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Small & Large Intestine Flashcards

1
Q

SMAD4 mutation syndrome

A

Juvenile polyposis

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2
Q

STK11 mutation syndrome

A

Peutz-Jeghers syndrome

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3
Q

Syndrome: mesenteric desmoid tumors, osteomas of mandible or skull, sebaceous cysts

A

Gardner syndrome

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4
Q

Syndrome: malignant central nervous system tumors (medulloblastoma, etc), gastrointestinal polyps, colon cancer

A

Turcot syndrome

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5
Q

Coloplasty

A

Longitudinal colotomy that is closed transversely to create more reservoir capacity for reconstruction after rectal cancer resection

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6
Q

Management of desmoid tumor

A

Sulindac and tamoxifen
Surveillance with MRI in 3-6mo intervals
(Avoid surgery if possible because tissue manipulation can cause formation of additional desmoid tumors)

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7
Q

Features of fistulas that are likely to close spontaneously

A

low output (<200/day), distal fistula, longer tract (>2cm)

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8
Q

Impediments to spontaneous closure of fistulas

A

FRIEND
Foreign body, radiation, inflammation/infection, epithelialization, neoplasia, distal obstruction

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9
Q

Kulichitsky cells

A

Interstitial cells of cajal (origin cells for GI stromal tumors)

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10
Q

Best test to diagnose colovesical fistula

A

CT with oral/rectal contrast

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11
Q

Causes of primary pneumatosis intestinalis

A

Asthma, COPD, IBD, or immunosuppressive agents - creates cystic pattern in intestinal wall, benign

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12
Q

Management of Stage 1 rectal cancer

A

Tis, T1, or T2 with no nodal involvement -> surgery

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13
Q

When to give neoadjuvant chemo for rectal cancer?

A

T3 or higher, with/without nodes

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14
Q

When can you do a transanal local excision for rectal cancer

A

T1 rectal cancer
<8cm from anal verge
<3cm in size
Well-differentiated
<30% of circumference involved
Mobile

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14
Q

Which layer maintains the tensile strength of bowel

A

Submucosa

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14
Q

Indications for radical resection (APR or LAR) of NET in hindgut

A

> 2cm in size
Invasion into muscularis propria (T2 or higher)
Lymphovascular invasion
Elevated mitotic rate/Ki67

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14
Q

Mutations associated with Lynch syndrome

A

MLH1, MSH2, MSH6, PMS2, EPCAM

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15
Q

Manifestations of Lynch syndrome

A

Keratoacanthomas, sebaceous adenoma/adenocarcinoma
Endometrial, stomach, small bowel, and ureter cancers

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16
Q

MUTYH-associated polyposis: inheritence

A

Autosomal recessive

17
Q

MUTYH-associated polyposis manifestations

A

Adenomatous polyps
Colon, duodenal, bladder, ovarian, skin, and endometrial cancers

18
Q

FAP manifestations

A

Desmoid tumors, osteomas, epidermoid cysts
Gastric and small intestine polyps
Hepatoblastoma
Papillary thyroid cancer variant

19
Q

Gene associated with Peutz-Jegher

20
Q

Mutation associated with Cowden syndrome

21
Q

Cowden syndrome manifestations

A

Gastric and small intestinal polyps, hereditary hemorrhagic telangiectasias

22
Q

Juvenile polyposis syndrome mutations

A

SMAD4, BMPR1A

23
Q

Juvenile polyposis syndrome manifestations

A

Mucocutaneous lesions, breast cancer, thyroid abnormalities, GU cancers (endometrial, RCC), neurologic tumors/disorders

24
Q

Most common extracolonic cancer in Lynch syndrome

A

Endometrial cancer

25
Q

Most common location for carcinoid tumor

A

Rectum (but if colonoscopy is negative, most likely location is ileum)

26
Q

Which part of the bowel regains motility the fastest

A

Small bowel (within 24h)
[Stomach and colon take 3-4 days]

27
Q

Management of incidentally found Meckel’s in an adult

A

Nothing - leave in place

28
Q

Most common type of intussusception

29
Q

Treatment for duodenal obstruction from Crohn’s strictures

A

Gastrojejunostomy (stricturoplasty is too difficult in duodenum)

30
Q

Cancer screening for FAP

A

Colonoscopy q1-2yrs starting age 10-15
EGD starting 20-25 or whenever colonic polyps appear
Thyroid US q2-5yrs starting in teenage years

31
Q

Bent inner tube on abdominal xray

A

Colonic volvulus

32
Q

Margins for colon cancer resection

33
Q

T1 colon cancer

A

Invades submucosa

34
Q

T2 colon cancer

A

Invades muscularis propria

35
Q

T3 colon cancer

A

Goes through muscularis propria and invades pericolonic tissue

36
Q

T4 colon cancer

A

Invades serosa (T4a)
Invades and is adherent to surrounding structures (T4b)

37
Q

N1 colon cancer

38
Q

N2a colon cancer

39
Q

N2b colon cancer

40
Q

Stage I colon cancer

A

T1 or T2, no nodes

41
Q

Stage II

A

T3 or T4, no nodes

42
Q

Stage III colon cancer

A

Any T stage, N1 or N2

43
Q

Indications for adjuvant therapy for colon cancer

A

Stage III and above (any N+ or M+)
Plus certain specific situations with lower stage disease

44
Q

Indications for neoadjuvant chemoradiation in rectal cancer

A

T3 or greater, any nodal disease

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