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45 Cards in this Set
- Front
- Back
Layers of colon wall
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Colon secretes _____ and reabsorbs _____.
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K
Na and water |
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Blood supply of colon
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Marginal artery of Drummond
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Collateral flow between SMA and IMA`
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Arc of Riolan
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Short direct connections between SMA and IMA
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Blood supply of rectum
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Superior rectal (IMA)
Middle rectal (Internal iliac) Inferior rectal (Internal pudendal from internal iliac) |
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Watershed areas of colon
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Splenic flexure (Griffith's point) - SMA and IMA
Rectum (Sudak's point) - superior and middle rectal a. |
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Landmarks from anal verge
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Anal canal: 0 - 5 cm
Rectum: 5 - 15 cm Rectosigmoid jx: 15 - 18 cm |
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Anterior fascia
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Denonvillier's (rectovesicular/rectovaginal)
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Posterior fascia
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Waldeyer's fascia (rectosacral)
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Main nutrient of colonocytes
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SCFA
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Polyps with increased cancer risk:
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- > 2 cm
- sessile - villous |
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Polypectomy adequate if:
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- 2 mm margins
- well-differentiated - no lymphovascular invasion |
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CRC associated organism
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Clostridium septicum
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CRC main gene mutations
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P53
APC k-ras DCC |
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Most important prognostic factor in CRC?
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Nodal status
-#1: Liver spread -#2: Lung spread |
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Worst prognosis with which histologic type of CRC?
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Mucoepidermoid
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Margins needed for CRC
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2 cm
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CRC staging and prognosis
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Duke's staging:
Stage I: A - B1 Stage II: B2 Stage III: C1 - C2 Stage IV: D |
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Transanal excision of rectal cancer appropriate when?
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- T1 < 4 cm
- Can get 1 cm negative margins - No neurovascular invasion |
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Neoadjuvant chemo-XRT in which stage of CRC cancer
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Stage II and III rectal CA
-May shrink rectal tumors and down-staging allowing LAR rather than APR -Decreases local recurrence and increases survival |
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Chemo in CRC
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FOLFOX
-5-FU -Leucovorin -Oxaliplatin |
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XRT complications
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Vasculitis
Ulcers Thrombosis Stricture |
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Total colectomy in FAP
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Age 20
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Most common cause of death in FAP following surgery
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Periampullary duodenal tumors
-Need duodenal endoscopy every 2 years |
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Gardner's syndrome
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Desmoid tumors
Osteomas CRC (FAP) |
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Turcot's Syndrome
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Brain tumors
CRC (FAP) |
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Lynch syndrome also known as _____ and associated with mutations in which gene?
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HNPCC
DNA mismatch repair genes |
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Types of Lynch syndrome
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Lynch I - CRC
Lynch II - CRC + ovarian, endometrial, bladder, stomach |
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Diagnostic criteria for HNPCC
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Amsterdam criteria:
3 first degree relatives 2 generations 1 under 50 |
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Sigmoid vs. cecal volvulus
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Sigmoid: Older patients, 50% can be decompressed with colonoscopy/sigmoid colectomy
Cecal: 20s-30s, 20% can be decompressed, right hemi |
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Extraintestinal manifestations that do not improve with colectomy in UC
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-PSC
-Ankylosing spondylitis |
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EI manifestations that improve with colectomy in UC
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-Most ocular problems
-Arthritis -Anemia |
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Ogilvie's treatment
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If colon > 10 cm, colonoscopic decompression and neostigmine, cecostomy if that fails
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Fecally contaminated food/water may contain?
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Entamoeba histolytica
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E. Histolytica infection
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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 |
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Cecal mass, abscess, fistula or induration that is suppurative or granulomatous may be?
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Actinomyces - see sulfur granules on pathologgy
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Treatment of actinomyces
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Penicillin or tetracycline, abscess drainage
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Arteriography detects?
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Bleeding > 0.5 cc/min
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Tagged RBC scan detect?
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Bleeding > 0.1 cc/min
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Angiodysplasia associated with?
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Aortic stenosis, improves after valve replacement
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Pneumatosis intestinalis following chemo
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Neutropenic typhilitis
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Treatment of neutropenic typhilits
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Antibiotics NOT surgery (unless perforated)
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Infection that mimics appendicitis
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Yersinia
Treat with tetracycline or Bactrim |
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Most common cause of acquired megacolon
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T. cruzi
Due to nerve destruction |