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absite flash cards > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

When can you do a transrectal excision of a rectal carcinoid tumor

A

meets following criteria:
- smaller than 1 CM
- freely mobile
- < 12 cm from dentate line
- no lymphadenopathy

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2
Q

is it better to do a staged or simultaneous repair of a vaginal and rectal prolapse?

A

simultaneous repair has better outcomes with less recurrence of prolapse

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3
Q

initial management for fecal incontinence

A

lifestyle modification, always first

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4
Q

what is the first step in a patient with a reducible rectal prolapse?

A

colonoscopy

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5
Q

how many lymph nodes are recommended for mesenteric lymphadenectomy

A

at least 12 node harvest for adequate staging

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6
Q

what is the role of somatostatin in neuroendocrine tumors

A

control symptoms once it is metastatic

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7
Q

how would you excise a rectal carcinoid tumor > 1 cm in size

A

proctectomty with mesorectal excision

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8
Q

another name for rectal prolapse

A

rectal procidentia

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9
Q

you read signet-ring component from colorectal cancer…what should you think about

A

Microsatellite instability

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10
Q

patient who has failed conservative management for fecal incontinence, next step

A

imaging

  • endoanal ultrasound
    or
  • MRI
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11
Q

where does anal margin start

A

lateral to the intersphinteric groove and extends 5cm out from that point

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12
Q

how do you treat SCC of the anal margin

A
  • < 1cm excise it
  • > T1 lesion or with LN involvement = chemoradiation like SCC of anal canal
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13
Q

what is the cut off to excise a thrombosed hemorrhoid?

A
  • < 72 hour history = excision
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14
Q

what is an anal marginal cancer

A

cancer located within the anal margin (from intersphincteric groove out 5 cm)

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15
Q

when can you do local excision on an anal margin SCC

A
  • less than 2 cm in size
  • well differentiated
  • no LN involvement
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16
Q

how do you drain a horseshoe abscess

A

internal posterior sphincterotomy with counter incisions bilaterally in the ischioanal fossae

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17
Q

most common extra-colonic malignancy in Lynch syndrome

A

endometrial cancer

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18
Q

when would you not do a proctocolectomy for UC if you saw atypia on a biopsy?

A

if there is active inflammation, the atypia may resolve after treatment

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19
Q

what kinds of hemorrhoids can be banded?

A

only internal hemorrhoids

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20
Q

surveillance for stage 1 colon cancer

A

colonoscopy at 1 year

from NCCN guidelines

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21
Q

surveillance for stage II or III colon cancer

A
  • H+P+CEA every 3-6 months for 2 years, then every 6 months for 5 years
  • CT CAP every 6-12 months for 5 years
  • Colonoscopy at 1 year

per NCCN

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22
Q

surveillance for stage IV colon cancer

A
  • H+P+CEA every 3-6 months for 2 years, then every 6 months for 5 years
  • CT CAP every 3-6 months for 2 years, then every 6-12 months for 5 years
  • Colonoscopy at 1 year

per NCCN

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23
Q

which colon resection does not require low lithotomy position?

A

right hemicolectomy

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24
Q

patient presents with new-onset bloody diarrhea and weight loss. Colonoscopy reveals acute colitis with biopsies showing mucosal inflammation and giant cell granulomas…what do they have

A
  • Acute Crohn’s flare
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25
Q

Patient with cecal volvulus, next step

A

Segmental Colonic resection

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26
Q

Treatment for mild to moderate ischemic colitis

A
  • intravenous fluids
  • broad spectrum antibiotics
  • bowel rest
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27
Q

which biliary disease is tied to ulcerative colitis

A

primary sclerosing cholangitis

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28
Q

Which extra colonic manifestations of UC improve after colectomy?

A
  • ocular problems
  • arthritis
  • pyoderma gangrenosum (50% of the time)
29
Q

What extra manifestations of UC do not improve after total abdominal colectomy?

A
  • primary sclerosing cholangitis
  • ankylosing spondylitis
30
Q

how long do you wait after chemoradiation for anal squamous cell carcinoma to determine if the patient has residual disease

A

6 months

31
Q

what is the space of Retzius

A

the extra-peritoneal space between the pubic symphysis and the bladder

32
Q

what is the procedure of choice for a patient with an anal sphincter defect?

A
  • overlying sphincterplasty
33
Q

Colonoscopy/histology findings that would necessitate repeat in 3 years

A
  • serrated adenoma
  • high grade dysplasia
  • villous or tubulovillous histology
  • 3-10 adenomatous polyps
  • polyp >/= 1 cm
34
Q

what is the treatment for a low rectovaginal fistula?

A

rectal advancement flap

35
Q

what kind of bowel prep is recommended for elective colorectal cases?

A

mechanical and oral antibiotics

36
Q

tenets of rubber band ligation in treating hemorrhoids?

A
  • band 2cm above dentate line
  • band only redundant mucosa
37
Q

for patients with Anal squamous cell carcinoma s/p Nirgo protocol who has persistent disease, what is the next step

A

Biopsy to confirm cancer before any resection is undertaken

38
Q

after a sigmoidectomy with high ligation, what is the remaining distal bowel perfused by

A

Marginal artery from SMA

39
Q

best first line treatment for idiopathic pouchitis

A

Oral ciprofloxacin

40
Q

what should you do for a patient with a lateral anal fissure

A

EUA with biopsy if appropriate

41
Q

Complication of stapled hemorrhoidopexy in women, unique to it being stapled

A

rectovaginal fistula

42
Q

Alternative treatment for internal hemorrhoids, for a patient on anti-coagulation

A

Sclerotherapy

43
Q

If you suspect an intestinal neuroendocrine tumor
(NET), what test(s) should you order to gain further information?

A
  • Serum chromogranin A
  • 24 hour urine 5-HIAA
44
Q

what is 5-HT, hint: it relates to NETs

A

5-hydroxytryptamine (AKA: serotonin)

45
Q

what is 5-HIAA, hint: it relates to NETs

A

5-hydroxyindoleacetic acid (AKA: main metabolite of serotonin, excreted in urine)

46
Q

risk of incontinence after lateral internal sphincterotomy

A

8-30%

47
Q

difference between trans-anal and trans-abdominal resection of a rectal adenocarcinoma, when comparing recurrence rates

A

trans-anal resection comes with a higher rate of local recurrence

48
Q

which vessel do you ligate in a mid-descending colon cancer?

A

inferior mesenteric artery

49
Q

what conservative therapy can you offer for internal hemorrhoids in a patient on blood thinners, who has already tried life style modification

A

sclerotherapy

  • less risk of bleeding than band ligation
50
Q

most common complication after loop ileostomy reversal

A

bowel obstruction (7% risk)

51
Q

You are unable to get the left colon to reach the upper rectum without tension, despite takedown of the splenic flexure and full dissection of the left mesocolon off the retroperitoneum. What is the next step to obtain more length?

A

divide the inferior mesenteric vein, should free colon from the central mesentery and give you enough length

52
Q

Patient s/p perianal wart removal, pathology returns with high and low grade dysplasia. How often should they be re-evaluated for lesions

A

every 6 months anoscopy and digital rectal examination

this is for both high grade OR low grade dysplasia

53
Q

Amsterdam criteria for Hereditary non-polyposis Colorectal cancer

A
  • at least 3 family members with proven adenocarcinoma (one is a first degree relative)
  • at least 2 generations involved
  • at least one person diagnosed before the age of 50
54
Q

What is the genetic mutation in HNPCC

A

DNA mismatch repair mutation
(MLH1, MSH2, MSH6, PMS2, or EPCAM)

55
Q

Length of a Ileal J pouch?

A

15-20 cm

56
Q

When do you start screening for colorectal cancer in patients with inflammatory bowel disease?

A

8 years after diagnosis, or at the age of 40 whichever is first

57
Q

anterior border for a total mesorectal excision during a low anterior resection

A

Denonvilliers fascia

58
Q

what diameter of colon (except cecum) with toxic megacolon?

A

> 5.5 cm

59
Q

when do you start screening for colorectal cancer in patient with IBD?

A

8 years after diagnosis

60
Q

what is FOLFOX chemotherapy?

A

FOLinic acid
Flourouracil
OXaliplatin

61
Q

what chemotherapy regimen is currently used in colorectal cancer?

A

FOLFOX

folinic acid, flourouracil, oxaliplatin

62
Q

role of CEA in colorectal cancer

A

most sensitive at detecting hepatic or retroperitoneal mets from colorectal cancer

63
Q

primary source of energy for enterocytes

A

Glutamine

64
Q

primary source of energy for colonocytes

A

short chain fatty acids

Acetate, butyrate, propionate

65
Q

What bacteria is associated with Colorectal Cancer?

A

Clostridium Septicum

66
Q

Superior rectal artery supply

A

IMA

67
Q

Middle rectal artery supply

A

internal iliac arteries

68
Q

inferior rectal artery supply

A

pudendal artery

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