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absite colorectal
| Question | Answer |
|---|---|
| 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
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