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Chapter 30. Large Intestine

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Protectomy requires pelvic dissection and has the potential to cause injury to the nerves that supply the rectum, pelvic floor muscles, and bladder, as well as the prostate and seminal vesicles in men. Which of the following associations is incorrect regarding the nerves at risk at different points in the operation?

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A. Superior hypogastric plexus near root of IMA

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B. Hypogastric nerves in the retrorectal space

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C. Nervi erigentes near lateral stalks

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D. Inferior hypogastric plexus near Denonvillier fascia

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D. Inferior hypogastric plexus near Denonvillier fascia

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A 60-year-old man presents with abdominal pain, fevers, and nausea. He is febrile, focally tender in the LLQ, and has a WBC of 18,000. CT shows sigmoid diverticulitis with a 4 cm pericolonic abscess. What is the optimal management strategy for this patient?

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A. Bowel rest, intravenous fluids, broad spectrum antibiotics

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B. Bowel rest, intravenous fluids, and broad spectrum antibiotics

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C. Bowel rest, intravenous fluids, broad spectrum antibiotics, and percutaneous drainage

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D. Urgent exploratory laparotomy

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C. Bowel rest, intravenous fluids, broad spectrum antibiotics, and percutaneous drainage

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An otherwise healthy 60-year-old man presents with abdominal pain. His CT shows an obstructing mass in the sigmoid colon with dilation of the cecum to 13 cm. After fluid resuscitation, what is the next step in management?

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A. Nasogastric decompression and observation

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B. NPO, antibiotics, and observation

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C. Flexible sigmoidoscopy with biopsies to further evaluate the mass

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D. Exploratory laparotomy

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D. Exploratory laparotomy

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A 65-year-old, asymptomatic, woman is found to have a 3 cm sessile polyp in the ascending colon on screening colonoscopy. It was biopsied but could not be resected. Pathology shows tubulovillous adenoma. What is next step in management?

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A. Colonoscopy in 1 year

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B. Colonoscopy in 3 years

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C. Local excision

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D. Right hemicolectomy

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D. Right hemicolectomy

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What is the most common symptom patients experience after removal of the colon?

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A. Vitamin K deficiency

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