Seer Training Modules: Colon

Front 1

The small intestine extends from

Back 1

the pyloric sphincter to the ileocecal valve

Front 2

accessory organs of the digestive system that are closely associated with the small intestine

Back 2

The liver, gallbladder, and pancreas

Front 3

The small intestine is divided into the

Back 3

duodenum, jejunum, and ileum

Front 4

macroscopically visible, crescent-shaped folds of the mucosa and submucosa. It extends around one-half to two-thirds of the circumference of the lumen of the small intestine.

Back 4

plicae circulares

Front 5

The absorptive surface area of the small intestine is increased by

Back 5

plicae circulares, villi, and microvilli.

Front 6

Exocrine cells in the mucosa of the small intestine secrete

Back 6

mucus, peptidase, sucrase, maltase, lactase, lipase, and enterokinase

Front 7

Endocrine cells secrete

Back 7

cholecystokinin and secretin

Front 8

The most important factor for regulating secretions in the small intestine is the presence of

Back 8

chyme

Front 9

The large intestine extends from

Back 9

the ileocecal junction, where the ileum enters the large intestine, and ends at the anus

Front 10

The large intestine consists of

Back 10

the colon, rectum, and anal canal

Front 11

The mucosa of the large intestine has a large number of goblet cells but does not have any

Back 11

villi

Front 12

The longitudinal muscle is limited to three distinct bands, called

Back 12

teniae coli

Front 13

Contraction of the teniae coli exerts pressure on the wall and creates a series of pouches, called

Back 13

haustra

Front 14

pieces of fat-filled connective tissue, attached to the outer surface of the colon.

Back 14

Epiploic appendages

Front 15

Unlike the small intestine, the large intestine produces no

Back 15

digestive enzymes

Front 16

Functions of the large intestine include

Back 16

the absorption of water and electrolytes and the elimination of feces.

Front 17

The rectum extends from the

Back 17

sigmoid colon to the anal canal

Front 18

Where does the rectum end?

Back 18

about 5 cm below the tip of the coccyx, at the beginning of the anal canal

Front 19

The last 2 to 3 cm of the digestive tract is the

Back 19

anal canal

Front 20

The mucosa of the rectum is folded to form

Back 20

longitudinal anal columns

Front 21

Rectal Cancer bone metastases can occur in the

Back 21

pelvis or other bones

Front 22

Risk factors for colorectal cancer:

Back 22

Ulcerative colitis
Familial or multiple polyposis
Crohn's Disease
Low fiber diet
Hx of Colon or Rectal Ca
Hx of Colon or Rectal Polyps
Family hx of colorectal ca or female genital cancer

Front 23

Ulcerative colitis is sometimes called

Back 23

panulcerative colitis

Front 24

a disease occurring in some families that consists of multiple adenomatous polyps of the colon which have high malignant potential.

Back 24

Familial or multiple polyposis

Front 25

a benign chronic granulomatous inflammatory disease of any or all parts of the colon

Back 25

Crohn's disease

Front 26

Risk factors for anal cancer include:

Back 26

Over 50 y/o
More frequent in women

Front 27

Inflammation of the colon

Back 27

colitis

Front 28

The early signs of colorectal cancer

Back 28

- Unexplained persistent diarrhea or constipation.
- Blood in or on the stool (can be bright red or very dark).
- Narrower stools than usual.
- Unexplained iron deficiency anemia.
- Intermittent abdominal pain

Front 29

The following symptoms can be signs of rectal cancer:

Back 29

- Blood in the stool.
- Diarrhea.
- A sense of bowel movement urgency.
- Feeling of inadequate emptying of bowel.
- Excessive straining to have a bowel movement without passing of stools.

Front 30

The exact cause of colorectal cancer is unknown, however at least eight different genes involved can be traced to

Back 30

dietary fat, particularly animal fat

Front 31

During fat metabolism, bacteria in the bowel form

Back 31

carcinogens (cancer-causing agents) that can irritate the intestinal lining

Front 32

is thought to be somewhat protective because it helps accelerate the rate at which fats pass through the bowel and/or dilutes the concentration of fats, reducing the exposure of the large intestine to carcinogens.

Back 32

A high-fiber diet

Front 33

account for 90 to 95 percent of all large bowel tumors

Back 33

Adenocarcinomas

Front 34

cancers usually grow into the space within the colon

Back 34

On the right side of the colon near the cecum

Front 35

Colon cancers can become large enough to cause bleeding, in these cases this is often one of the first signs

Back 35

anemia from chronic blood loss

Front 36

Most polyps and cancers appear on which side of the colon?

Back 36

Left side

Front 37

typically constricts the bowel channel, causing partial blockage

Back 37

Left-sided colon cancer

Front 38

Typical symptoms of colon cancer include:

Back 38

constipation, change in bowel habits, and narrow, ribbon-shaped stool when a cancer is low in the rectum.

Front 39

When colon cancers do spread, it is usually through invasion of

Back 39

nearby lymph nodes

Front 40

colorectal cancers tend to be slow growing, gradually enlarging and eventually

Back 40

penetrating the bowel wall

Front 41

The most common sites of distant metastasis are

Back 41

the liver, lungs, and brain

Front 42

Rectal cancer can spread to

Back 42

adjacent organs in the pelvic region, such as the ovaries or the prostate

Front 43

6 x 9 cm pouch covered with peritoneum

Back 43

Cecum (proximal right colon)

Front 44

A vermiform (wormlike) diverticulum located in the lower cecum

Back 44

Appendix

Front 45

20-25 cm long, located behind the peritoneum

Back 45

Ascending colon

Front 46

Lies under right lobe of liver

Back 46

Hepatic flexure

Front 47

Lies anterior in abdomen, attached to gastrocolic ligament

Back 47

Splenic flexure

Front 48

Near tail of pancreas and spleen

Back 48

Splenic flexure

Front 49

10-15 cm long, located behind the peritoneum

Back 49

Descending colon

Front 50

Loop extending distally from border of left posterior major psoas muscle

Back 50

Sigmoid colon

Front 51

Between 10 and 15 cm from anal verge

Back 51

Rectosigmoid segment

Front 52

12 cm long; upper third covered by peritoneum; no peritoneum on lower third which is also called the rectal ampulla. About 10 cm of the rectum lies below the lower edge of the peritoneum (below the peritoneal reflection), outside the peritoneal cavity

Back 52

Rectum

Front 53

Most distal 4-5 cm to anal verge

Back 53

Anal canal

Front 54

A blood test measuring the presence of an antigen in malignancies arising in endodermal (embryonic) or gastrointestinal tissue. Persistent elevated levels indicate residual or recurrent metastatic carcinoma

Back 54

CEA

Front 55

What is a normal CEA?

Back 55

< 2.5 ng/ml

Front 56

CEA level that suggests extensive disease

Back 56

> 10 ng/ml

Front 57

CEA levels that suggest metastatic disease

Back 57

> 20 ng/ml

Front 58

Monitors post-therapeutic gastrointestinal cancer for recurrence; nonspecific to colorectal cancer

Back 58

CA 19-9

Front 59

Detects colon cancer; changing level indicates progression or regression of tumor load

Back 59

CA 195

Front 60

Criteria for TNM Clinical Staging:

Back 60

Physical examination and history; histologic type; imaging (barium enema, chest x-ray, and so forth), endoscopy, and studies to determine presence or absence of distant metastases

Front 61

Criteria for TNM Pathological Staging:

Back 61

Information from clinical staging; surgical exploration; pathologic examination of resected specimen, including depth of penetration into wall of bowel; evaluation of number and location of involved lymph nodes

Front 62

Synonyms for in situ carcinoma

Back 62

Stage 0, non-infiltrating, superficial, no invasion of lamina propria, limited to mucosa, non-invasive, no penetration of the basement membrane

Front 63

For Stage II and III rectal cancer, the recommended therapy is

Back 63

surgery, high-dose pelvic irradiation, and chemotherapy.

Front 64

removing the entire rectum, most of the sigmoid colon, the mesocolon and its regional lymph nodes, removes the anal sphincter and leaves the patient with a permanent colostomy

Back 64

abdominoperineal resection

Front 65

resection preserves the anal sphincter and preserves bowel continuity by creating an anastomosis after the segment of bowel containing the tumor is removed.

Back 65

Anterior/Posterior

Front 66

If tumor is below 5 cm from the anal verge, AP probably stands for

Back 66

Abdominoperineal

Front 67

If tumor is above 5 cm, AP probably means

Back 67

Anterior/Posterior

Front 68

When is chemotherapy recommended in colorectal cancer?

Back 68

Stage III (positive lymph nodes)

Front 69

What is the recommended chemotherapy for colorectal cancer?

Back 69

5-FU alone
5-FU and levamisole (Biological Response Modifier)
5-FU and leucovorin (under clinical evaluation)-ancillary drug
5-FU plus radiation therapy for rectal cancer
Portal vein infusion of 5-FU for known or suspected liver metastases (under clinical evaluation—has shown improvement in palliation but not in survival)