ABCRS flashcards

32 cards. Read the term and the definition here. The deck at the top of this page is optional.

Total mesorectal excision

Sharp dissection of the rectum with its intact mesorectum and enveloping fascia. Standard for rectal cancer; reduces local recurrence compared with blunt dissection.

Lynch syndrome screening

Universal mismatch repair immunohistochemistry or MSI testing on all colorectal cancers identifies Lynch syndrome, guiding surveillance and family counseling.

CEA surveillance

Carcinoembryonic antigen is checked postoperatively after colorectal cancer resection. A rising level suggests recurrence and warrants imaging; it is not a screening test.

Toxic megacolon

Colonic dilation greater than 6 cm with systemic toxicity in colitis. Colonoscopy and antimotility drugs are contraindicated; treat with IV fluids, steroids, and surgical consultation.

Pouchitis

Inflammation of an ileal pouch after IPAA, causing increased stool frequency and urgency. First-line treatment is antibiotics such as ciprofloxacin or metronidazole.

Perianal Crohn fistulas

Complex fistulas in Crohn disease are managed with seton drainage rather than fistulotomy to preserve continence; MRI and exam under anesthesia guide therapy.

Goodsall rule

Anterior anal fistulas generally track radially to the anal verge; posterior fistulas curve to the posterior midline. Guides surgical planning for fistula-in-ano.

Thrombosed external hemorrhoid

Painful perianal clot below the dentate line. Excision within 72 hours of onset relieves pain; later presentation is managed conservatively.

Lateral internal sphincterotomy

Definitive treatment for chronic anal fissure refractory to medical therapy. Division of the internal sphincter reduces anal pressure but carries a small incontinence risk.

Anal cancer treatment

Squamous cell anal cancer is treated first-line with chemoradiation using 5-fluorouracil and mitomycin. Abdominoperineal resection is reserved for salvage.

Sacral neuromodulation

Implanted device stimulating sacral nerves, used for refractory fecal incontinence and some constipation after a successful test phase. Contraindicated in pregnancy.

Dyssynergic defecation

Paradoxical contraction or failure to relax pelvic floor muscles during defecation. Diagnosed by manometry or defecography; first-line therapy is biofeedback.

Rectal prolapse repair

Full-thickness rectal prolapse may be repaired abdominally with rectopexy or perineally (Altemeier). Choice depends on patient fitness and continence status.

Sphincteroplasty

Overlapping repair of an anal sphincter defect, typically greater than 120 degrees on ultrasound, for fecal incontinence after obstetric injury.

Damage control laparotomy

Staged surgery for severely injured patients: control hemorrhage and contamination, temporary abdominal closure, then correct acidosis, hypothermia, and coagulopathy before re-exploration.

Colon injury management

Most low-energy civilian colon injuries can be primarily repaired. Diversion is considered for destructive injuries, shock, heavy contamination, or severe comorbidities.

Cecal perforation risk

In large bowel obstruction with a competent ileocecal valve, a closed loop forms; cecal diameter above 9-12 cm signals impending perforation.

SMA embolus

Superior mesenteric artery embolism often lodges at the middle colic branch, causing pain out of proportion to exam. CT angiography is diagnostic.

ERAS protocol

Enhanced recovery pathway including carbohydrate loading, multimodal analgesia, avoidance of routine drains, early feeding, and early ambulation to shorten length of stay.

Extended VTE prophylaxis

After colorectal cancer resection, low-molecular-weight heparin is continued for 4 weeks postoperatively because venous thromboembolism risk persists beyond discharge.

Sepsis bundle

Obtain cultures, give broad-spectrum antibiotics within 1 hour, and give 30 mL/kg crystalloid for hypotension or lactate of 4 or greater.

ARDS Berlin criteria

Acute onset within 1 week, bilateral opacities not explained by cardiac failure, and PaO2/FiO2 of 300 or less. Managed with low tidal volume ventilation.

High-output ileostomy

Ileostomy output exceeding 1-1.5 L per day risks dehydration and electrolyte losses; requires monitoring, antimotility agents, and fluid replacement.

Hasson technique

Open laparoscopic entry with fascial incision and direct trocar placement under vision, reducing risk of major vascular or bowel injury compared with blind Veress needle entry.

CO2 embolism

Rare laparoscopic complication causing sudden hypotension, arrhythmia, and desaturation. Treat with desufflation, 100 percent oxygen, and left lateral decubitus positioning.

Pneumoperitoneum physiology

CO2 insufflation at 12-15 mmHg causes hypercapnia, reduced venous return, and elevated airway pressures; effects are greater in hypovolemic or cardiopulmonary-compromised patients.

Robotic surgery advantages

Articulating instruments, tremor filtration, and three-dimensional visualization improve dexterity in confined spaces such as the pelvis for rectal cancer surgery.

Informed consent elements

Disclosure of diagnosis, proposed treatment, alternatives, and material risks, plus confirmation of patient comprehension and voluntary decision-making before proceeding.

Belmont Report principles

Respect for persons, beneficence, and justice form the ethical framework for human subjects research and guide institutional review board oversight.

Sensitivity and specificity

Sensitivity is true positives divided by all diseased; specificity is true negatives divided by all non-diseased. Both are independent of disease prevalence.

Positive predictive value

Proportion of test-positive patients who truly have disease. Unlike sensitivity, PPV varies with disease prevalence in the population tested.

Levels of evidence

Systematic reviews of randomized trials rank highest; cohort and case-control studies intermediate; case reports and expert opinion lowest in the evidence hierarchy.