Notes in Chapter_36:_Colorectal

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Published	07/07/2024	Peritoneum completely surrounds the {{c1::upper::upper/middle/lower}} third of the rectum
Published	07/07/2024	Peritoneum partially covers the {{c1::middle::upper/middle/lower}} third of the rectum
Published	07/07/2024	As the rectum {{c2::de}}scends, the {{c1::middle::upper/middle/lower}} third has progressively less fascia posteriorly and inferiorly
Published	07/07/2024	Anal canal is at {{c1::4}} cm
Published	07/07/2024	The lower, middle, and upper rectum are {{c1::4}} cm long each
Published	07/07/2024	The superior rectal artery is a branch of the {{c1::inferior mesenteric}} artery The middle rectal artery is a branch of the&…
Published	07/07/2024	Watershed areas: - colon is the splenic flexure ({{c1::Griffith's}} point) - rectum is the {{c2::superior}} and {{c2::middle}} rectal artery…
Published	07/07/2024	The colon is {{c2::more}} sensitive to ischemia than small bowel because it has fewer {{c1::collateral vessels}}(more or less)
Published	07/07/2024	In the rectum, the {{c2::in}}ternal sphincter (s{{c1::mooth}} muscle) is under {{c1::autonomic}} control
Published	07/07/2024	In the rectum the external sphincter (s{{c1::triated}} muscle) is a continuation of the {{c2::levator ani}} muscle and is under {{c3::voluntary}}…
Published	07/07/2024	{{c2::Ex}}ternal sphincter is innervated by {{c1::pudendal nerve}}{{c2::In}}ternal sphincter is innervated by {{c1::pelvic splanchnic nerves}}
Published	07/07/2024	The {{c1::levator ani}} marks the transition between {{c2::anal canal}} and {{c2::rectum}}
Published	07/07/2024	{{c1::Waldeyer's}} fascia separates the {{c2::rectum}} and {{c2::sacrum}}
Published	07/07/2024	{{c1::Denonvilliers'}} fascia separates the rectum from the {{c2::prostate/vagina}} and {{c2::bladder}}
Published	07/07/2024	Polyp characteristics that increase risk of cancer include {{c1::sessile}} morphology, {{c1::villous}} histology, and >{{c2::2}} cm in si…
Published	07/07/2024	{{c2::Sessile}} colon polyps require {{c1::segmental}} resection
Published	07/07/2024	{{c1::Colonoscopy}} screening should NOT be done in people with a recent {{c3::MI::cardiac}} or if they have {{c2::spleno}}megaly
Published	07/07/2024	Drugs that can cause a false positive occult blood test include {{c1::iron}} and {{c2::cimetidine}}
Published	07/07/2024	A polypectomy that shows T1 (same for T1 villous rectal polyp) is adequate if: - margins are {{c1::2}} mm - is well differentiated &nbs…
Published	07/07/2024	Extensive low rectal villous adenomas with atypia requires {{c1::transanal}} excision
Published	07/07/2024	A villous rectal polyp discovered to have T{{c2::2}} pathology after transanal excision requires {{c1::abdominoperineal resection (APR)}}
Published	07/07/2024	Colon cancer has an association with infection by {{c1::Clostridium septicum}} and Streptococcus bovis
Published	07/07/2024	The most common site of colon cancer is the {{c1::sigmoid}} colon
Published	07/07/2024	Colon cancer metastasizes to the lungs via the {{c1::iliac}} veins
Published	07/07/2024	Rectal cancer can metastasize to the spine directly via {{c1::Batson's}} venous plexus
Published	07/07/2024	Rectal cancer invasion depth is assessed with {{c1::transrectal ultrasound}}
Published	07/07/2024	For rectal tumors, you must also resect {{c1::Waldeyer's}} and {{c1::Denonvilliers'}} fascia
Published	07/07/2024	In general, right-sided colon cancer can be treated with primary anastomosis wi{{c1::thout}} ostomy
Published	07/07/2024	Rectal pain with rectal cancer is an indication for {{c1::abdominoperineal resection (APR)}}
Published	07/07/2024	Colon cancer resection requires {{c1::2}} cm margins
Published	07/07/2024	Cecal tumor resection involves ascending colon until about the {{c1::middle of the transverse colon}}
Published	07/07/2024	{{c1::Hepatic flexure::colon region}} tumor resection involves the {{c2::ascending colon}} all the way until just before {{c2::the splenic f…
Published	07/07/2024	{{c1::Splenic flexure::colon location}} tumor resection requires cutting the distal third of the {{c2::transverse}} colon all the way u…
Published	07/07/2024	{{c1::Sigmoid}} tumors require resection of the {{c3::proximal}} third of the {{c3::descending}} colon all the way until the {{c2::rect…
Published	07/07/2024	{{c1::Descending colon::colon region}} tumor resection involves cutting the distal third of the {{c3::transverse}} colon all the way un…
Published	07/07/2024	The best intraoperative test to detect intrahepatic mets from colon cancer is {{c1::intraoperative ultrasound}}
Published	07/07/2024	Conventional US resolution is roughly {{c1::10}} mm, while intraoperative US resolution is {{c2::3}}-{{c2::5}} mm
Published	07/07/2024	{{c2::Abdominoperineal}} resection requires excision of the anal canal thus the patient will require a permanent {{c1::colostomy}}
Published	07/07/2024	Abdominoperineal resection neurologic complications include {{c2::impotence}} and {{c2::bladder dysfunction}} due to {{c1::pudendal}} nerve …
Published	07/07/2024	Low anterior resection (LAR) requires at least {{c2::2}}-cm margins from the {{c3::levator ani muscles}}, otherwise the patient will need {{c1::APR}}
Published	07/07/2024	Colon cancer has a {{c1::lower}} rate of recurrence than rectal cancer(higher or lower)
Published	07/07/2024	P{{c2::re}}operative Chemo Radiation produces complete response in some patients with rectal cancer and preserves {{c1::sphincter}} function in some
Published	07/07/2024	Colorectal cancer staging:T{{c1::2}} - {{c2::into}} the muscularis propria
Published	07/07/2024	Colorectal cancer staging: T{{c1::3}} - {{c2::through}} the muscularis propria
Published	07/07/2024	Stage {{c2::II}} and {{c2::III}} colorectal cancer require {{c1::neoad}}juvant chemo
Published	07/07/2024	Stage {{c2::III}} and {{c2::IV}} colorectal cancer require {{c1::ad}}juvant chemo
Published	07/07/2024	Stage {{c4::4}} rectal cancer is treated with {{c2::chemo/radiation::treatment}}, {{c3::colostomy::surgical procedure}}, and usually avoiding {{c1::ab…
Published	07/07/2024	Colorectal cancer radiation complications: - The {{c4::rectum}} is most commonly injured - Vascular complications: {{c1::vasculitis}}, …
Published	07/07/2024	The main advantage to neoadjuvant chemo-radiation for rectal cancer is that it may shrink the tumor, allowing for down-staging, and possibly…
Published	07/07/2024	Colorectal cancer post-op surveillance is done via colonoscopy at {{c1::1 year::timeframe}}
Published	07/07/2024	At 1 year after colorectal tumor resection 20% have recurrence and {{c1::5}}% have a new primary tumor (aka {{c2::metachronous}} tumor)
Published	07/07/2024	Surveilance in patients with suspected FAP is {{c1::flexible sigmoid}}oscopy
Published	07/07/2024	Patients with FAP require {{c2::total colectomy}} by the age of {{c1::20}}
Published	07/07/2024	In addition to flexible sigmoidoscopy, FAP patients will also require {{c1::upper endoscopy}} every {{c2::1-2}} year(s) to check for {{c1::d…
Published	07/07/2024	FAP surgery involves {{c1::total proctocol}}ectomy, {{c3::rectal mucos}}ectomy, and a(n) {{c2::ileoanal pouch (J-pouch)}}
Published	07/07/2024	Lynch {{c1::I}} syndrome only has increased colon cancer risk
Published	07/07/2024	Lynch {{c1::II}} syndrome has increased colon, {{c2::endometrial}}, {{c2::ovarian}}, bladder, and stomach cancer risk
Published	07/07/2024	{{c2::Amsterdam}} criteria for {{c3::Lynch}} syndrome 3 {{c1::first-degree relatives}}2 {{c1::generations}}1 {{c1::with cancer before 50}}
Published	07/07/2024	Surgical management of Lynch syndrome typically involves {{c1::total proctocol}}ectomy
Published	07/07/2024	People from the middle east are at a higher risk of {{c1::sigmoid}} volvulus due to their {{c2::high}}-fiber diet
Published	07/07/2024	Sigmoid volvulus management - Usually managed with {{c4::detorsion/decompression}} via {{c4::sigmoidoscopy/colonoscopy}} - Indications for {…
Published	07/07/2024	Sigmoid volvulus has a {{c1::50}}% recurrence rate
Published	07/07/2024	Small bowel involvement in ulcerative colitis occurs due to {{c1::backwash}} ileitis
Published	07/07/2024	Mucosal friability is more common in {{c1::ulcerative colitis::UC or Crohn's}}
Published	07/07/2024	{{c1::Toxic colitis}} criteria: - >6 bloody stools per day - Fever - ↑ HR - ↓ Hgb - Leukocytosis
Published	07/07/2024	{{c2::Toxic megacolon}} criteria: - >6 bloody stools per day - Fever - ↑ HR - ↓Hgb - Leukocytosis  - {{c1::Diste…
Published	07/07/2024	Absolute indications for surgery in toxic colitis and toxic megacolon: - Diffuse Peritonitis - Localized peritonitis with increasing ab…
Published	07/07/2024	The most common site of perforation in UC is the {{c1::transverse colon}};the most common site in Crohn's is the {{c1::distal ileum}}
Published	07/07/2024	The extraintestinal manifestations of ulcerative colitis that do improve after colectomy are {{c3::ocular}} problems, {{c2::arthritis}}…
Published	07/07/2024	The extraintestinal manifestations of ulcerative colitis that DON'T improve after colectomy are {{c1::PSC}} and {{c2::ankylosing spondylitis}}
Published	07/07/2024	Pyoderma gangrenosum is treated with {{c3::steroids}}
Published	07/07/2024	Carcinoid tumor of the colon and rectum is treated with APR if >{{c1::2}} cm or {{c2::invasion of muscularis propria::histology}}
Published	07/07/2024	The most common causes of colonic obstruction are cancer, {{c1::diverticulitis}}, and {{c2::volvulus}}
Published	07/07/2024	Air in the portal venous system is an ominous sign that indicates significant infection or {{c1::necrosis}} of bowel
Published	07/07/2024	Ogilvie management: - IVFs - check {{c4::electrolytes (K and Mg)}} - discontinue {{c3::hypomotility drugs (morphine)}} - Decompres…
Published	07/07/2024	{{c2::Actinomyces::bacteria}} can present as a mass, abscess, or fistula in the {{c1::cecum}}
Published	07/07/2024	A patient that develops UC-like symptoms after recent travel to Mexico is concerning for {{c1::entomoeba histolytica}} infection
Published	07/07/2024	The prevalence of colonic diverticula in the population is {{c1::35}}%
Published	07/07/2024	GI bleed imaging: - {{c2::Arteriography}} requires bleeding to be > {{c1::0.5}} cc/min - {{c2::Tagged RBC scan}} requires bleeding to be …
Published	07/07/2024	GI bleed imaging: - Massive hemorrhage - {{c1::angiography}} - Slow bleed - {{c1::colonoscopy}}
Published	07/07/2024	{{c1::Men::gender}} are more likely to develop colovesicular fistula after diverticulitis
Published	07/07/2024	Most (80%) right-sided diverticulitis is incidentally discovered during {{c1::appendectomy}} incision
Published	07/07/2024	Right-sided diverticulitis is treated with {{c1::right hemicolectomy}}
Published	07/07/2024	The best diagnostic test for colovesicular fistula is {{c1::cystoscopy}}
Published	07/07/2024	The antibiotic treatment for uncomplicated diverticulitis is {{c1::levofloxacin}} and {{c1::metronidazole}}
Published	07/07/2024	The most common complication of diverticulitis is {{c1::abscess formation}}
Published	07/07/2024	Complicated diverticulitis signs include {{c1::obstruction}} symptoms, {{c2::fluctuant}} mass, {{c3::peritoneal::physical exam}} signs, temperatu…
Published	07/07/2024	The most sensitive imaging test for GI bleeds is {{c1::tagged RBC scan}}
Published	07/07/2024	Diverticulosis bleeding - {{c1::NG tube}} to rule out {{c1::upper GI source}} - Massive bleed (hypotensive tachycardic): {{c2::angiography::…
Published	07/07/2024	Angiodysplasia bleeding risk factors? - {{c1::Old age::#1}} - {{c2::Aortic stenosis::cardiac}} - {{c3::Renal}} dysfunction - {{c4:…
Published	07/07/2024	Angiodysplasias cause {{c1::venous::arterial or venous}} bleeding
Published	07/07/2024	The two most common symptoms of ischemic colitis are {{c1::abdominal pain}} and {{c1::bleeding}}
Published	07/07/2024	Ischemic colitis with {{c1::peritonitis}} suggests gangrenous colitis and is a contraindication to {{c2::colonoscopy}}
Published	07/07/2024	Non-operative treatment for ischemic colitis includes NPO, antibiotics, and {{c1::IVFs}}
Published	07/07/2024	{{c2::Neutropenic typhlitis (enterocolitis)}} occurs after chemotherapy where mucosal injury of the {{c1::terminal ileum}} and {{c1::right}}…
Published	07/07/2024	Neutropenic typhlitis (entercolitis) treatment is {{c1::antibiotics}}
Published	07/07/2024	Surgery is indicated in neutropenic typhlitis (enterocolitis) if there is {{c1::free perforation}}
Published	07/07/2024	During an LAR, important structures to visualize when retracting the sigmoid mesocolon toward the anterior abdominal wall - Inferior mesenteric a…
Published	07/07/2024	A - splenic flexureB - spleenC - {{c1::phrenocolic}} ligamentD - splenocolicE - {{c2::gastrocolic}} ligament
Published	07/07/2024	Dissection for a robotic LAR will start at the sacral {{c1::promontory}}, dorsal to the {{c2::superior hemorrhoidal}} artery, going distally over…
Published	07/07/2024	During {{c3::Denonvilliers'}} fascia dissection: - In men you should retract the {{c1::prostate}} and {{c2::seminal vesicles}}  - …
Published	07/07/2024	The three landmarks of the cecum during colonoscopy are the appendiceal orifice, ileocecal valve, and {{c1::crow's feet folds}}
Published	07/07/2024	These structures in the {{c2::rectum}} are called the {{c1::upper, middle, and lower valves of Houston}}
Published	07/07/2024	Low Anterior Resection Syndrome presents with incontinence, urgency, diarrhea, or constipationPathophysiology is the result of {{c2::denerv}}ation, {{…
Published	07/07/2024	Colonoscopies miss malignancy roughly {{c1::15}}% of the time
Published	07/07/2024	Diverticular disease perforation is more likely in: - {{c1::young}}er {{c2::m}}en - {{c1::old}}er {{c2::wom}}en(age, gender)
Published	07/07/2024	Around {{c1::15}}% of people with diverticuli will develop diverticulitis symptoms
Published	07/07/2024	Patients with diverticular disease have colonic pressures exceeding {{c1::90}} mmHg (Normal ~ 10 mmHg)
Published	07/07/2024	{{c2::Puls}}ion diverticula examples are {{c1::Zenker's}} and {{c1::colonic diverticula}}
Published	07/07/2024	{{c2::Tract}}ion diverticula example is {{c1::mid-esophagus}}
Published	07/07/2024	Diverticulitis complication: - {{c2::M}}en most likely to have {{c1::bleeding}} - {{c2::Wom}}en most likely to have {{c1::fistula}}
Published	07/07/2024	Acute diverticulitis can be divided into: - {{c1::Simple}} - {{c2::localized}} - {{c1::Complicated}} - {{c2::perforated}}
Published	07/07/2024	Other than acute and chronic, what are the other two ways to classify diverticulitis? - {{c4::Complex}} - {{c2::fistula}}, {{c3::stricture}}, {{c…
Published	07/07/2024	If diverticulitis abscess is perforated that is considered conversion from Hinchey class {{c1::II}} to a class {{c1::III}}
Published	07/07/2024	The percent of recurrence after first diverticulitis episode is {{c1::10}}%
Published	07/07/2024	If diverticulitis has pelvic abscess or retroperitoneal involvement the patient may have a positive {{c1::psoas}}/{{c1::obturator}} sign
Published	07/07/2024	{{c2::Irritable Bowel Syndrome (IBS)}} is diagnosed with the {{c1::Rome}} criteria
Published	07/07/2024	When dissecting the {{c3::later}}al part of the colon for a right or left hemicolectomy, you keep going until you see the {{c1::renal}}&nbsp…
Published	07/07/2024	Diverticulitis with a confined pericolic inflammation or phlegmon is Hinchey class {{c1::1a}}
Published	07/07/2024	Mild clinical diverticulitis is Hinchey class {{c1::0}}
Published	07/07/2024	Diverticulitis with a confined pericolic abscess is Hinchey class {{c1::1b}}
Published	07/07/2024	Diverticulitis with pelvic, intra-abdominal, or retrocolic abscess is Hinchey class {{c1::2}}
Published	07/07/2024	Diverticulitis with generalized purulent peritonitis is Hinchey class {{c1::3}}
Published	07/07/2024	Diverticulitis with generalized fecal peritonitis is Hinchey class {{c1::4}}
Published	07/07/2024	Colonoscopy landmarks:{{c2::Rectosigmoid junction}} is at {{c1::16}} cm
Published	07/07/2024	Colonoscopy landmarks:{{c2::Sigmoid}} colon from {{c1::16}} to {{c1::60}} cm
Published	07/07/2024	Colonoscopy landmarks:{{c2::Descending colon}} is at {{c1::60}} to {{c1::80}} cm
Published	07/07/2024	How long are the ascending and descending colon?{{c1::~20}} cm each
Published	07/07/2024	Colonoscopy landmarks:The {{c2::transverse}} colon is {{c1::50}} cm long
Published	07/07/2024	Colonoscopy landmarks:{{c2::Transverse}} colon runs from {{c1::80}} to {{c1::130}} cm
Published	07/07/2024	Colonoscopy landmarks:{{c2::Ascending}} colon runs from {{c1::130}} to {{c1::150}} cm
Published	07/07/2024	Colonoscopy landmarks:{{c1::Cecal}} colon is at {{c2::150}} cm
Published	07/07/2024	{{c2::Fecal}} incontinence treatment is guided by calculating the {{c1::Wexner}} score
Published	07/07/2024	The most helpful imaging study in {{c2::fecal incontinence::pathology}} is {{c1::defecography}}
Published	07/07/2024	{{c3::Villous adenocarcin}}omas of the colon cause hyp{{c1::o}}{{c2::kal}}emia
Published	07/07/2024	Most cecal ulcers are associated with {{c2::NSAID}} use
Published	07/07/2024	Which types of appendicitis do not require post-op antibiotics?{{c1::simple and purulent}}
Published	07/07/2024	Radiographic air under the diaphragm due to trapped {{c2::colon}} above the liver is called {{c1::Chilaiditi's}} sign
Published	07/07/2024	Chilaiditi syndrome is usually managed similarly to {{c1::small bowel obstruction (NG decompression, bowel rest, fluids)}}
Published	07/07/2024	Indications for surgery in Chilaiditi syndrome include {{c4::failure of non-operative management}}, {{c1::ischemia}}, {{c2::volvulus}} or {{c3::p…
Published	07/07/2024	The transverse appendectomy incision is called the {{c1::Rockey-Davis}} incision
Published	07/07/2024	The most common scoring system to predict likelihood of {{c2::appendicitis}} is the {{c1::Alvarado}} score
Published	07/07/2024	If a first degree relative had colon cancer at the age of 60, a colonoscopy should be performed at the age of {{c1::40}}
Published	07/07/2024	If a patient has a 2nd degree relative with colon cancer at the age of 50, they should undergo colonoscopy at the age of {{c1::50}}
Published	07/07/2024	Bowel prep should be completed {{c1::2}} hour(s) before anesthesia is started
Published	07/07/2024	{{c2::Miralax}} is NOT used for bowel prep because it is {{c1::not FDA approved}}
Published	07/07/2024	For patients with prosthetic heart valves, antibiotic prophylaxis for colonoscopy {{c1::is not::is or is not}} indicated
Published	07/07/2024	Antibiotic prophylaxis for colonoscopy in artificial joints is only indicated if the joint was placed within the last {{c1::6}} months
Published	07/13/2024	{{c2::Warfarin::anti coagulant}} should be held for {{c1::5}} days prior to elective surgery
Published	07/07/2024	NOACs should be held for {{c2::2}} days prior to colonoscopy, unless the patient has {{c3::renal disfunction (Cr<60)}}
Published	07/07/2024	Colonoscopy mortality rates are {{c2::higher::higher or lower}} with {{c1::conscious sedation::anesthesia type}}
Published	07/07/2024	Patients with a first degree relative with colon polyps should have a colonoscopy at the age of {{c1::40 or age of onset}}
Published	07/07/2024	After colorectal cancer resection, patients should have colonoscopy to assess anastomotic integrity at {{c1::1 year::time frame}} post-op
Published	07/07/2024	The most common location of colonoscope looping is the {{c2::sigmoid}}, and it is easiest to un-twist at the {{c1::hepatic flexure}}
Published	07/07/2024	Intraluminal colon lipomas should {{c1::NOT be::be or not be}} snared because of their high water content, which generates heat and has a higher risk …
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