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absite colorectal

QuestionAnswer
what are tenia coli 3 bands run longitudinally
what is plicae seimulnaris transverse band that forms haustra
what direction does muscularis propria run circular
what are the branches of the SMA and what do they supply ileocolic, R and middle colic; supply asc and 2/3 of transverse colon
what are the branches of the IMA and what do they supply L colic, sigmoid, S rectal: 1/3 transverse, desc and sigmoid colon, upper portion of rectum
what's the marginal artery SMA-IMA collaterals
what the arc of riolan SMA-IMA collaterals
supply of rectum and anal canal and what they branch off of S rectal (off IMA), middle sacral (off Ao right before bifurcation), m rectal off hypogastric; I rectal off internal pudendal
generally venous return does what follows arterial, exception IMV that also gets superior and middle rectal veins
where does I rectal vein drain? Superior and middle? inferior drains into internal iliac and caval system, superior and middle into IMV and then splenic and then portal
watershed areas splenic felxure (griffith's point, SMA/IMA jxn); rectum (superior/middle rectal a jxn)
which is more sensitive to isch, colon or rectum colon bc decrsd collaterals
what controls ext sphincter? What mscl is it? CNS/voluntary, puborectalis that is continuation of levator ani (striated mscl)
what controls internal sphincter? What mscl is it? nmlly contracted, continuation of circular band of colon mscl (sm mscl)
what are the 2 nerve plexus in anal region Meissner (inner), Auerbach (outer)
are Pelvic nerves parasymp or symp? Lumbar? Splanch? Hypogastric? pevlic are parasymp, all others are symp
what 2 nerves specifically control external sphincter internal pudendal nerve and perineal branch of S4
what are the borders of the anal canal, rectum and rectosigmoid jxn anal canal goes up 5cm from anal verge, rectum 5-15cm, rectosigmoid 15-18cm
what changes at rectosigmoid jxn taenia coli change, become broad and completely encircle bowel
what mscl marks transition from anal canal to rectum levator ani (W coccygus forms pelvic diaphragm)
what are crypts of lieberkuhn mucus secreting goblet cells
what are the nutrients for colon short chain fatty acids
tx of stump pouchitis flagyl
s/s lymphocytic colitis watery diarrhea and inflamm bowel symptoms; tx=sulfsalazine
what is denonvilliers fascia the anterior fascia of rectum, rectovesicular fascia in men and rectovaginal in women
what is the posterior rectal fascia called? waldeyer's (rectosacral) fascia
where are polyps MC located L side
3 types of polyps, MC, and risk hyperplastic (MC) no cancer risk, tubular adenoma (pedunculated), villous/sessile that are large 50% cancer esp if >2cm
extent of cancerous cells in carcinoma in situ mucosa only, not thru BM not into submucosa
if lesion into submucosa what stage is it? Mgmt? T1, can do polypectomy if 2mm margin (unless vascular/lymph involvement then need APR or LAR)
causes of false + guaiac beef, vitC, Fe, cimetidine
guidelines CRC screening if avg risk >50: fecal occult q1yr, colonoscopy q10 (or flex sigmoid q5)
who is moderate risk CRC, their screening guidelines CRC or polyp <60 or 2 or more 1st degree w CRC; colonoscopy q5 >40 or 10yr less than youngest
screening for FAP 10-12yo annual sigmoidoscopy, can stop 40 if nml
screening for HNPCC 20-25yo biennial colonoscopy or 10y younger than youngest; once 40yo do annually
if benign polyp removed f/u screening <1cm adenoma f/u colonoscopy 5y (if nml go back to nml surveillance); >1cm f/u colonoscopy 3y
f/u screening s/p curative resxn colonoscopy 1yr, then 3yr then 5yr
4 mutations assoc w CRC APC, DCC, p53, kras
MC primary site CRC, which sites do worse sigmoid; rectosigmoit and rectal
which more advanced exophytic or ulcerative exophytic is less advanced
most impt factor px nodal status
where do CRC met #1, #2 liver (via portal vein), then lung
is lymphocytic infiltration better or worse? Aneuploidy? Mucoepidermoid lymphocytic infiltration do better; aneuploidy and mucoepidermoid do worse
how does fat relate to CRC the fat thgt to lead to O2 radicals
which CRC resxns can be done w 1ry anastomosis R sided
what margin needed for CRC 2cm
what's the diff APR and LAR APR used for lower 1/3 rectum; removes anus, rectum, sigmoid and sigmoidostomy; LAR leaves rectal sphincter intact
cxns assoc APR impotence from nerve supply, bladder dysfxn
what surgery for rectal T1, T2? T1=transanal resection if <4cm; if T2 need APR or LAR
what are the T types for CRC T1=submucosa, T2=muscularis propria, T3=serosa, T4=thru serosa into free peritoneal cavity or adj organs
what's stage I T2N0M0
what's stage II T3 or 4 N0M0
what's stage III any N1
what's stage IV any M1
when do chemo or XRT for colon CRC? Pre or post op? Stage III or higher (positive nodes, distant mets)--give post op chemo no XRT
when do chemo or XRT for rectal CRC? Pre or post op? Stage II pre op or post op Chemo + XRT post op…can also do preop to debulk
which chemo agents are used in CRC 5FU, leucovirin, oxaliplatin
cxns of XRT, MC location rectum vasculitis, thrombosis, ulcers, strictures
what % FAP get cancer, by when? 100% by 40
gene mutation in FAP APC on chromo 5
tx FAP prophylactic total colectomy age 20 w proctocolectomy, rectal mucosectomy, ileoanal (J) pouch. Need lifetime surveillance of residual rectal mucosa and EGD q2 bc duo polyps
sigmoidoscopy v colonoscopy for FAP surveillance sigmoidoscopy is enough
inheritance FAP AD, 20% spontaneous
what gene in Gardners APC
what 3 syndromes assoc w APC Gardner, Turcot, FAP
besides CRC, what other dz do Gardners pts get desmoid tumors and osteomas
besides CRC, what other dz do Turcots get brain cancer
juvenile polyposistypes of polyps, surveillance hamartomous polyps, colonoscopy q2, total colectomy if cancer develops
what other dz besides CRC in Peutz-Jegher GI hamartomas w dark pigmentation around mucous membranes, risk of colon/duo cancer, as well as gonadal, breast, biliary
what does the gene in HNPCC/Lynch syndrome do DNA mismatch repair
CRC in HNPCC/Lynch is where R sided, mltpl cancers
2 types of Lynch and different cancer risks Lynch I: CRC, Lynch II also ovarian, endometrial, bladder, stomach cancer
women w LynchII need what screening besides CRC screening endometrial bx q3yr + annual pelvic (ovarian), more freq mammo
what's amsterdam criteria re Lynch syndrome ”3,2,1” at least 3 first degree relatives, over 2 generations, 1 w cancer <50yo
when CRC screening start for Lynch 25 (or 10yr before 1st)
tx sigmoid volvulus decompress w colonoscopy, then sigmoid colectomy [but if peritoneal signs or gangrenous bowel take straight to OR]
which is more likely: sigmoid or cecal volvulus? How manage cecal volvulus? cecal volvulus is less common; less likely to be able to decompress w colonoscopy, tx=R hemicolectomy
key features UC not full thickness, colon only w contiguous involvement from rectum; no strictures or fistulas
surgery for UC ileoanal anastomosis w J pouch, needs temporary ileostomy while pouch heals
when colonoscopy s/p UC diagnosis yearly starting 8-10yrs s/p diagnosis
things get better in UC s/p colectomy; things don't better: ocular, arthritis, anemia; not better: PSC, ankylosing spondylitis
what gene assoc sacroiliitis and ankylosing spondylitis HLA B27
tx toxic megacolon NGT, fluids, steroids, bowel rest, TPN and Abx…50% get better 50% need surgery.
key features Crohns Transmural inflamm, granulomas, stricture/fistulas, aphthous ulcers (discrete ulcers w surrounding mucosa nml), perianal dz but rectum not involved; small bowel involved
if colon obstruction, where colon most likely to perf cecum
MC causes colon obstruction #1 cancer, #2 diverticulitis
what is Ogilvie’s syndrome pseudoobstruction assoc w opiates, bedridden, elderly w recent surgery, infxn, trauma; tx=colonoscopy w decompression and neostigmine
MC site actinomyces; tx cecum; tx PCN and drainage
MC site of diverticula, MC site of diverticular bleeding L side/sigmoid; R side
pathology of diverticula Herniation of mucosa thru colon wall at sites where arteries enter from incrsd intraluminal P
pathology of diverticulitis perfs in mucosa and adjacent fecal contam
tx diverticulitis, f/u Flagyl, bactrim, bowel rest 3-4d; need f/u Ba enema to r/o cancer
sites of amebic infxn 1ry in colon, 2ry in liver
MC cxn diverticulitis and tx abscess, perQ drainage
indications surgery diverticular dz recurrent dz: 2nd attack assoc w 50% recurrence rate, should resect sigmoid up to superior rectum; some say any complicated diverticulitis
what fistulas do men and women get w diverticulitis colovesicular in men, colovaginal in women
how acive bleeding for arteriography to show GI bleeding? For RBC scan? 0.5cc/min; 0.1
tx diverticulosis bldg colonoscopy can coag bleeder; arteriography can use vasopressin of coil embolization; if recurrent will need resxn of area
compare diverticulosis and angiodysplasia bldg both R side; diverticulosis MC and more severe and arterial bldg, angiodysplasia more likely to recur and venous bldg w ~25% w AS
s/s isch colitis abd pain and bright red bleeding
MC locations isch colitis splenic flexure and desc colon
MC site of Pseudomem colitis (C Dif) distal colon
Created by: ehstephns on 2013-01-23



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