外科：大直外

45 flashcards · Other · by Wanying Koh

1. Meckel diverticulum true or false diverticulum?

   true diverticulum (all layers 膨出)

2. Colonic diverticulum true or false diverticulum?

   false diverticulum (all except muscular layer 膨出)

3. most common reason for lower GI bleeding

   diverticular hemorrhage / diverticulosis (fresh red bloody stool)

4. Hartmann's procedure 1) 怎麼做 2) for what dx

   1) 切掉病灶部位 sigmoid colectomy + defunctionalized rectal pouch + colostomy 2) sigmoid volvulus, peritonitis due to diverticulitis

5. most common reason for enterovesical fistula

   diverticulitis

6. most common type of polyp is hyperplastic / adenoma / hamartomatous / inflammatory?

   hyperplastic

7. hemorrhoids common in? x3

   hard stools --> inc. abd pressure to pass out long periods of squatting/sitting pregnancy

8. risk factors of internal hemorrhoids x2

   males pregnancy --> progesterone 血管擴張

9. colon ca gold std diagnosis colonoscopy, sigmoidoscopy, air-contrast enema？

   colonoscopy

10. post-surgical leakage s/s x4

    fever leukocytosis abd pain drainage levels inc. 引流量變多

11. anorectal sensory receptor 位於直腸哪一層? mucosa/submucosa/muscular/serosa

    muscularis

12. tx of sigmoid volvulus

    1) without peritonitis: conservative sigmoidoscopy decompression 2) with peritonitis: surgery Hartmann procedure

13. diverticular hemorrhage tx 1) need abx? 2) colonoscopy? 3) angiography 4) surgical indications

    1) no 2) yes 3) yes 4) continuous bleeding despite conservative tx

14. most common cause for enterovesical fistula

    diverticulutis

15. diagnosis of diverticulitis colonoscopy / CT / barium enema?

    only CT best. advised not to do colonoscopy / barium enema to prevent diverticulitis rupture

16. Ogilvie‘s syndrome 還可以稱為什麼

    colonic pseudo-obstruction

17. ogilvie syndrome tx

    1) decompression 2) neostigmine (inhibit acetylcholinesterase). but cause bradycardia so need atropine standby 3) stop anti- gastric motility meds: opioids, anti-ACh meds

18. most commonly involved site of ischemic colitis that causes colon stricture

    stricture = muscle 相關 = muscularis layer

19. ischemic colitis 少發生在腸子哪一部分，為什麼？

    rectum has its own blood supply

20. treatment for Crohn's / UC 1) conservative 2) surgery ?

    1) conservative 5-ASA steroids abstain from dairy products 2) surgery only for UC: protocolectomy + 保留 anus Crohn's: NO surgery - occurs anywhere in GI tract

21. pseudopolyp in UC or Crohn's?

    UC: +++ Crohn's: +

22. involved layers of UC / Crohn's

    UC: mucosa / submucosa Crohn's: transmural (記得 involvement 整個 GI tract, 整個 layer)

23. continuous / skip lesions in UC / Crohn's

    UC: continuous Crohn's: skip lesions

24. colorectal villous adenoma： focal adenoCa risk （%）

    50%

25. most common type of appendix malignancy

    appendix carcinoid tumor

26. appendix carcinoid tumor 1) s/s 2) tx

    1) asymptomatic usually. as mostly at distal 1/3 of appendix --> doesnt cause obstruction 2) based on size <1cm: appendectomy 1-2cm: recommend R hemicolectomy >2cm: R hemicolectomy

27. colon ca staging T1N2M0 stage?

    stage IIIa

28. filling defect present --> cecal tumor

29. R vs. L colon Ca s/s

    R colon Ca: anemia - headache R abd pain L colon Ca: 血便 constipation 排便不順 / 習慣改變 bloating

30. tx for anal fissure

    conservative 軟便劑 warm bath glyceryl trinitrate ointment - int. sphincter relaxation surgical lateral internal sphincterotomy

31. bowel perforation s/s

    elevated WBC free air seen under abd imaging

32. laparoscopic colectomy causing mesenteric defect: does defect need to be closed during the operation ?

    no consensus. closure may cause further damage to other tissue, and difficult under laparoscopic procedure. although defect may cause internal hernia (mostly at ileocolic junction)

33. colorectal ca + KRAS mutation tx w cetuximab?

    cannot use EGFR inhibitors like cetuximab due to KRAS mutation -- 使 EGFR inhibitors 失效

34. colorectal ca vs anal ca risk factors 是否similar?

    NO. colorectal ca: HNCCP, FAP family hx UC Crohn's dz anal ca: old age anal sex anal 菜花 anorectal fistula pelvic RT

35. most common recurrence of colorectal ca located at?

    distant meta recurrence - at lungs, liver

36. colorectal ca tx for different stages

    st 1-2: OP poor prognosis st 2-3: neoadj CCRT --> OP st 4: OP --> adj CCRT chemo + target therapy (if not for OP)

37. inflammatory bowel dz most commonly occurs at Western or Asian populations?

    Western populations

38. w right lower quadrant pain, nausea Dx

    appendicitis image 為 appendicitis stone (calcified)

39. total mesorectal excision 用在什麼 ca preserves what n. good outcomes? =

    gold standard for rectal cancers and the middle lower third of the rectum preserves pelvic n. decrease sexual dysfunction, bladder incontinence good LT prognosis, lowers local recurrence,

40. UC or Crohn's 血便 diarrhea / abd pain lymphoid aggregates thickened colon wall

    血便 - UC diarrhea / abd pain - Crohn's lymphoid aggregates - present in both thickened colon wall - present in both

41. ileal pouch indications

    UC FAP (手術為大腸大部分切除，小腸與remaining直腸連結: Crohn's contraindicated --> recurrence 高）

42. surgical indications include which abscess of 2cm peritonitis intestinal perforation colovesical fistula anemia septic shock stenosis recurrent diverticulitis

    ALL except: abscess - 可以 ABx + drainage anemia - 可以 CTA check bleeding origin + transfusion

43. muscles of the pelvic floor include

    levator ani puborectalis pubococcygeus iliococcygeus 2. coccygeus

44. sup. rectal a. supplied by int. pudendal a. sup. vescical a. inf. gluteal a.

    sup. rectal a. supplied by inf. mesenteric a. 其餘 by int. iliac a.

45. colorectal ca tx w FOLFOX (oxaliplatin) or FOLFIRI (irinotecan)

    FOLFOX