Fiser 36: Colorectal

Front 1

Layers of colon wall

Back 1

Front 2

Colon secretes _____ and reabsorbs _____.

Back 2

K
Na and water

Front 3

Blood supply of colon

Back 3

Front 4

Marginal artery of Drummond

Back 4

Collateral flow between SMA and IMA`

Front 5

Arc of Riolan

Back 5

Short direct connections between SMA and IMA

Front 6

Blood supply of rectum

Back 6

Superior rectal (IMA)
Middle rectal (Internal iliac)
Inferior rectal (Internal pudendal from internal iliac)

Front 7

Watershed areas of colon

Back 7

Splenic flexure (Griffith's point) - SMA and IMA
Rectum (Sudak's point) - superior and middle rectal a.

Front 8

Landmarks from anal verge

Back 8

Anal canal: 0 - 5 cm
Rectum: 5 - 15 cm
Rectosigmoid jx: 15 - 18 cm

Front 9

Anterior fascia

Back 9

Denonvillier's (rectovesicular/rectovaginal)

Front 10

Posterior fascia

Back 10

Waldeyer's fascia (rectosacral)

Front 11

Main nutrient of colonocytes

Back 11

SCFA

Front 12

Polyps with increased cancer risk:

Back 12

- > 2 cm
- sessile
- villous

Front 13

Polypectomy adequate if:

Back 13

- 2 mm margins
- well-differentiated
- no lymphovascular invasion

Front 14

CRC associated organism

Back 14

Clostridium septicum

Front 15

CRC main gene mutations

Back 15

P53
APC
k-ras
DCC

Front 16

Most important prognostic factor in CRC?

Back 16

Nodal status
-#1: Liver spread
-#2: Lung spread

Front 17

Worst prognosis with which histologic type of CRC?

Back 17

Mucoepidermoid

Front 18

Margins needed for CRC

Back 18

2 cm

Front 19

CRC staging and prognosis

Back 19

Duke's staging:
Stage I: A - B1
Stage II: B2
Stage III: C1 - C2
Stage IV: D

Front 20

Transanal excision of rectal cancer appropriate when?

Back 20

- T1 < 4 cm
- Can get 1 cm negative margins
- No neurovascular invasion

Front 21

Neoadjuvant chemo-XRT in which stage of CRC cancer

Back 21

Stage II and III rectal CA
-May shrink rectal tumors and down-staging allowing LAR rather than APR
-Decreases local recurrence and increases survival

Front 22

Chemo in CRC

Back 22

FOLFOX
-5-FU
-Leucovorin
-Oxaliplatin

Front 23

XRT complications

Back 23

Vasculitis
Ulcers
Thrombosis
Stricture

Front 24

Total colectomy in FAP

Back 24

Age 20

Front 25

Most common cause of death in FAP following surgery

Back 25

Periampullary duodenal tumors
-Need duodenal endoscopy every 2 years

Front 26

Gardner's syndrome

Back 26

Desmoid tumors
Osteomas
CRC (FAP)

Front 27

Turcot's Syndrome

Back 27

Brain tumors
CRC (FAP)

Front 28

Lynch syndrome also known as _____ and associated with mutations in which gene?

Back 28

HNPCC
DNA mismatch repair genes

Front 29

Types of Lynch syndrome

Back 29

Lynch I - CRC
Lynch II - CRC + ovarian, endometrial, bladder, stomach

Front 30

Diagnostic criteria for HNPCC

Back 30

Amsterdam criteria:
3 first degree relatives
2 generations
1 under 50

Front 31

Sigmoid vs. cecal volvulus

Back 31

Sigmoid: Older patients, 50% can be decompressed with colonoscopy/sigmoid colectomy

Cecal: 20s-30s, 20% can be decompressed, right hemi

Front 32

Extraintestinal manifestations that do not improve with colectomy in UC

Back 32

-PSC
-Ankylosing spondylitis

Front 33

EI manifestations that improve with colectomy in UC

Back 33

-Most ocular problems
-Arthritis
-Anemia

Front 34

Ogilvie's treatment

Back 34

If colon > 10 cm, colonoscopic decompression and neostigmine, cecostomy if that fails

Front 35

Fecally contaminated food/water may contain?

Back 35

Entamoeba histolytica

Front 36

E. Histolytica infection

Back 36

Primary - colonic, resembles UC with dysentery, 3-4 BM/day, cramping, fever
Secondary - liver

Diagnosis - colonoscopy shows ulceration, trophozoites. Anti-amebic antibodies.

Treatment - FLAGYL, diiodohydroxyquin

Front 37

Cecal mass, abscess, fistula or induration that is suppurative or granulomatous may be?

Back 37

Actinomyces - see sulfur granules on pathologgy

Front 38

Treatment of actinomyces

Back 38

Penicillin or tetracycline, abscess drainage

Front 39

Arteriography detects?

Back 39

Bleeding > 0.5 cc/min

Front 40

Tagged RBC scan detect?

Back 40

Bleeding > 0.1 cc/min

Front 41

Angiodysplasia associated with?

Back 41

Aortic stenosis, improves after valve replacement

Front 42

Pneumatosis intestinalis following chemo

Back 42

Neutropenic typhilitis

Front 43

Treatment of neutropenic typhilits

Back 43

Antibiotics NOT surgery (unless perforated)

Front 44

Infection that mimics appendicitis

Back 44

Yersinia

Treat with tetracycline or Bactrim

Front 45

Most common cause of acquired megacolon

Back 45

T. cruzi

Due to nerve destruction