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74 Cards in this Set
- Front
- Back
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test of choice for diverticulitis
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CT
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it's important to distinguish diverticulitis from ___
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rectosigmoid cancer
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tx for uncomplicated diverticulitis (2)
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antibiotics
colonoscopy 6 weeks later |
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rate of recurrence of diverticulitis is high/low
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low
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3 complications of diverticulitis
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abscess
obstruction fistula |
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tx of diverticulitic abscess (2)
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drainage
surgery 6 weeks later |
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diverticulitis surgery removes colon which is ___ (2)
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thickened
brittle |
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sigmoid vesical fistulae can present as ___ (4)
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pneumaturia
fecaluria UTI air in bladder (by CT) |
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diverticulitis fistulae can be from colon to ___ (4)
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skin
bladder vagina small bowel |
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generalized peritonitis from diverticulitis requires ___
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Hartmann's procedure
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2/3 of all volvulus is ___ volvulus
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sigmoid
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abdomen in volvulus is ___ (2)
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distended
tympanic |
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dx of volvulus is based on ___ (2)
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clinical presentation
abdominal xray |
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2 radiologic signs of volvulus
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coffee bean
beak |
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if no signs of ___ are present, tx of colonic volvulus is via (3)
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colonic necrosis
IV fluids rectal tube through proctoscope cathartics |
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if detorsion of volvulus with tube doesn't work, do ___
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Hartmann's
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recurrence rate for volvulus is high/low
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high (50\%)
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because of recurrence rate ___ is recommended for volvulus
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sigmoid resection
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DD of large bowel obstruction
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tumors
volvulus diverticulitis |
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3 kinds of closed loop obstructions
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strangulated hernia
volvulus colon obstruction with competent ileocecal valve |
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2 peaks of UC incidence
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15--35
50--60 |
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GIT layers affected in UC
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mucosa
submucosa |
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biliary disease associated with UC
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PSC
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conservative tx for UC
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surveillance colonoscopy
medical tx |
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surveillance colonoscopy for UC is done every ___ years starting 8 years after onset of ___, or ___ years after onset of ___
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1--2
pancolitis 12--15 left-sided colitis |
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medical tx includes (3)
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aminosalicylates
CS immunomodulators |
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tx for fulminant colitis or toxic megacolon (2 parts)
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total abdominal colectomy (rectum preserved)
ileostomy |
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3 options for elective UC surgery
most popular is ___ |
total proctocolectomy with Brooke ileostomy
total proctocolectomy with Kock pouch proctocolectomy with ileal pouch anal anastomosis (IPAA) last one |
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IPAA is often protected by ___
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diverting loop ileostomy
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2 areas of colon most vulnerable to ischemic colitis
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splenic flexure
rectosigmoid junction (watershed areas) |
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conservative tx for ischemic colitis (4)
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IVF
NGT NPO antibiotics |
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3 acute indications for surgery in ischemic colitis
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peritoneal signs
massive bleeding fulminant colitis/toxic megacolon |
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definitive tx for FAP: ___ with ___ and ___
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restorative proctocolectomy
distal rectal mucosectomy IPAA |
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2 FAP screening recommendations
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flexible sigmoidoscopy every year starting age 10
EGD every 1--3 years after polyps present |
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HNPCC screening colonoscopy recommendations (2)
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every 2 years starting age 20
every year after age 35 |
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right hemicolectomy is for lesions in (3)
the resection ends at ___ |
cecum
ascending colon hepatic flexure between R & L branches of middle colic a. |
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extended right hemicolectomy is for lesions in ___
resection ends at ___ |
transverse colon
after L branch of middle colic a. |
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left hemicolectomy is for lesions in ___ (2)
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splenic flexure
descending colon |
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4 kinds of polyps
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adenomatous
hyperplastic inflammatory hamartomatous |
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only ___ polyps can become cancer
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adenomatous
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Peutz-Jeghers has primarily ___ polyps, but can also have ___ polyps
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hamartomatous
adenomatous |
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3 morphological kinds of polyps idoof
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tubular
tubulovillous villous |
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worst kind of polyp is ___, because ___.
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villous sessile
associated with severe atypia or dysplsia |
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2 risk factors for adenoma-carcinoma progression
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polyp size
preexisting CRC |
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tx for adenomatous polyp
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colonoscopic polypectomy
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a colorectal adenocarcinoma is considered invasive if ___
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cells penetrate muscularis mucosae
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HNPCC screening recommendations
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colonoscopy
transvaginal US/endometrial aspirate urinary tract US & urinalysis |
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HNPCC transvaginal US/endometrial aspirate should be done starting ___
HNPCC urinary tract US & urinalysis should be done starting ___ |
age 20--25
age 30--35 |
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Amsterdam criteria for HNPCC (4)
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3 or more relatives with non-FAP CRC
the 3 relatives are first degree relations of each other 2 successive generations affected at least 1 of the 3 presented before age 50 |
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surgery for HNPCC: ___ with ___.
if female, add ___ (2). |
total abdominal colectomy
IPAA total abdominal hysterectomy bilateral salpingo-oophorectomy |
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right colon ca presents with ___ (2)
left colon ca presents with ___ (2) |
melena
anemia changes in bowel habits obstruction |
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fully obstructing colon tumors are more common on left/right.
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left
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T/F: do a pre-op colonoscopy for a fully obstructing tumor of left colon
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false
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tx for fully obstructing tumor of left colon (2)
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water soluble contrast enema
Hartmann's |
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water soluble contrast enema does ___.
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shows level of obstruction
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fully obstructing tumor of right colon presents with ___, assuming ___
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symptoms of small bowel obstruction
incompetent ileocecal valve |
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tx for fully obstructing tumor of right colon (2)
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water soluble contrast study
right hemicolectomy |
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if tumor is not fully obstructing, do ___
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workup for mets
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workup for CRC mets (5)
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physical exam
CXR LFTs CEA level CT or MRI |
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T/F: primary tumor should be excised even if liver mets present
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true
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goals of CRC surgery (3)
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excision of primary with sufficient margins
regional lymphadenectomy anastomosis |
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T stage of CRC is given by ___
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depth of invasion
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most common sx of rectal ca
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hematochezia
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in pre-op assessment for rectal ca, do ___ and evaluate ___ (4)
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full colonoscopy
distance from anal sphincter extent of invasion & nodal mets other comorbidities patient's body habitus |
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full colonoscopy in rectal ca is done to ___
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exclude synchronous colon tumors
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in rectal ca, distance from anal sphincter is measured with
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rigid proctosigmoidoscope
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in rectal ca, extent of invasion & nodal mets are evaluated with ___ and one of ___ (2)
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digital PR
EUS MRI |
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tumors in ___ of rectum are most challenging. if tumor is small (i.e., ___) , do ___. otherwise, either do ___ or both of ___ and ___.
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distal 3--5 cm
T1 transanal resection neoadjuvant chemo + rads proctectomy total mesorectal excision |
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fulguration is ___. it is indicated for ___ patients with tumors located ___ly.
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electrocautery
high risk patients with poor prognosis below peritoneal reflection |
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abdominal perineal reflection is aka ___. indications are ___ (4).
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Miles procedure
tumor involves sphincters tumor too close to sphincters poor preop sphincter condition body habitus precludes sphincter preservation |
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miles procudure includes excision of ___ (3) and creation of ___.
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distal rectum
anal sphincters anus permanent colostomy |
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anterior resection means ___
low anterior resection means ___. both use ___ and usually include ___. |
resection of proximal rectum above peritoneal reflection
resection of proximal rectum extending below peritoneal reflection primary reanastomosis sigmoidectomy |
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sometimes neoadjuvant tx allows performing ___ instead of Miles
the distal colon is made into a ___. |
sphincter preserving perineal resection with coloanal anstomosis
j pouch |
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general CRC screening recommendation
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colonoscopy every 10 years starting at 50
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