Colorectal

Carlos Glanville; Anton Kelly; Dale A. Dangleben

TEST TAKING TIPS

Test Taking Tips

Questions regarding colorectal anatomy, physiology, and pathology are all too common on the ABSITE – while most subjects are fair game there are common themes tested. Comparing and contrasting ulcerative colitis and Crohn disease will always draw a question or two while other benign conditions such as volvulus and diverticulitis will garner questions about nonoperative and operative management.
Colorectal cancer is a broad topic with many items, which may be tested. Know the proto-oncogenes and tumor suppressor genes associated with the condition, as well as the eponymous diseases, which are risk factors or markers for the development of malignancy. It is also helpful to know the treatment of the different stages of colorectal cancer in regards to neoadjuvant and adjuvant chemotherapy as well as radiotherapy.

ANATOMY AND PHYSIOLOGY

Where does the hindgut begin and end?

Hindgut begins at distal third of the transverse colon and extends to the rectum

The hindgut relies on which artery for its blood supply?

Inferior mesenteric artery

What are the white lines of Toldt?

The lateral peritoneal reflections of the ascending and descending colon

What parts of the gastrointestinal (GI) tract do not have a serosa?

Esophagus, middle, and distal rectum

What are the major anatomic differences between the small bowel and colon?

The small bowel is smooth, whereas the colon has fat appendages (appendices epiploicae), haustra, and taenia coli

What is the arterial blood supply to the rectum?

Proximal: superior hemorrhoidal artery (superior rectal artery) from the inferior mesenteric artery
Middle: middle hemorrhoidal artery (middle rectal artery) from the hypogastric artery (internal iliac artery)
Distal: inferior hemorrhoidal artery (inferior rectal artery) from the pudendal artery, which is a branch of hypogastric artery (internal iliac artery)

What is the venous drainage of the rectum?

Proximal: inferior mesenteric vein that joins the splenic vein to drain into the portal vein
Middle: iliac vein into the inferior vena cava
Distal: iliac vein into inferior vena cava

FIGURE 20-1.

Arterial supply to the rectum and anal canal. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz Principles of Surgery. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)