36 Colorectal ANATOMY AND PHYSIOLOGY
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Questions and Answers

Which layer of the colon secretes potassium and primarily reabsorbs sodium and water?

  • Submucosa
  • Muscularis propria
  • Mucosa (correct)
  • Serosa

    • What is the approximate length of the rectum from the anorectal ring to the anorectal verge?

  • 10-12 cm (correct)
  • 5-8 cm
  • 15-18 cm
  • 20-25 cm

    • Which part of the colon is covered by the peritoneum in the anterior upper and middle ⅓?

  • Cecum
  • Descending colon
  • Sigmoid colon
  • Ascending colon (correct)

    • What are the transverse bands that form haustra in the colon known as?

    <p>Plicae semilunares</p> Signup and view all the answers

    What is the name of the 3 longitudinal bands that run along the colon?

    <p>Taenia coli</p> Signup and view all the answers

    Where is the anal transition zone located?

    <p>At the anorectal ring</p> Signup and view all the answers

    What is the recommended repeat colonoscopy interval after removal of 3–10 or advanced adenoma?

    <p>3 years</p> Signup and view all the answers

    Which site is the most common for primary colorectal cancer?

    <p>Sigmoid colon</p> Signup and view all the answers

    What is the main gene mutation associated with colorectal cancer?

    <p>APC</p> Signup and view all the answers

    What is the #1 site of metastases in colorectal cancer?

    <p>Liver</p> Signup and view all the answers

    For potentially resectable isolated liver or lung metastases, what is the recommended approach?

    <p>Resection followed by chemotherapy</p> Signup and view all the answers

    What is the best method of detecting intrahepatic metastases during surgery?

    <p>Intraoperative ultrasound</p> Signup and view all the answers

    What is the main goal of en bloc resection in colorectal cancer surgery?

    <p>Including mesocolon and regional adenectomy</p> Signup and view all the answers

    What is the standard treatment for low rectal T2 or higher (muscularis propria or greater) cancer?

    <p>Abdominoperineal resection (APR)</p> Signup and view all the answers

    Which of the following symptoms is associated with colorectal cancer?

    <p>Narrow caliber stools and lower GI bleeding</p> Signup and view all the answers

    What is the recommended interval for repeat colonoscopy after removal of a large sessile adenoma?

    <p>3 months</p> Signup and view all the answers

    What is the most important prognostic factor for colorectal cancer?

    <p>Nodal status</p> Signup and view all the answers

    Which method is best for assessing depth of invasion, recurrence, and lymphadenopathy in rectal tumors?

    <p>Endorectal ultrasound (ERUS)</p> Signup and view all the answers

    What is the main nutrient for colonocytes?

    <p>Butyrate</p> Signup and view all the answers

    What is the most common polyp in the colon, with no cancer risk?

    <p>Hyperplastic polyp</p> Signup and view all the answers

    Which artery provides collateral flow between the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA)?

    <p>Marginal artery</p> Signup and view all the answers

    What junction is known as Sudeck's point?

    <p>Superior rectal and middle rectal junction</p> Signup and view all the answers

    Which nerve controls the external sphincter (puborectalis muscle) of the anal canal?

    <p>Pudendal nerve</p> Signup and view all the answers

    What is the main reason for not performing an abdominoperineal resection (APR) unless cancer is present?

    <p>Risk of denervation of levator ani muscle</p> Signup and view all the answers

    What is the primary screening age range for normal risk individuals for colon cancer?

    <p>40-75</p> Signup and view all the answers

    Which substance can lead to false-positive guaiac stool tests?

    <p>Beetroot</p> Signup and view all the answers

    What type of polyp is most likely to produce symptoms?

    <p>Villous adenoma</p> Signup and view all the answers

    What is the main cause of ischemia in the splenic flexure?

    <p>Hypotension or low-flow state</p> Signup and view all the answers

    What is the primary method for treating extensive low rectal villous adenomas with atypia?

    <p>Transanal excision</p> Signup and view all the answers

    What provides the main sympathetic innervation to the colon and rectum?

    <p>Hypogastric plexus</p> Signup and view all the answers

    Which stage of rectal cancer is characterized by 1–3 positive nodes?

    <p>Stage IIIA</p> Signup and view all the answers

    What is the recommended chemo regimen for postoperative treatment of colon/rectal cancer?

    <p>FOLFOX for 6 months</p> Signup and view all the answers

    What is the most common cause of death in patients with Familial Adenomatous Polyposis (FAP) following colectomy?

    <p>Periampullary tumors of duodenum</p> Signup and view all the answers

    What type of syndrome is associated with a predilection for right-sided and multiple cancers?

    <p>Lynch II syndrome</p> Signup and view all the answers

    What is the recommended surveillance program for Lynch syndrome patients?

    <p>Surveillance colonoscopy every 1–2 years starting at age 25</p> Signup and view all the answers

    What imaging technique may show a 'bird’s beak sign' in cases of sigmoid volvulus?

    <p>Gastrografin enema</p> Signup and view all the answers

    What is the first-line treatment for cecal volvulus?

    <p>Right hemicolectomy with primary anastomosis</p> Signup and view all the answers

    What are the symptoms commonly associated with ulcerative colitis?

    <p>Bloody diarrhea and weight loss</p> Signup and view all the answers

    Which stage of rectal cancer is characterized by distant metastases?

    <p>Stage IV</p> Signup and view all the answers

    What is the recommended chemo regimen for pre-operative treatment of potentially resectable rectal cancer?

    <p>FOLFOX for 6 months</p> Signup and view all the answers

    Which type of syndrome is associated with a total proctocolectomy requirement after the first cancer operation?

    <p>Lynch II syndrome</p> Signup and view all the answers

    Which imaging technique is recommended to confirm the diagnosis of cecal volvulus?

    <p>CT scan with contrast</p> Signup and view all the answers

    Which of the following is a common feature of Crohn Disease?

    <p>Fibrosis</p> Signup and view all the answers

    What is a distinguishing feature of Ulcerative Colitis compared to Crohn Disease?

    <p>Small-bowel involvement</p> Signup and view all the answers

    Which statement is true regarding treatments for toxic colitis and toxic megacolon?

    <p>NG tube, fluids, steroids, bowel rest, and antibiotics are part of initial treatment</p> Signup and view all the answers

    What is a potential surgical indication for ulcerative colitis?

    <p>Localized peritonitis with increasing abdominal pain and/or colonic distension &gt;10 cm</p> Signup and view all the answers

    What is a distinguishing feature of Crohn Disease compared to Ulcerative Colitis?

    <p>Fistulas</p> Signup and view all the answers

    Which feature is more common in Crohn Disease compared to Ulcerative Colitis?

    <p>Mucosal cobblestoning</p> Signup and view all the answers

    What is a distinguishing feature of Ulcerative Colitis compared to Crohn Disease?

    <p>#1 cancer and #2 diverticulitis</p> Signup and view all the answers

    Which statement is true regarding carcinoid of the colon and rectum?

    <p>&gt; 2 cm low rectal carcinoids require formal resection</p> Signup and view all the answers

    What is a distinguishing feature of Crohn Disease compared to Ulcerative Colitis?

    <p>&gt; 50% granulomas</p> Signup and view all the answers

    'Increasing megacolon' is an indication for surgery in which condition?

    <p>'Increasing megacolon' with Ulcerative Colitis</p> Signup and view all the answers

    Which statement best describes the treatment for Pseudo-obstruction of colon in Ogilvie's syndrome?

    <p>Initial treatment includes fluid resuscitation, replace electrolytes, NG tube, bowel rest, and stop anti-cholinergics.</p> Signup and view all the answers

    What is the most common cause of lower gastrointestinal bleeding?

    <p>Diverticulosis bleeding</p> Signup and view all the answers

    What is the initial diagnostic step to rule out upper gastrointestinal bleeding in diverticulosis bleeding?

    <p>NG tube placement</p> Signup and view all the answers

    What is the best initial intervention for massive diverticulosis bleeding with hypotension and tachycardia?

    <p>Angiography</p> Signup and view all the answers

    What is the most sensitive test for intermittent bleeds that are hard to localize in diverticulosis bleeding?

    <p>Tagged RBC scan</p> Signup and view all the answers

    Where does angiodysplasia bleeding commonly occur in the colon?

    <p>Right side</p> Signup and view all the answers

    What is a soft sign of angiodysplasia on angiogram?

    <p>'Tufts' and 'slow emptying'</p> Signup and view all the answers

    Which condition is most likely to involve the left colon and can be caused by a low-flow state or embolus/thrombosis of the IMA?

    <p>Ischemic colitis</p> Signup and view all the answers

    Which part of the colon is most vulnerable to low-flow state in ischemic colitis?

    <p>'Griffith’s point'</p> Signup and view all the answers

    What is the recommended management for recurrent diverticular bleeds?

    <p>'Resection' of the area</p> Signup and view all the answers

    What is a potential cause of angiodysplasia?

    <p>Ruptured arteriovenous malformation (AVM)</p> Signup and view all the answers

    Which antibiotic is the first-line treatment for uncomplicated diverticulitis?

    <p>Levofloxacin and Flagyl</p> Signup and view all the answers

    What is the most common location for cecal volvulus?

    <p>Ascending colon</p> Signup and view all the answers

    What is the recommended diagnostic test if worried about complicated diverticulitis?

    <p>CT scan</p> Signup and view all the answers

    Which antibiotic is indicated for the treatment of actinomycosis?

    <p>Penicillin</p> Signup and view all the answers

    In lower gastrointestinal bleeding, what may indicate the diagnosis of upper GI bleeding?

    <p>Bloody fluid aspiration on NG tube</p> Signup and view all the answers

    What is the most common complication of diverticulitis?

    <p>&lt; 4 cm abscess formation</p> Signup and view all the answers

    What is the first-line treatment for neostigmine-induced bradycardia in the treatment of cecal volvulus?

    <p>Atropine</p> Signup and view all the answers

    Which artery provides collateral flow between the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) in cases of lower GI bleeding?

    <p>Riolan's arcade</p> Signup and view all the answers

    Which imaging technique is recommended to confirm the diagnosis of cecal volvulus?

    <p>CT scan</p> Signup and view all the answers

    What is the primary cause of lower GI bleeding from angiodysplasia, diverticulosis, hemorrhoids, polyps, or cancer?

    <p>Arteriovenous malformation</p> Signup and view all the answers

    Which antibiotic regimen is recommended for postoperative treatment of colon/rectal cancer?

    <p>Levofloxacin and Flagyl</p> Signup and view all the answers

    What is the most common site for primary colorectal cancer?

    <p>Rectum</p> Signup and view all the answers

    Study Notes

    Colon Structure and Function

    • The colon layer that secretes potassium and primarily reabsorbs sodium and water is not specified.
    • The rectum is approximately 12-15 cm long from the anorectal ring to the anorectal verge.
    • The anterior upper and middle ⅓ of the colon is covered by the peritoneum.
    • The transverse bands that form haustra in the colon are known as taenia coli.
    • The three longitudinal bands that run along the colon are known as taenia coli.

    Colorectal Cancer

    • The most common site for primary colorectal cancer is the sigmoid colon.
    • The main gene mutation associated with colorectal cancer is APC (adenomatous polyposis coli).
    • The #1 site of metastases in colorectal cancer is the liver.
    • For potentially resectable isolated liver or lung metastases, the recommended approach is surgical resection.
    • The main goal of en bloc resection in colorectal cancer surgery is to remove the tumor and surrounding tissue.
    • The standard treatment for low rectal T2 or higher (muscularis propria or greater) cancer is chemoradiation followed by surgery.
    • One of the symptoms associated with colorectal cancer is rectal bleeding.

    Rectal Cancer

    • The anal transition zone is located at the junction of the rectum and anus.
    • The recommended repeat colonoscopy interval after removal of 3–10 or advanced adenoma is 3-5 years.
    • The most important prognostic factor for colorectal cancer is the presence of lymph node metastases.
    • The method best for assessing depth of invasion, recurrence, and lymphadenopathy in rectal tumors is endorectal ultrasound.
    • The main nutrient for colonocytes is short-chain fatty acids.

    Polyps

    • The most common polyp in the colon, with no cancer risk, is a hyperplastic polyp.
    • The type of polyp most likely to produce symptoms is a pedunculated polyp.

    Blood Supply

    • The artery that provides collateral flow between the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) is the marginal artery of Drummond.
    • Sudeck's point is the junction of the SMA and IMA.

    Anal Canal

    • The nerve that controls the external sphincter (puborectalis muscle) of the anal canal is the pudendal nerve.

    Screening and Surveillance

    • The primary screening age range for normal risk individuals for colon cancer is 50-75 years.
    • The recommended surveillance program for Lynch syndrome patients includes annual colonoscopy starting at age 20-25.

    Miscellaneous

    • The substance that can lead to false-positive guaiac stool tests is vitamin C.
    • The main cause of ischemia in the splenic flexure is atherosclerosis of the SMA.
    • The primary method for treating extensive low rectal villous adenomas with atypia is surgical resection.
    • The main sympathetic innervation to the colon and rectum is provided by the sympathetic trunk.
    • The recommended chemo regimen for postoperative treatment of colon/rectal cancer is FOLFOX or CapeOX.
    • The most common cause of death in patients with Familial Adenomatous Polyposis (FAP) following colectomy is duodenal cancer.
    • The type of syndrome associated with a predilection for right-sided and multiple cancers is Lynch syndrome.
    • The imaging technique that may show a 'bird’s beak sign' in cases of sigmoid volvulus is a barium enema.
    • The first-line treatment for cecal volvulus is colonoscopic decompression.
    • The symptoms commonly associated with ulcerative colitis are diarrhea, rectal bleeding, and abdominal pain.
    • The stage of rectal cancer characterized by distant metastases is stage IV.
    • The recommended chemo regimen for pre-operative treatment of potentially resectable rectal cancer is combined 5-FU, leucovorin, and oxaliplatin.
    • The type of syndrome associated with a total proctocolectomy requirement after the first cancer operation is Lynch syndrome.
    • The imaging technique recommended to confirm the diagnosis of cecal volvulus is CT scan.
    • The common feature of Crohn Disease is transmural inflammation.
    • The distinguishing feature of Ulcerative Colitis compared to Crohn Disease is the absence of granulomas.
    • The distinguishing feature of Crohn Disease compared to Ulcerative Colitis is the presence of granulomas.
    • The true statement regarding treatments for toxic colitis and toxic megacolon is that they require urgent surgical intervention.
    • The potential surgical indication for ulcerative colitis is refractory disease or bowel obstruction.
    • The distinguishing feature of Crohn Disease compared to Ulcerative Colitis is the presence of skip lesions.
    • The true statement regarding carcinoid of the colon and rectum is that it is a rare tumor.
    • 'Increasing megacolon' is an indication for surgery in ulcerative colitis.
    • The true statement regarding the treatment for Pseudo-obstruction of colon in Ogilvie's syndrome is that it is initially managed with supportive care.
    • The most common cause of lower gastrointestinal bleeding is diverticulosis.
    • The initial diagnostic step to rule out upper gastrointestinal bleeding in diverticulosis bleeding is nasogastric lavage.
    • The best initial intervention for massive diverticulosis bleeding with hypotension and tachycardia is fluid resuscitation and transfusion.
    • The most sensitive test for intermittent bleeds that are hard to localize in diverticulosis bleeding is tagged RBC scan.
    • Angiodysplasia bleeding commonly occurs in the right colon.
    • A soft sign of angiodysplasia on angiogram is a tumoral blush.
    • The condition most likely to involve the left colon and can be caused by a low-flow state or embolus/thrombosis of the IMA is ischemic colitis.
    • The part of the colon most vulnerable to low-flow state in ischemic colitis is the splenic flexure.
    • The recommended management for recurrent diverticular bleeds is segmental resection.
    • A potential cause of angiodysplasia is aortic stenosis.
    • The first-line treatment for uncomplicated diverticulitis is antibiotics.
    • The most common location for cecal volvulus is the right lower quadrant.
    • The recommended diagnostic test if worried about complicated diverticulitis is CT scan.
    • The antibiotic indicated for the treatment of actinomycosis is penicillin.
    • In lower gastrointestinal bleeding, what may indicate the diagnosis of upper GI bleeding is a positive nasogastric aspirate.
    • The most common complication of diverticulitis is abscess formation.
    • The first-line treatment for neostigmine-induced bradycardia in the treatment of cecal volvulus is atropine.
    • The artery that provides collateral flow between the superior mesenteric artery (SMA) and the inferior mesenteric artery (IMA) in cases of lower GI bleeding is the marginal artery of Drummond.
    • The imaging technique recommended to confirm the diagnosis of cecal volvulus is CT scan.
    • The primary cause of lower GI bleeding from angiodysplasia, diverticulosis, hemorrhoids, polyps, or cancer is diverticulosis.
    • The antibiotic regimen recommended for postoperative treatment of colon/rectal cancer is cefotetan and metronidazole.

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    Description

    This quiz covers the treatment options for colonic pseudo-obstruction, including the use of neostigmine, atropine, colonoscope decompression, and surgical indications based on different scenarios and outcomes. Test your knowledge on managing colonic pseudo-obstruction and its associated complications.

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