Lower Abdomen Flashcards
Right hemicolectomy indications for carcinoid appy
The operative treatment of appendiceal carcinoid tumors includes completion hemicolectomy for all tumors >2 cm and for tumors between 1 and 2 cm in the presence of:
Mesoappendiceal invasion
Positive or unclear margins
Higher grade
Angioinvasion
Mixed histology (goblet cell carcinoid, adenocarcinoid)
Hemicolectomy recs for appy
adeno
mucinous
carcinoid
all adenos except T1
For all females with abdominal pain check this
bHCG
When to use a hot snare for polyp
1cm
What genetic stuff should you look for in GIST results
exon 9 - need sunitinib
full GIST workup
endo u/s with FNA
CT CAP
1cm adeno ca of appendix comes back…. what next
colonoscopy, CT CAP
2 techs for passing scope if difficult to pass
What to do if cant pass at all
reduce loops
abdominal pressure
Stiffen scope and turn flexures
CT colonoscopy
colonoscopy follow up criteria for:
1-2 tub adenos <1cm
>10 adenomas
Piecemeal
>10mm adenoma
High grade dyplasia
7-10
1y
6m
3y
3y
what is the colonoscopy prep to describe
Split dose poly ethyleneglycol solution in evening and morning
high risk gist features
> 10 cm
10 mitotic index(per 50 HPFs)
3 s/s of gastric cancer
anemia/melena
Early satiety
weight loss
Siewart 2 class and treatment
1cm above GEJ and 2cm below
total gastrectomy
Staging for gastric ca
CT CAP
PET
EUS
s/s indicative of IBD
bloody bms, frequent stools, pain, incontinence
when assess for ibd initially you need to rule out what
c diff, cancer, infection
ibd ddg
celiac
colitis
panc insuff
crohns
uc
definition of fulminant colitis
10 BM per day in hospital with no pain relief and rising wbc, peritonitis
Go to op for fulminant uc
total with end ileostomy
hartman pouch remains
Going to OR for UC emergently, what other preop stuff should be done
iv access
ivf
Abx
tap blocks
2nd op for UC
Jpouch after completion proctectomy
medical crohns management
medical uc managment
ibd big gun med
infliximab
Stage 1 colon ca cutoff
musculature
stage 3 colon cancer begins with ….
nodes
Risk strat for stage 2 colon cancer
why does this matter
dMMR or MSI - High w/…
polyposis genes tested for
APC
MLH1
PTEN
STK11
first abx step for c diff
oral vanc
Emergent surgery for c diff
Subtotal colectomy with ileostomy
when should a loop ileostomy be performed for LAR for rectal ca?
preadjuvant radiation
conservative stuff for fissure
meds?
miralax, sitz bath, avoid caffeine
lidocaine ointment
Diltiazem
second tier for fissure treatment
botox injection
final tier for fissure treatment? Risk factors?
lateral sphincterotomy ; incontinence
what anatomic position of anal fissure is expected? what if its not?
midline; crohns
fissure surgery if incontinent
anal advancement flap
why would someone prefer mastectomy for DCIS
no rads
lower recurrence
Post op stuff for DCIS
receptor treatment
mammogram
re-excision if needed
