19
Q

Patient with chronic lower right quadrant pain, presumed appendicitis. In OR normal appendix with inflamed cecum and/or terminal ileum…what do you do?

A
  • take out appendix even if grossly normal

- patient likely has Chron’s and is presenting with terminal ileitis

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20
Q

Peutz-Jeghers syndrome is characterized by what

A
  • hamartomatous polyps throughout GI

- hyperpigmented macules on the buccal mucosa, lips, and digits

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21
Q

Peutz-Jeghers increases the risk of what?

A
  • GI malignancy

- extraintestinal malignancy (breast, uterus, cervix, testes, pancreas, lung)

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22
Q

How do you diagnose Chronic Appendicitis

A

its a diagnosis of exclusion, must rule out everything else

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23
Q

patient with protocolectomy with J-pouch anastomosis, presenting with pouchitis…what is the treatment?

A
  • Antibiotic treatment with metronidazole or a fluoroquinolone
  • 5-ASA can be used for refractory cases
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24
Q

how do you close a previous ostomy site?

A

purse string closure…has lowest complication rate of any closure method

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25
Q

What does Toxin A from Clostridium Difficile result in?

A

Intestinal necrosis

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26
Q

How much invasion in a T1 colorectal adenocarcinoma lesion?

A

to but not through the muscularis mucosa

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27
Q

How much invasion in a T2 colorectal adenocarcinoma lesion?

A

invades into muscularis propria

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28
Q

How much invasion in a T3 colorectal adenocarcinoma lesion?

A

invades through the muscularis propria into pericolorectal tissue

29
Q

How much invasion in a T4 colorectal adenocarcinoma lesion?

A

invades through visceral peritoneum or into adjacent organs

30
Q

N1 disease = how many + LNs

31
Q

Patient has stage III rectal cancer after neoadjuvant therapy and surgery…what is next step

A

adjuvant chemo

  • this only pertains to stage III rectal cancer
32
Q

when do you do recommend surgical intervention for an anal fissure?

A

after patient has tried stool softeners, laxatives, situ baths, and calcium channel blocker ointment like nifidepine

33
Q

describe the delorme procedure

A

for rectal prolapse, incision in mucosa of prolapsed rectum is made 1 cm above dentate line. You take out the mucosa of all the redundant rectum and then plicate muscularis propria and bring mucosa edges together

34
Q

How is the altemeier procedure different than the delorme?

A

used for rectal prolapse greater than 5 cm, full thickness excision is made instead of just a mucosal excision

35
Q

1.7 cm adenocarcinoma at tip of appendix on final pathology of appendicitis, next step

A

Right hemicolectomy

36
Q

1.7 cm appendiceal carcinoma at tip of appendix on final pathology of appendectomy, next step

A

no further steps necessary

37
Q

patient had a left hemicolectomy, on follow up reports inability to ejaculate

A

injury to superior hypogastric plexus, occurs with high ligation of inferior mesenteric artery

38
Q

what kind of nerve fibers constitute the superior hypogastric plexus

A

sympathetic nerves

39
Q

what kinds of nerves constitute the inferior hypogastric plexus

A

parasympathetic and sympathetic nerve fibers

40
Q

at what size should you drain an intra-abdominal abscess?

A

if its greater than 3 cm, any smaller should be treated with antibiotics

41
Q

purpose of anal electromyography

A
  • evaluate patients thought to be neurogenic sphincter weakness
42
Q

use of defecography

A

detect enteroceles, rectoceles, and rectal prolapse

43
Q

use of endoanal US

A

detect sphincter dysfunction in patients with fecal incontinence

44
Q

standard treatment for a low rectovaginal fistula

A

endorectal advancement flap

45
Q

best way to diagnose a fistula from diverticulitis?

A

CT scan of the abdomen and pelvis

  • will show air in the bladder
46
Q

most common cause of lower GI bleeds in older patients?

A

diverticulosis

47
Q

most common symptom of an abdominal carcinoid tumor

A

abdominal pain

48
Q

secondary causes of constipation

A
  • drugs
  • neurogenic
  • non-neurogenic
  • irritable bowel syndrome
49
Q

how do you diagnose slow transit time constipation

A
  • use radio-opaque markers, if there are more than 5 markers on day six you have a positive test
50
Q

surgery for an upper rectum cancer?

A

left hemicolectomy

51
Q

how far away from the anal verge is an upper rectum cancer?

A

10-12 cm above the anal verge

52
Q

how far away is a middle rectal cancer from the anal verge?

A

7-10 cm from the anal verge

53
Q

surgery indicated for a middle rectal cancer?

A

low anterior resection

54
Q

surgery indicated for a lower rectal cancer

A

total abdominal perineal resection

55
Q

when can you do a transanal excision of a rectal cancer?

A

a T1 rectal cancer with the following:

  • within 8 cm of anal verge
  • < 3cm in size / < 30% circumference
  • freely mobile
56
Q

what is unique about the Lugano staging system for non-hodgkin lymphoma?

A

there is no Stage III

57
Q

most common cause of severe GI bleeding?

A
  • Diverticulosis
58
Q

Infliximab

A
  • monoclonal Ig-G1 antibody with affinity to TNFa
59
Q

patient with Crohn’s disease, what is the indication(s) for Infliximab?

A
  • perianal fistula disease

- Crohn’s disease refractory to medication

60
Q

management of < 1cm rectal carcinoid tumor

A

endoscopic or local excision

61
Q

management of 1-2 cm rectal carcinoid tumor

A
  • full thickness excision

- if invades muscularis or LN involvement need full surgical resection (APR) with total mesolectal excision

62
Q

management of > 2cm rectal carcinoid tumor?

A

full surgical excision (APR)

63
Q

when would you need a hemicolectomy if pathology showed an appendices mucinous neoplasm

A
  • > 2 cm in size
  • postive margin
  • lymphovascular invasion
  • mesoappendiceal invasion
64
Q

what mutation would prevent you from using Cetuximab for advance colorectal cancer

A

KRAS mutation

65
Q

if you see an anal fissure laterally what should you be suspicious of

A 
Chron's disease
malignancy
HIV
Syphilis 
tuberculosis
66
Q

if you see multiple anal fissures what should you be suspicious of

67
Q

how many lymph nodes do you need to harvest for a colon cancer

A

12 minimum

68
Q

When would you do pre-sacral drainage for a rectal injury repair

A
  • if you repair it trans-abdominally
69
Q

how long should you wait to repair a rectovaginal fistula

A
  • 3-6 months, some will spontaneously repair

True Learn Studying 2021 (27 decks)

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