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Surgery > Large Intestines > Flashcards

Large Intestines Flashcards

1
Q

Derived from endoderm except ectoderm derived distal anal canal

A

LI

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2
Q

LI develops during

A

4th gestational week

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3
Q

Right colon

Proximal 2/3 of transverse colon

A

Midgut

SMA

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4
Q

Distal 1/3 or transverse colon

Left colon descending, sigmoid and proximal rectum

A

Hindgut derived

IMA

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5
Q

Hindgut development

A

Joining of endoderm and ectoderm at dentate line and division of urogenital sinus and rectum by urorectal septum

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6
Q

Divides endo and ectoderm

A

Dentate line

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7
Q

Retroperitoneal

A

Right and left colon

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8
Q

Intraperitoneal

A

Transverse

Sigmoid

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9
Q

Layers of colon and rectum

A

Mucosa
Submucosa (similar to SI)
Inner circular muscle: coalesce in anal canal to form internal sphincter
Outer longituginal: taenia coli (cecum to sigmoid)
In rectum, cirumferential
Serosa: midlower rectum at peritoneal reflection

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10
Q

Contiguous and inferior to pelvic floor muscle (levator ani)

A

External sphincter (voluntary striated)

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11
Q

Attaches to presacral fascia posteriorly and fasia propria of mesorectum anteriorly

A

Retrosacral Waldeyer’s fascia

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12
Q

Separates rectum from prostate and seminal vesicle from vagina

A

Denonvillier’s fascia

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13
Q

Colon differentiated from SI by

A 
appendices epiploicae (intraperitoneal fat pad) 
haustra (circumferential plicae in SI)
bands of outer longitudinal (taenia coli)
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14
Q

Largest diameter
Thinnest wall
Inc risk of perforation

A

Cecum

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15
Q

Most redundant

Inc risk of volvulus

A

Sigmoid

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16
Q

Narrowest

Inc risk of obstruction

A

Sigmoid

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17
Q

Colonic and rectal mucosa epithelium

A

Simple columnar with intestinal glands (crypts of Lieberkuhn) secreting maltase sucrase deeper than in SI

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18
Q

2cm proximal to anal verge

A

dentate

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19
Q

2 cm proximal to anal verge, epithelium

A

changes to anal transition zone with mixture of columnar, cuboidal and squamous epithelium

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20
Q

Connects terminal branches of arteries supplying the colon

A

Marginal artery of Drummond

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21
Q

Watershed area
Junction of SMA and IMA
Vulnerable to ischemia

A

Splenic flexure

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22
Q

IMV drains to

All others run parallel to artery

A

spelnic vein

All others portal vein

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23
Q

Rectal submucosal hemorrhoidal plexus drains into

A

Superior
Middle
Inferior rectal vein

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24
Q

Sympathetic inn of large intestine

A

Thoracic splanchnic T10-T12 right

L1-L3 left colon and rectum

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25
Q

Parasympathetic inn of large intestine

A

Vagus right colon

S2-S4 left colon and rectum

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26
Q

Internal anal sphincter innervation

A

Sympa and para from pelvic plexus

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27
Q

External anal sphincter

Sensation and motor function

A

Inferior rectal nerve S2-S4 from pudendal

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28
Q

Lymph drainage of colon

A

Muscularis mucosa (epicolic bowel wall, paracolic, intermediate and main SMA and IMA) nodes

Rectum proximal to anal canal drains to IMA via mesorectum

Proximal anal canal drains to IMA or inguinal nodes

Distal anus drains to inguinal

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29
Q

Key component of radical resection for rectal cancer

A

Total mesorectal excision

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30
Q

Colon function

A

Water absortion 5L
Na, K, Cl absorption
Colonic bacteria: FA and NH4

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31
Q

Provide energy to colonocytectrom complex carbs

A

Short chain FA

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32
Q

Maintain tonic contraction at rest

A

Internal and external sphincter

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33
Q

Maintained by adequate sensory innervation
Compliance of rectum
Support from pevic floor muscle
Tone from IS and ES

A

Anal continence

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34
Q

As feces reach rectum, pelvic dloor and IS relax and ES contracts allowing feces to approach anus and anoderm

A

Rectoanal reflex

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35
Q

Colon lacks

A

MMEC but has low and high amplitude contraction from vagal stimulation

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36
Q

Normal epithelium mutating to dysplastic epithelium

A

APC

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37
Q

Early adenoma to intermediate adenoma

A

KRAS

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38
Q

Intermediate adenoma to late adenoma

A

DCC/DPC4/JV18?

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39
Q

Late adenoma to carcinoma

A

p53

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40
Q

Carcinoma to metastasis

A

Other changes

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41
Q

19, F
RLQ pain, febrile, hemodynamically stable

RLQ rebound tenderness and guarding

WBC= 13, HCG negative

CT: AA without perforation

OR: inflamed, attached to inflamed edematous ovary with purulence

Next step in management?

A

PID

Right oophorectomy and Appendectomy

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42
Q

Most common surgical emergency of abdomen
7% of population, W 2nd-4th decade
Occlusion of lumen

A

Acute appendicits

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43
Q

Pain upon palpation of left lower quadrant

A

Rovsing’s sign

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44
Q

Pain upon hip flexion

A

Psoas sign

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45
Q

Pain on Internal rotation of right leg

A

Obturator sign

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46
Q

Atypical symptoms of AA occur in

A

children
pregnant
elderly

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47
Q

Mild leukocytosis with or without left shift

A

AA

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48
Q

High sensitivity 95% preferred for dx of AA

A

CT Scan in most populations: enlarged enhancing appendix >6mm with or without fecalith, periappendiceal fat stranding and wall thickening

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49
Q

Beneficial dx in pregnant women and children

A

UTZ

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50
Q

AA tx

Gold standard

A

Lap or open appendectomy

If phlegmon, delay resection start antibiotic and perform interval appendectomy

15% negative appendectomy rate in spite of advances in imaging and technology

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51
Q

Used as landmark to find cecum and appendiceal base

A

Taenia coli

Divide appendiceal artery, resect appendix and invert and oversew base

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52
Q

Oblique incision

A

McBurney

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53
Q

Transverse incision

A

Rocky-Davis

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54
Q

Most common malignancy of appendix

A

Carcinoid tumor

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55
Q

Yellow mass <2cm at appendiceal tip in association with pain or obstruction

Arises from neuroendocrine enterochromaffin cells
90% in the appendix or distal ileum

A

Carcinoid tumor

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56
Q 
Flushing
Wheezing
Edema
Diarrhea
Tricuspid insufficiency
A

carcinoid syndrome

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57
Q

Most conmonly found in the SI

A

Carcinoid

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58
Q

If tumor >2cm involves the appendiceal base or terminal ileum or is metastatic,

A

perform a right hemicolectomy

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59
Q

May alleviate symptoms of carcinoid syndrome

A

Ocreotide

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60
Q

15% of intestinal obstruction
May be caused by cancer, diverticulitis, volvulus, fecal impaction, postoperative adhesions, hernias or loss of peristalsis (pseudoobstruction)

A

Large bowel obstruction

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61
Q

Most common cause of LBO

A

Cancer

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62
Q

Pseudoobstruction

A

Ogilvie’s syndrome

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63
Q

Confirms LBO

A

CT

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64
Q

Abdominal radiograph in LBO

A

colonic distention
SI airfluid level
dilated colon without air in rectum - mechanical obstruction
air in rectum - pseudoobstruction

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65
Q

Tx LBO

A

Fluid resuscitation
Correct metabolic abnormality
NGT
Antibiotics if ischemic

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66
Q

First line in tx of LBO

A

surgery

resect and anastomose

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67
Q

Pseudoobstruction tx

A

NGT

Neostigmine to inc motility

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68
Q

Closed loop obstruction in at least two locations by twistint of bowel >/= 180 deg

Most common in sigmoid, cecum and transverse colon

A

Volvulus

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69
Q

Anteromedial folding of cecum on itself

A

Cecal bascule

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70
Q

Axial rotation of cecum around ileocolic vessel, resulting in twisting of mesentery

A

Cecal volvulus

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71
Q

Rf for volvulus

A 
Redundant segment
Megacolon
Bedridden condition
Chronic constipation
Pregnancy
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72
Q

Involves rotation around mesosigmoid

A

Sigmoid volvulus

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73
Q

Involves rotation of ileum, cecum and ascending colon around mesentery and ileocolic vessel

A

Cecal volvulus

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74
Q

Volvulus may present with

A

sudden onset abdominal distention and pain

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75
Q

Confirms dx of volvulus

A

Abdominal radiograph: bent inner tube narrowing into a bird’s beak (sigmoid)

coffee bean - dilated cecum

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76
Q

Dilated cecum on radiograph

A

Coffee bean

does not resolve with NGT

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77
Q

Loops that are interposed between liver and diaphragm at risk for volvulus

A

Chilaiditi’s syndrome

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78
Q

First line for nonstrangulated sigmoid volvulus

A

endoscopic decompression (sigmoidoscopy, colonoscopy) placement of rectal tube

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79
Q

Passage of air and feces indicate

A

reduction of volvulus

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80
Q

Emergent surgery

A

cecal volvulus

cecopexy, right colectomy

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81
Q

Associated with high recurrence and reserved for selected cases

A

Cecostomy

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82
Q

First line for sigmoid volvulus but not for cecal

A

Endoscopic decompression

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83
Q 
43, M
Severe lower quadrant abdominal pain
Denies prior nausea or vomiting
Febrile but stable
Slightly distended abdomen and tender B lower quadrant with guarding
Leukocytosis

CT: diverticulosis of sigmoid with adjacent diverticular abscess on antimesenteric side of sigmoid colon
No pneumoperitoneum

Mx?

A

Admit
NPO
initiate IV antibiotics

Consider IR drainage if abscess is in amenable location

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84
Q

Most common colonic pathology

A

Diverticular disease

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85
Q

Diverticulosis most affects

A

sigmoid 95

86
Q

Rf for diverticulosis

A

Low fiber diet
Sedentary lifestyle
Tobacco use
Chronic constipation

87
Q

False diverticula involving herniation of mucosa and muscularis mucosa through muscularis externa at an area of weakness (ie near vessel)

A

Diverticulosis

88
Q

More common in young Asian population

A

Right sided diverticulum

89
Q

Multiple non inflamed lesions

Asymptomatic

A

Diverticulosis

90
Q

Inflammation and infection of diverticulum (from microperforation)
Complicated by abscess, gross perforation or obstruction

A

Diverticulitis

91
Q

Asymptomatic or

sudden painless bright red blood per rectum (BRBPR)

A

Divericulosis

92
Q

Painless bright red blood per rectum

LLQ pain, fever, leukocytosis

A

Diverticulitis

93
Q

Dx of diverticulitis

A

Clinical with CT (identify complication)

94
Q

Complications of diverticulosis

A

phlegmon
abscess
perforation
obstruction

95
Q

Indications for elective resection

A

Recurrent attack of diverticulitis
Episode complicated by abscess or microperforation
Diverticulitis in young or immunosuppressed patient

96
Q

Uncomplicated diverticulosis tx

A

high fiber diet
bowel rest
oral antibiotics
ir drainage if abscess is present

97
Q

Sx for diverticulosis perforation

A

sigmoidectomy and Hartmann

98
Q

After episode of complicated disease (abscess)
After episode of diverticulitis in young or immunosuppressed
After recurrent attack

A

Delayed elective resection

99
Q

Men

Source of bleeding distal to ligament of Treitz

A

Lower gastrointestinal bleeding

100
Q

LGIB is a result of

A 
angiodysplasia
diverticulosis
Meckel’s
ischemia
IBD
infection 
neoplasm
hemorrhoids
101
Q

Most common cause of LGIB

A

angiodysplasia

diverticulosis

102
Q

Negative NGT aspirate in UGI source for GI bleeding

A

does not rule out UGIB

103
Q

LGIB mx

A

Fluid resuscitation

Serial Hct

104
Q

Suspected LGIB tx

A

resuscitation, multiple organ support
correct coagulopatht/thrombocytopenia
ET for shock
Surgical consultation

105
Q

+ aspirate NGT or risk factors for UGIB

A

Urgent EGD

106
Q
  • aspirate and low risk for UGIB
A

Urgent colonoscopy

after oral PEG purge

107
Q

Visualization of LGI source

A

thermal/injection therapy

108
Q

Nonvisualization of LGI source

Severe bleeding preventing endoscopic visualization

A

Angiography (+/- prior TRBC scan) with possible angiographic therapy

109
Q

NEC affecting terminal ileum, cecum and right colon

A

Typhilitis

110
Q

Typhilitis rf

A

leukemia

immunosupression (AIDS, chemo, transplant)

111
Q

Confirms dx of typhilitis

A

CT: dilation of bowel, wall thickening, mesenteric stranding, pneumatosis intestinalis if ischemic)

112
Q

Typhilitis mx

A 
Medical
Immediately instituted
NPO
NGT 
fluid resuscitation 
broad spec antibiotics
113
Q

Resection in typhilitis if

A 
hemodynamically unstable
perforation
hemorrhage
complete bowel obstruction
sepsis
114
Q

15% of IBD cases have

A

indeterminate cause

115
Q

Active form of sulfasalazine

A

5-ASA

116
Q

Extra intesinal manifestation of IBD

A 
Primary sclerosing cholangitis (UC)
Erythema nodosum
Pyoderma gangrenosum
Arthritis
Sacroileitis
Anemia 
Pancreatic insufficiency
Pericarditis
Ankylosing spondyltitis
Uveitis
Scleritis
117
Q

Patients with IBD should have

A

annual colonoscopy after disease has been diagnosed for 8-12 years due to risk of colorectal cancer

118
Q

Indications for emergent surgery UC

A

toxic megacolon
fulminant/steroid resistant disease
severe bleeding
perforation

119
Q

Indications for elective surgery UC

A 
Dysplasia or malignancy
Stricture
Intractable symptoms
Inability to tolerate medical management
Extra intestinal disease 
Growth retardation
120
Q

Second leading cause of cancer deaths

No gender predominance

A

Colorectal cancer

121
Q

Rf for CRC

A

> 50 yrs
hx of colon adenoma
IBD (UC)
fmx of colorectal cancer HCCS

122
Q

Premalignant

A

Adenoma

123
Q

Most common adenoma

A

Tubular

124
Q

Adenoma with inc risk for cancer

A

villous

125
Q

May present with asymptom, obstruction, rectal bleeding, changes in stool pattern or caliber, tenesmus or anemia

Exam: guaiac + stool, palpable rectal mass or signs of LBO

A

CRC

126
Q

Indications for surgery Crohn’s

A 
Fistula
Abscess
Strictures/obstruction/failed medical management 
Perforation
Hemorrhage
Dysplasia/malignancy
Growth retardation
127
Q

CRC may reveal

A

Anemia

Inc CEA

128
Q

Screening for CRC

A 
DRE
FOBT
Flexible sigmoidoscopy
Air contrast barium enema
CT colonography (virtual colonoscopy)
Colonoscopy (preferred)
129
Q

Staging for CRC

A 
endoscopic ultrasound
pelvic MRI (assess depth of local invasion)
CT (distant metastases)
130
Q

Tx for CRC

A

CIS (adenoma with high grade dysplasia) endoscopic resection

Invasive cancer in polyp (cancer invading through muscularis mucosa) segmental resection if lymphatic or vascular invasion + margin or poorly diff histology
Endoscopic resection if criteria are absent

All other invasive colon cancers: segmental resection add postoperative chemo (5-FU, oxaliplatin, leucovorin) if + lymph node

131
Q

CRC screening guidelines for average risk patients starting 50

A

Annual FOBT and flexible sigmoidoscopy every 5 years

Colonoscopy every 10 years

Air contrast barium enema every 5 years

Opinion favors colonoscopy

132
Q

Outcomes for stage IV disease with hepatic metastases are

A

improved if hepatic disease is resected

133
Q

Resection should include at least

A

12 lymph nodes for optimal staging

If tumor is perforated or obstructing, surgery is directed at removal of malignancy although bypass or colostomt may be all that is possible

134
Q

Treatment for rectal cancer

A

May include radiation with chemotherapy

135
Q

Carcinoma in situ rectal tx

A

Endoscopic resection or transanal local excision

136
Q

T1 rectal disease

A

Radical resection or for small accessible lesions, transanal, full thickness local excision

137
Q

T2 or higher stage rectal disease tx

A

Radical resection including at least 5cm distal margin of rectum and mesorectum (for upper rectum and rectosigmoid) or TME 1-2 cm distal margin of rectal wall (for mid to low rectal cancer)

138
Q

For very low rectal cancers near canal or sphincter tx

A

APR

139
Q

T3 or node + rectal disease

A

Add chemoradiation to radical surgery preferably preoperatively
Dec morbidity compared to postoperative chemoradiation

Also add postoperative chemotherapy for any node + rectal cancer (as for colon cancer)

140
Q

Surgery for CRC involves

A

segmental resection including involved portion of colon and lymphatic drainage to the root of associated mesentery

141
Q

Amsterdam Criteria for HNPCC (3,2,1 rule)

A

> /= 3 relatives, 1 of whom is a first degree relative with HNPCC related cancer
/= 2 generations affected
/= 1 person affected <50 years
Confirmation that pathologic tumors are not FAP related

142
Q

Most common surgery for UC

A

Total proctocolectomy

143
Q

Most common complication of total proctocolectomy

A

Pouchitis

144
Q

Curative for UC but not for Crohn’s disease

A

Surgery

145
Q

3rd and 7th decase
Inc risk Ashkenazi Jew
Dec risk with tobacco
Colon (left and rectum)
Diarrhea, hematochezia, abdominal pain (crampy), fever
Colonoscopy, biopsy
Mucosa and submucosa
Continuous, friable mucosa, crypt abscess, pseudopolyp
Fulminanct UC, hemorrhage, toxic megacolon, CRC, extra-intestinal manifestation

For maintenance: Sulfasalazine or 5-ASA
6-mercaptopurine or azathioprine

For acute attack: steroid, sulfa, 5-ASA

A

Ulcerative colitis

146
Q

For severe UC tx

A

Infliximab

147
Q

For fulminant steroid-refractory UC tx

A

Cyclosporine

148
Q

2nd and 6th decase
Inc risk with Ashkenazi Jew
Inc risk with tobacco
Anywhere in GI: most common terminal ileum
Diarrhea, obstruction, abdominal pain, weight loss, hematochezia, fever
Colonoscopy with biopsy, small bowel follow through CT scan
Transmural
Skip lesion (ulceration with interspersed normal mucosa), noncaseating granuloma, fistula perianal, abscess, cobblestoning, stricture
Fulminant colitis, toxic megacolon, extra-intestinal manifestation, colorectal and small bowel cancer
Metronidazole for maintenance of perianal disease

A

Crohn’s disease

149
Q

AD
Hamartomatous polyp throughout GI tract
Inc risk of CRC

A

Juvenile polyposis

150
Q

AD
Hamartomatous polyp most often located within jejunum/ileum and possibly rectum
Concurrent hyperpigmentation of buccal mucosa
Slightly inc risk of adenomatous degeneration
Inc risk of extra intestinal cancer (breast, gonad, pancreaticobiliary)

A

Peutz-Jeghers syndrome

151
Q

AD
PTEN mutation
GI polyp, mucocutaneous lesion, uterine leiomyoma, thyroid and breast tumor

A

Cowden syndrome

152
Q

Sporadic
GI polyposis
Epidermal changes including alopecia, nail plate dystrophy, hyperpigmentation

A

Cronkite-Canada syndrome

153
Q

APC mutation ch5q
Colonic adenoma with 100% lifetime CRC risk
Inc risk of periampullary, thyroid, adrenocortical cancer

If + APC = flexible sigmoidoscopy annually at 10-15 yrs
Upper GI endoscopy every 1-3 years from 25 years

A

FAP

154
Q 
APC mutation ch5q
Colonic adenoma with inc risk of CRC
Desmoid tumor 
Osteoid tumor
Epidermoid skin cyst

As for FAP

A

Gardner

155
Q

APC mutation ch5q

Colonic adenoma with inc risk of CRC, brain tumors

As for FAP

A

Turcot’s syndrome

156
Q

hMLH1, hMSH2 mutation (DNA mismatch repair genes)
85% lifetime risk of CRC

Screening colonoscopy annually starting at 20-25 years or 10 years earlier than the youngest CRC diagnosis

Endometrial biopsy or transvaginal ultrasound annually starting at 25-35 years

A

HNPCC (Lynch)

157
Q

Early onset CRC

A

Lynch I

158
Q

Inc risk of brain, stomach, SI, pancreaticobiliary, genitourinary, endometrial malignancy

A

Lynch II

159
Q

Engorged anal submucosal cushion

(CT, arteriole and venule) not varicose

A

Hemorrhoid

160
Q

Hemorrhoids rf

A 
inc intraabdominal pressure
obesity
pregnancy
staining with defacation
most common location are right anterolateral, right posterolateral and left lateral
161
Q

Internal hemorrhoid
Insensatr
Transitional/columnar epithelium

A

superior to dentate line

162
Q

First degree hemorrhoid

A

Prolapse

163
Q

Second degree hemorrhoid

A

+ spontaneous reducing prolapse

164
Q

Third degree hemorrhoid

A

+ prolapse requiring manual reduction

165
Q

fourth degree hemorrhoid

A

+ nonreducible prolapse

166
Q

Inferior to dentate line
Squamous epithelium
Innervated anoderm hence sensitive

A

External hemorrhoid

167
Q

Most common cause of acute anal pain

A

thrombosis of external hemorrhoid
perianal abscess
anal fissure

168
Q

Cause bothersome swelling and diffuclty with hygiene

A

External hemorrhoid

169
Q

Cause bright red bleeding BRBPR and mucous discharge

A

Internal hemorrhoid

170
Q

Family hx of CRC
>40 years
Suspicious symptom
With hemorrhoid

A

Perform flexible sigmoidoscopy or colonoscopy

171
Q

Complication of stapled and traditional hemorrhoidectomy

A

Pain
Bleeding
Urinary retention

172
Q

Tear or ulcer in anoderm distal to the dentate line usually midline

A

Anal fissure

173
Q

Anal fissures are caused by

A

Hypertonic internal anal sphincter muscle from insufficient dietary fiber

174
Q

Small longitudinal ulcer in anoderm with sentinel pile distally or hypertrophic anal papilla proximally

A

Anal fissure

175
Q

Best way to diagnose anal fissure

A

inspection

176
Q

DRE of anal fissure

A

internal sphincter spasm and tenderness

177
Q

Dx for anal fissure

A

Anoscopy

Sigmoidoscopy

178
Q

Anal fissure tx

A

Stool softener
Sitz bath
Nifedipine ointment

179
Q

Failure of medical management in anal fissure:

A

lateral internal sphincterotomy

180
Q

Relaxes internal sphincter

A

Nifedipine

181
Q

Occasional complication of lateral internal sphincterotomy

A

Minor incontinence

182
Q

Fistula between anal canal and perineal skin

A

Fistula-in-ano

183
Q

Anterior or anterolateral external opening track

A

directly radially to anal canal

184
Q

Posterior or posterolateral opening tracks

A

curvilinearly to posterior midline in anal canal

185
Q

Fistula in ano tx

A

fistulotomy

186
Q

Complication if sphincter is divided

A

Fecal incontinence

187
Q

Proper evaluation for any anorectal complaint

A

Careful anal inspection
Rectal exam
Anoscopy
Sigmoidoscopy and sometimes colonoscopy

188
Q

Infected hair containing sinus in gluteal cleft
Hirsute men 15-40
Pain superior to gluteal cleft

Dx: clinical, abscess or multiple pits or sinuses with hair

Sx: excision, marsupialization

A

Pilonidal cysy

189
Q

Inflammation of anorectum
Syphilis, gonorrhea, herpes, HPV, CMV, Chlamydia, chancroid, UC, Crohn’s

Rectal pain, urgency, BRBPR mucuous discharge

Treatment is etiology spec

A

Proctitis

190
Q

Protrusion of entire rectal wall through anus

W >60

A

Rectal prolapse

191
Q

True rectal prolapse present

A

circumferential mucosal fold

192
Q

Mucosal prolapse present with

A

radial fold in mucosal prolapse

193
Q

Rectal prolapse dx

A

Colonoscopy
Contrast enema
Defecography

194
Q

Rectal prolapse procedure (less invasive)

A

Delorme’s

Perineal rectosigmoidoscopy

195
Q

Good operative candidates for rectal prolapse

A

Laparotomy

Rectopexy with or without rectosigmoid resection

196
Q

Anal cancer most commonly is

A

SCC by HPV

197
Q

Pain, pruritus, sense of anal fullness, rectal bleeding

Anal mass occasionally with lymphadenopathy

A

Rectal cancer

198
Q

Confirms dx of rectal ca

A

Biopsy

199
Q

Wide locsl excision

A

small lesion or on perianal skin ca

200
Q

Chemoradiation

A

Large lesions and anal canal (Nigro protocol)

201
Q

Nigro protocol

A

5-FU

Mitomycin

202
Q

Recurrent or persistent disease after chemoradiation is treated with

A

APR

203
Q

Appendectomy
3cm yellow mass at tip of nonperforated appendix

Mx?

A

Because tumor is >2 cm

right colectomy indicated for carcinoid tumor

204
Q

70
diagnosed with colon cancer
What is the incidencr of a synchronous lesion?

A

5-10% synchronous cancer

20-50% synchronous adenoma

205
Q

Next step in eval of LGIB if UGI snd LGI endoscopies are negative
Px is hemodynamically stable

A

Tagged red cell scan
Angiography
Capsule endoscopy

206
Q

Traits of T1 colon cancer necessitate segmental resection rather than endoscopic resection

A

Lymphovascular invasion <1mm margin

Poorly differentiated lesion

207
Q

25, F
Lynch II
Screening recommendation

A

Anually starting at 20-25 yrd of age
10 yrs earlier than youngest CRC dx
Endometrial biopsy or transv UTZ anually starting 25-35 yrs

208
Q

Adjuvant chemo regimen for stage III colon cancer

Indications for adjuvant chemotherapy in stage II disease

A

STAGE III: FOLFOX

Stage II: perforation, obstruction, high-grade lesion, lymphovascular invasion
<12 lymph node in resected specimen

209
Q

Highly sensitive and specific marker for detecting INTESTINAL INFLAMMATION

A

Lactoferrin

210
Q

Level correlates well with histologic inflammation, predict relapses and detect pouchitis

A

Fecal calprotectin

211
Q

Earliest radiologic change of UC in barium enema

A

Fine mucosal granularity

212
Q

Earliest lesion of Crohn’s

A

Apthuous ulcer

Surgery (17 decks)

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