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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
Patient with cecal volvulus, next step
Segmental Colonic resection
26
Treatment for mild to moderate ischemic colitis
- intravenous fluids - broad spectrum antibiotics - bowel rest
27
which biliary disease is tied to ulcerative colitis
primary sclerosing cholangitis
28
Which extra colonic manifestations of UC improve after colectomy?
- ocular problems - arthritis - pyoderma gangrenosum (50% of the time)
29
What extra manifestations of UC do not improve after total abdominal colectomy?
- primary sclerosing cholangitis - ankylosing spondylitis
30
how long do you wait after chemoradiation for anal squamous cell carcinoma to determine if the patient has residual disease
6 months
31
what is the space of Retzius
the extra-peritoneal space between the pubic symphysis and the bladder
32
what is the procedure of choice for a patient with an anal sphincter defect?
- overlying sphincterplasty
33
Colonoscopy/histology findings that would necessitate repeat in 3 years
- serrated adenoma - high grade dysplasia - villous or tubulovillous histology - 3-10 adenomatous polyps - polyp >/= 1 cm
34
what is the treatment for a low rectovaginal fistula?
rectal advancement flap
35
what kind of bowel prep is recommended for elective colorectal cases?
mechanical and oral antibiotics
36
tenets of rubber band ligation in treating hemorrhoids?
- band 2cm above dentate line - band only redundant mucosa
37
for patients with Anal squamous cell carcinoma s/p Nirgo protocol who has persistent disease, what is the next step
Biopsy to confirm cancer before any resection is undertaken
38
after a sigmoidectomy with high ligation, what is the remaining distal bowel perfused by
Marginal artery from SMA
39
best first line treatment for idiopathic pouchitis
Oral ciprofloxacin
40
what should you do for a patient with a lateral anal fissure
EUA with biopsy if appropriate
41
Complication of stapled hemorrhoidopexy in women, unique to it being stapled
rectovaginal fistula
42
Alternative treatment for internal hemorrhoids, for a patient on anti-coagulation
Sclerotherapy
43
If you suspect an intestinal neuroendocrine tumor (NET), what test(s) should you order to gain further information?
- Serum chromogranin A - 24 hour urine 5-HIAA
44
what is 5-HT, hint: it relates to NETs
5-hydroxytryptamine (AKA: serotonin)
45
what is 5-HIAA, hint: it relates to NETs
5-hydroxyindoleacetic acid (AKA: main metabolite of serotonin, excreted in urine)
46
risk of incontinence after lateral internal sphincterotomy
8-30%
47
difference between trans-anal and trans-abdominal resection of a rectal adenocarcinoma, when comparing recurrence rates
trans-anal resection comes with a higher rate of local recurrence
48
which vessel do you ligate in a mid-descending colon cancer?
inferior mesenteric artery
49
what conservative therapy can you offer for internal hemorrhoids in a patient on blood thinners, who has already tried life style modification
sclerotherapy - less risk of bleeding than band ligation
50
most common complication after loop ileostomy reversal
bowel obstruction (7% risk)
51
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?
divide the inferior mesenteric vein, should free colon from the central mesentery and give you enough length
52
Patient s/p perianal wart removal, pathology returns with high and low grade dysplasia. How often should they be re-evaluated for lesions
every 6 months anoscopy and digital rectal examination this is for both high grade OR low grade dysplasia
53
Amsterdam criteria for Hereditary non-polyposis Colorectal cancer
- 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
What is the genetic mutation in HNPCC
DNA mismatch repair mutation (MLH1, MSH2, MSH6, PMS2, or EPCAM)
55
Length of a Ileal J pouch?
15-20 cm
56
When do you start screening for colorectal cancer in patients with inflammatory bowel disease?
8 years after diagnosis, or at the age of 40 whichever is first
57
anterior border for a total mesorectal excision during a low anterior resection
Denonvilliers fascia
58
what diameter of colon (except cecum) with toxic megacolon?
> 5.5 cm
59
when do you start screening for colorectal cancer in patient with IBD?
8 years after diagnosis
60
what is FOLFOX chemotherapy?
FOLinic acid Flourouracil OXaliplatin
61
what chemotherapy regimen is currently used in colorectal cancer?
FOLFOX folinic acid, flourouracil, oxaliplatin
62
role of CEA in colorectal cancer
most sensitive at detecting hepatic or retroperitoneal mets from colorectal cancer
63
primary source of energy for enterocytes
Glutamine
64
primary source of energy for colonocytes
short chain fatty acids Acetate, butyrate, propionate
65
What bacteria is associated with Colorectal Cancer?
Clostridium Septicum
66
Superior rectal artery supply
IMA
67
Middle rectal artery supply
internal iliac arteries
68
inferior rectal artery supply
pudendal artery

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