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20 Cards in this Set

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What are the white lines of Toldt?
lateral and peritoneal reflections of the ascending and descending colon
What parts of GI tract do not have serosa?
esophagus, middle and distal rectum
What is the blood supply to the rectum?
proximal: superior hemorrhoidal from the IMA

middle: middle hemorrhoidal from the hypogastric (int. iliac)

distal: inf. hemorrhoidal from the pudendals
Waht is the venous drainage of the rectum?
proximal: via the IMV to the splenic vein, then to the portal vein

middle: via the iliac v. to the IVC

distal: via the iliac to the IVC
Main purpose of the colon?
H2O absorption and stool storage
What is colorectal CA?
adenocarcinoma of the colon or rectum
What is the incidence of Colorectal CA?
most common GI CA
second most common CA in the US
increased incidenc with age starting at 40 and peaks at 70 to 80 years
second most common cause of cancer deaths
male:female ratio is 1:1
what are the risk factors for colon CA?
dietary: low-fiber, high fat diets INC rates

Genetic: fam hx is imp. risk factor; FAP, lynch syndrome

IBD: UC>Chron's

Age, previous colon CA
What is Lynch's syndrome?
HNPCC: Hereditary NonPolyposis Colon Cancer - autosomal dominant inheritance of high risk for development of colon CA
What are current ACS recommendations for Colon Ca screening (without (+) family hx)?
annual digital rectal exam starting at age 40
annual fecal occult blood test starting at age 40
colonoscopies every ten years starting at age 50
What are the signs and symptoms associated with right sided Colon Ca?
microcytic anemia
occult melena > hematochezia PR
postprandial discomfort
fatigue

Right sided colon has a large luminal diameter so CA may attain a large size before causing any problems
What are the signs and symptoms associated with left sided Colon Ca?
change in bowel habits (small caliber stools)
colicky pain
signs of obstruction - abdominal mass, heme+ stools or gross blood
nausea, vomiting, constipation

left sided colon has a smaller luminal diameter and semisolid contents
From which sided colon ca is melena more common?
Right
from which sided colon Ca is hematochezia more common?
left
What are the signs and symptoms of rectal ca?
MC symptom is hematochezia (passage of red blood +/- stool) or mucus
tenesmus
feelinf of incomplete evacuation of stool
rectal mass
what is the differential dx of colon tumor/mass?
adenoCa, carcinoid tumor, lipoma, leomyoma, lymphoma, UC, Chron's dz, benign polyps
Dx exams for colon ca?
H&P with rectal
heme occult
CBC
barium enema
sigmoid/ colonoscopy
How does colon Ca spread?
direct extension: circumferentially and then thru bowel wall to later involve other abdominoperineal organs
Hematogenous: portal circulation to liver; lumbar vertebral veins to lungs
lymphogenous: regionally
transperitoneal
intraluminal
What tests are useful to help find colon ca mets?
CXR
LFTs
abdominal CT
Hwat diagnostic test is useful for rectal Ca?
endorectal US - probe is placed transanally and depth of invasion and nodes are evaluated