Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

General Surgery > CRC > Flashcards

CRC Flashcards

1
Q

Superior mesenteric artery

A

Ascending colon Proximal 1/2 transverse colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Inferior mesenteric artery

A

Distal _ transverse colon Descending colon Sigmoid colon Upper _ rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Middle and inferior rectal artery

A

Lower 1/2 rectum Anus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Bowel wall layers

A

Mucosa Submucosa Muscularis Serosa (except middle and distal rectum)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other structures in bowel

A

Taeniae coli Haustra Appendices epiploicae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Colonic motility

A

Segmentation contractions and mass contractions Movement: 18-48 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Acceleration of colonic transit time

A

Emotional states Diet Disease Infection Bleeding Drugs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Typical defecation pattern

A

Once/24 hours May vary from 8-72 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Changes in bowel habit: Constipation

A

Ability to pass flatus but not stool

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Changes in bowel habit: Obstipation

A

Inability to pass stool or flatus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Person presenting with significant change in bowel habits

A

Must be evaluated for possibility of serious disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Colonic Bacteria

A

Greatest number and variety of bacteria Majority: anaerobes Also: gram + and - aerobes Degrade bile pigments and produce vitamin K Infection risk in colorectal surgery

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Pre-op bowel prep

A

Mechanical cleansing Oral abx IV abx pre-op and 24 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Dx evaluation tools

A

Digital rectal exam Rigid sigmoidoscopy Flexible fiberoptic sigmoidoscopy Fiberoptic colonoscopy Abdominal X-ray series (flat and upright) Barium enema CT scan Angiography Nuclear bleeding scan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Anastamosis

A

Surgical union of two hollow or tubular structures Types: End-to-end, end-to-side, side-to-end, side-to-side

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

End-to-End Anastamosis

A

Performed when 2 segments of bowel are roughly the same caliber Most often employed in rectal resections, but may be used for colocolostomy or small bowel anastamoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

End-to-Side Anastamosis

A

Used when one limb of bowel is larger than the other Used in chronic obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Side-to-End Anastamosis

A

Used when proximal bowel is smaller caliber than distal bowel Ileorectal anastamosis May have less tenuous blood supply than end-to-end anastamosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Side-to-Side Anastamosis

A

Allows a large, well vascularized connection to be created on the antimesenteric side of two segments of intestine Used in ileocolic and small bowel anastamoses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Resection

A

Operative removal of organ or gland

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Anterior resection

A

Used to describe resection of rectum from an abdominal approach to the pelvis with no need for a perineal, sacral, or other incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

High anterior resection

A

Resection of distal sigmoid colon and upper rectum Used for benign lesions and disease in rectosigmoid junction (diverticulitis)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Low anterior resection

A

Removes lesions in the upper and mid rectum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Extended low anterior resection

A

Removes lesions located in distal rectum, but several cm above sphincter

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Abdominoperineal resection (APR)
Involves removal of entire rectum, anal canal, and anus with construction of permanent colostomy from descending or sigmoid colon
26
-Ectomy
Denotes operative removal of an organ or gland
27
-Stomy
Denotes artificial or surgical opening -When two organs precede the suffix, the opening is between them
28
Colostomy
Surgically created connection between colon lumen and abdominal wall skin for diversion of fecal stream
29
Loop Colostomy
Also double-barrel Usually temporary Loop ileostomy
30
End colostomy
One lumen Most permanent stomas
31
Fistula
An abnormal tract between two hollow organs or an organ to the skin -Infectious -Inflammatory -Malignant -Surgical
32
Hartmann's Procedure
Resect sigmoid colon Create end colostomy with L colon Close rectal stump and leave in peritoneal cavity (Hartmann's) Alt: Bring rectal stump to abd wall (Mucous Fistula)
33
Proctum
Synonym for rectum
34
One stage
Diseased segment resected and anastamosis performed at same operation
35
Two stage
1st: create proximal stoma and resect diseased segment 2nd: if not already done, resect disease, then perform anastamosis and reverse colostomy
36
Three stage
3rd: reverse colostomy
37
Ulcerative Colitis
Only affects colon/rectum Long standing: colon is foreshortened and lacks haustral markings ("Lead pipe" colon) Cure: remove affected intestinal segment (colon and rectum)
38
Thumb Printing
Similar appearance of thumbs protruding into intestinal lumen Caused by thickened haustral mucosal folds Abd thumb printing is sign of intestinal ischemia Observed in exacerbations of conditions like UC
39
UC: Emergency surgery
Massive life-threatening hemorrhage -Proctectomy and creation of permanent ileostomy or ileal pouch-anal anastamosis
40
Complications of UC
Toxic megacolon Fulminant colitis -Total abdominal colectomy with end ileostomy (with or without mucus fistula)
41
UC: Elective surgery
Intractability despite max medical therapy High-risk development of major complications (aseptic necrosis of joints from chronic steroid use) At risk of developing colorectal carcinoma
42
UC: Elective resection procedure
Total proctocolectomy with end ileostomy TREATMENT OF CHOICE: Restorative proctocolectomy with ileal pouch-anal anastamosis
43
Crohn's Disease: Areas affected
Any portion of the intestinal tract, from mouth to anus -Skip lesions -Rectal sparing (40%) -Terminal ileum and cecum involved in 41% -Small intestine involved in 35%
44
Crohn's Disease: When to do surgery
Complications of the disease
45
String sign
Narrowing of loop of bowel-- thin stripe of contrast within the lumen looks like a string Observed in Crohn's
46
Crohn's: Internal fistulae and/or intra-abdominal abscess
CT guided drainage of abscess Resection of fistulae with segment of bowel
47
Crohn's: Strictures/Obstruction
Tx: resection or stricturoplasty
48
Crohn's: creation of stroma
Consider if patient is: -Hemodynamically stable -Septic -Malnourished -Receiving high-dose immunosuppressive therapy -Extensive intra-abdominal contamination
49
Diverticular Disease
Mucosal herniation through muscular wall usually at penetration of marginal artery (false diverticula) 5th -- 8th decade Low-fiber diet Chronic constipation Sigmoid colon
50
Diverticulosis
Multiple colonic diverticuli 80% asx finding on exam Sx: recurrent abd pain, usually LLQ. Constipation, diarrhea, or alternating Tx: high fiber diet
51
Diverticulitis
Infection or perf of diverticulum, leading to infection/inflammation of peridiverticular tissue Abscess formation or generalized peritonitis -LLQ pain and tenderness -Alteration in bowel habits -Fever, chills -Leukocytosis -LLQ "mass"
52
Contraindicated tests in diverticulitis acute stage
Barium enema Colonoscopy
53
Initial tx of diverticulitis
NPO, IVF IV Abx (cipro/flagyl) -Sick patients need most aggressive therapy
54
Diverticulitis: perforation tx
Emergent surgery Resect perforated segment and create proximal colostomy (Hartmann) Post-op: treat infection aggressively Delay 2nd stage 6-12 weeks
55
Diverticulitis: Abscess tx
Emergent drainage: open or image guided Treat infection Many can undergo one-stage procedure electively If fail: treat as perf
56
Diverticulitis: Obstruction tx
Incomplete: prep bowel; 1 stage operation Complete: unprepped bowel; 2-3 stage operation *CA is a cause of obstruction*
57
Diverticulitis: Fistula
Colovesicular, colovaginal, coloenteric -If no sepsis or abscess: one stage repair. -Sepsis or abscess: two stage repair.
58
Hemorrhoids: etiology
Cushions of submucosal tissue consisting of venules and smooth muscle fibers located in the upper anal canal become displaced downward during straining at defecation causing dilation of venules
59
Location of hemorrhoids
Left lateral: 3:00 Right posterior: 7:00 Right anterior: 11:00
60
Internal hemorrhoids
Above dentate line Covered by insensitive rectal mucosa S/S: discomfort, bleeding, prolapse
61
External hemorrhoids
Below dentate line Covered by well innervated anoderm S/S: severe pain from thrombosis
62
Grading of hemorrhoids
I. Remain above dentate line II. Prolapse through anus with straining but reduce spontaneously III. Prolapse through anus with minimal strain and/or require manual reduction IV. Continuous prolapse and/or cannot be manually reduced
63
Treatment of hemorrhoids: I, II
Diet and lifestyle
64
Treatment of hemorrhoids: I, II-- unresponsive
Rubber band ligation Alt: infrared photocoagulation, sclerotherapy,
65
Treatment of hemorrhoids: III, IV
Hemorrhoidectomy
66
Treatment of hemorrhoids: thrombosed external
Excise thrombus
67
Treatment of hemorrhoids: Strangulated
Hemorrhoidectomy
68
What is the most common GI cancer?
Carcinoma of the colon and rectum -40s, 70s-80s -Male = female -RF: genetics, diet, IBD
69
Sx: right colon cancer
Weight loss Mass Virchow's node Blummer's shelf Anemia
70
Sx: left colon cancer
+/- weight loss Rectal bleeding Blummer's shelf Obstruction
71
Sx: Rectum cancer
Rectal bleeding Tympany Obstruction
72
ACS recommendations: no first degree family hx
Annual DRE starting age 40 Annual fecal occult blood starting age 40 Sigmoidoscopy age 50 and q 3-5 years
73
ACS recommendations: positive CRC in first degree relative
Colonoscopy or BE starting age 35-40 and q 5 years
74
Pre-malignant polyps
Adenomatous polyps Subdivisions: -Tubular -Tubovillous -Villous adenoma (> 2 cm in size, most commonly malignant) Can be: sessile or pedunculated Tx: colonoscopic polypectomy
75
Large bowel CA
Most common source of large bowel obstruction in adults Sx depend on site TEST OF CHOICE: ENDOSCOPY Tx: Biopsy, CEA, CT scan of abdomen (staging)
76
Classic sign of large bowel CA
Apple core lesion
77
Tx: CRC
Wide surgical resection of lesion Include venous and lymphatic drainage Minimum 2 cm margin (usually 5 cm or more) Chemo for nodal mets Radiation for RECTAL (not colon)
78
Who needs total or subtotal colectomy?
Patients with fulminant colitis, attenuated FAP, or synchronous colon carcinomas
79
CRC Staging: A
Confined to mucosa 5 year survival: 85-90%
80
CRC Staging:B1
Negative nodes; extension into, but not through, the muscularis propria 5 yr survival: 70-75%
81
CRC Staging: B2
Negative nodes; extension through the muscularis propria 5 yr survival: 60-65%
82
CRC Staging: C1
Same level of penetration as B1 but with positive nodes 5 yr survival: 30-35%
83
CRC Staging: C2
Same level of penetration as B2 but with positive nodes 5 yr survival: 25%
84
Rectal carcinoma
Adenocarcinoma Tx: APR (abdominoperineal resection) or LAR (low anterior resection) Fulguration-- used in stage A Adjuvant chemo
85
Anal Carcinoma
Squamous cell type Tx: Nigro protocol (5 fluorouracil and mitomycin and medical radiation if
86
What is the most common cause of large bowel obstruction?
Colon cancer (65%) Other: diverticular stricture (20%), volvulus (5%), other (10%; IBD, benign tumors, FB, fecal impaction)
87
Sx of obstruction
Crampy intermittent abdominal pain Abd distension No BM No flatus Previous surgery Hypo/hyperactive bowel sounds Metallic quality Ascites--intravascular volume depleted *Severe, persistent pain = strangulation or perforation*
88
Large Bowel Obstruction: lab values
BUN/CR: > 20:1 Hypernatremia Urine electrolytes Hemoconcentration Acidosis Leukocytosis
89
Possible locations of obstruction
Proximal Mid-gut Distal
90
Obstruction: Radiology
Supine and erect abd x-ray Erect CXR (including diaphragm) Single-contrast barium enema CT scan
91
Colon cut-off sign
Abrupt termination of gas in proximal colon at level of splenic flexure Most common = acute pancreatitis
92
Tx of bowel obstruction
Fluid resuscitation and monitoring NG tube for decompression Pre-op abx Exploratory laparotomy
93
Bowel obstruction complications
Fluid and electrolyte imbalance Dehydration... hypovolemic shock Ischemia of bowel leading to strangulation, necrosis, perforation Peritonitis Sepsis Death

General Surgery (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions