Absite_Colorectal

Front 1

treatment of squamous cell cancer of anal canal

Back 1

Rx with Nigro protocol (chemo and XRT), not surgery; APR for recurrent dz

Front 2

time required for transformation of polyp to cancer

Back 2

~8 years

Front 3

treatment of T1 anal cancer

Back 3

T1 (limited to submucosa) rectal adenoCA can be excised transanally; do not do transanal if poor differentiation

Front 4

treatment of T2 anal cancer

Back 4

T2: 20% are node +, rec APR;

Front 5

treatment of stage III colon cancer

Back 5

chemotherapy, no XRT

Front 6

treatment of stage II and III rectal cancer

Back 6

chemo and XRT

Front 7

genetic mutations in colon cancer

Back 7

1/2 of colon CA has ras mutation, p53 absent in 85%, DCC (deleted in colon CA) in 70%

Front 8

genetics of familial adenomatous polyposis

Back 8

autosomal dominant, APC gene.

Front 9

natural history of familial adenomatous polyposis

Back 9

CA by 40

Front 10

treatment for familial adenomatous polyposis

Back 10

Need total colectomy prophylactically; Have UGI polyps as well, need to survey duodenum for CA; also develop desmoids - benign, but very difficult to manage. Can treat polyps with sulindac.

Front 11

HNPCC forms

Back 11

Lynch I R sided, multiple CA's, young; Lynch II a/w CA of ovary, bladder, stomach

Front 12

general genetic anomaly in HNPCC

Back 12

Both a/w DNA mismatch repair gene mutations

Front 13

Amsterdam criteria

Back 13

3 1st degree relatives, over 2 generations , one diagnosed before 50

Front 14

Gardner's syndrome

Back 14

colon CA and desmoid tumors

Front 15

Turcot's syndrome

Back 15

colon CA and brain tumors

Front 16

Peutz Jegher's syndrome

Back 16

polyposis (not colon CA) and mucocutaneous pigmentation

Front 17

treatment of sigmoid volvulus

Back 17

decompress with scope, prep bowel, do sigmoid colectomy that admission

Front 18

treatment of Cecal volvulus

Back 18

likely will not decompress, take to OR, most recommend R hemicolectomy with ileo-transverse anastomosis, cecopexy is alternative

Front 19

treatment for carcinoid of appendix

Back 19

if >2 cm or involving base = do R hemicolectomy, otherwise appendectomy only

Front 20

layers of colon

Back 20

mucosa -> submucosa -> muscularis propria -> serosa

Front 21

arterial supply of the colon

Back 21

ascending and 2/3 of transverse (SMA via ileocoloc, right and middle colic arteries), 1/2 transverse to upper rectum by IMA (left colic, sigmoid branches, superior rectal artery), marginal artery (SMA->IMA along colon)

Front 22

venous drainage of the colon

Back 22

IMV -> splenic vein + SMV => portal vein

Front 23

venous drainage of the rectum

Back 23

superior rectal and middle rectal veins -> IMV, inferior rectal veins -> internal iliac veins

Front 24

arterial supply of rectum

Back 24

superior rectal artery (from IMA), middle rectal artery (internal iliac), inferior rectal (from pudendal artery)

Front 25

anal sphincter innervation

Back 25

external sphincter: inferior rectal branch of internal pudendal nerve and perineal branch of S4; internal sphincter (involuntary): continuation of colonic muscularis propria

Front 26

names of nerve plexuses in colon

Back 26

Meissner's plexus (inner), Auerbach's plexus (outer)

Front 27

management of normal appendix on ex-lap where Crohn's is noted

Back 27

take appendix (unless cecum involved in inflammation). Does not incr fistula rate.

Front 28

treatment of perianal abscess in pt with Crohn's

Back 28

incision and drainage as with any abscess

Front 29

electrolytes actively secreted by colon

Back 29

K+ and HCO3-

Front 30

symptoms of ulcerative colitis that are relieved by proctocolectomy

Back 30

may help skin and anemia; rarely helps arthritis; no change in sclerosing cholangitis,

Front 31

disease associated with HLA-B27

Back 31

sacroilitis / spondyloarthritis

Front 32

treatment of pouchitis

Back 32

flagyl or short-chain fatty acid enemas

Front 33

treatment of pyoderma gangrenosum

Back 33

dapsone and/or steroids (topical or systemic)

Front 34

location of fistulae-in-ano

Back 34

10% are anterior in women; nearly all others posterior midline

Front 35

treatment of fistulae-in-ano

Back 35

sitz baths, water + fiber, exploration +/- seton +/- fistulotomy; consider NTG cream or botox

Front 36

diseases associated with off-center fissure (3)

Back 36

IBD, TB, syphilis

Front 37

characteristics and treatment for Bowen's dz

Back 37

intraepidermal squamous cell carcinoma, only 5% invasive -> wide local excision

Front 38

characteristics of perianal paget's dz

Back 38

rare intraepidermal neoplasm of apocrine glands, long pre-invasive phase. +PAS stain

Front 39

cardiac diseases associated with colonic AVM (2)

Back 39

aortic stenosis in 1/4, CAD in 1/2

Front 40

finding on colonoscopy in pt with campylobacter colitis

Back 40

aphthous ulcers

Front 41

main nutrient of colonocytes

Back 41

short-chain fatty acids

Front 42

treatment of stump pouchitis (i.e. after Hartmann's procedure)

Back 42

short-chain fatty acid enema

Front 43

two fasciae around rectum

Back 43

denonviliers' fascia - anterior; waldeyer's fascia - posterior

Front 44

genes associated with colon ca

Back 44

APC, DCC, p53, k-ras

Front 45

syndromes associated with APC

Back 45

FAP (colon and duodenal CA), Gardner's (colon ca, desmoid tumors, ostomas), Turcot (colon ca, brain tumors)