absite colorectal
Quiz yourself by thinking what should be in
each of the black spaces below before clicking
on it to display the answer.
Help!
|
|
||||
|---|---|---|---|---|---|
| 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
🗑
|
Review the information in the table. When you are ready to quiz yourself you can hide individual columns or the entire table. Then you can click on the empty cells to reveal the answer. Try to recall what will be displayed before clicking the empty cell.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
To hide a column, click on the column name.
To hide the entire table, click on the "Hide All" button.
You may also shuffle the rows of the table by clicking on the "Shuffle" button.
Or sort by any of the columns using the down arrow next to any column heading.
If you know all the data on any row, you can temporarily remove it by tapping the trash can to the right of the row.
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Created by:
ehstephns
Popular Midwifery sets