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45 Cards in this Set

  • Front
  • Back
Layers of colon wall
Colon secretes _____ and reabsorbs _____.
Na and water
Blood supply of colon
Marginal artery of Drummond
Collateral flow between SMA and IMA`
Arc of Riolan
Short direct connections between SMA and IMA
Blood supply of rectum
Superior rectal (IMA)
Middle rectal (Internal iliac)
Inferior rectal (Internal pudendal from internal iliac)
Watershed areas of colon
Splenic flexure (Griffith's point) - SMA and IMA
Rectum (Sudak's point) - superior and middle rectal a.
Landmarks from anal verge
Anal canal: 0 - 5 cm
Rectum: 5 - 15 cm
Rectosigmoid jx: 15 - 18 cm
Anterior fascia
Denonvillier's (rectovesicular/rectovaginal)
Posterior fascia
Waldeyer's fascia (rectosacral)
Main nutrient of colonocytes
Polyps with increased cancer risk:
- > 2 cm
- sessile
- villous
Polypectomy adequate if:
- 2 mm margins
- well-differentiated
- no lymphovascular invasion
CRC associated organism
Clostridium septicum
CRC main gene mutations
Most important prognostic factor in CRC?
Nodal status
-#1: Liver spread
-#2: Lung spread
Worst prognosis with which histologic type of CRC?
Margins needed for CRC
2 cm
CRC staging and prognosis
Duke's staging: 
Stage I: A - B1
Stage II: B2
Stage III: C1 - C2
Stage IV: D
Duke's staging:
Stage I: A - B1
Stage II: B2
Stage III: C1 - C2
Stage IV: D
Transanal excision of rectal cancer appropriate when?
- T1 < 4 cm
- Can get 1 cm negative margins
- No neurovascular invasion
Neoadjuvant chemo-XRT in which stage of CRC cancer
Stage II and III rectal CA
-May shrink rectal tumors and down-staging allowing LAR rather than APR
-Decreases local recurrence and increases survival
Chemo in CRC
XRT complications
Total colectomy in FAP
Age 20
Most common cause of death in FAP following surgery
Periampullary duodenal tumors
-Need duodenal endoscopy every 2 years
Gardner's syndrome
Desmoid tumors
Turcot's Syndrome
Brain tumors
Lynch syndrome also known as _____ and associated with mutations in which gene?
DNA mismatch repair genes
Types of Lynch syndrome
Lynch I - CRC
Lynch II - CRC + ovarian, endometrial, bladder, stomach
Diagnostic criteria for HNPCC
Amsterdam criteria:
3 first degree relatives
2 generations
1 under 50
Sigmoid vs. cecal volvulus
Sigmoid: Older patients, 50% can be decompressed with colonoscopy/sigmoid colectomy

Cecal: 20s-30s, 20% can be decompressed, right hemi
Extraintestinal manifestations that do not improve with colectomy in UC
-Ankylosing spondylitis
EI manifestations that improve with colectomy in UC
-Most ocular problems
Ogilvie's treatment
If colon > 10 cm, colonoscopic decompression and neostigmine, cecostomy if that fails
Fecally contaminated food/water may contain?
Entamoeba histolytica
E. Histolytica infection
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
Cecal mass, abscess, fistula or induration that is suppurative or granulomatous may be?
Actinomyces - see sulfur granules on pathologgy
Treatment of actinomyces
Penicillin or tetracycline, abscess drainage
Arteriography detects?
Bleeding > 0.5 cc/min
Tagged RBC scan detect?
Bleeding > 0.1 cc/min
Angiodysplasia associated with?
Aortic stenosis, improves after valve replacement
Pneumatosis intestinalis following chemo
Neutropenic typhilitis
Treatment of neutropenic typhilits
Antibiotics NOT surgery (unless perforated)
Infection that mimics appendicitis

Treat with tetracycline or Bactrim
Most common cause of acquired megacolon
T. cruzi

Due to nerve destruction