| What is the blood supply to the rectum: | Proximal?
Superior hemorrhoidal (or superior rectal) from the IMA
Middle?
Middle hemorrhoidal (or middle rectal) from the hypogastric (internal iliac)
Distal?
Inferior hemorrhoidal (or inferior rectal) from the pudendal artery (a branch of
the hypogastric artery) |
| What is venous drainage of rectum? | Proximal?
Via the IMV to the splenic vein, then to the portal vein
Middle?
Via the iliac vein to the IVC
Distal?
Via the iliac vein to the IVC |
| What is the incidence of rectal cancer? | Comprises 20% to 30% of all colorectal cancer |
| What are the signs/symptoms of rectal cancer? | Most common symptom is hematochezia (passage of red blood ± stool) or
mucus; also tenesmus, feeling of incomplete evacuation of stool (because of the
mass), and rectal mass |
| What do all rectal cancer operations include? | Total mesorectal excision—remove the rectal mesentery, including the LNs |
| What is the minimal surgical margin for rectal cancer? | 2 cm |
| What is the adjuvant treatment for T3–T4 rectal cancer? | Preoperative radiation therapy and 5-FU chemotherapy as a “radiosensitizer |
| What are rectal polyps?? | Tissue growth into bowel lumen, usually consisting of mucosa, submucosa, or
both |
| How is classification of rectal polyps? | Sessile (flat)
Pedunculated (on a stalk) |
| What are histologica subtypes of rectal polyps? | Inflammatory (pseudopolyp)?
As in Crohn’s disease or ulcerative colitis
Hamartomatous?
Normal tissue in abnormal configuration
Hyperplastic?
Benign—normal cells—no malignant potential
Neoplastic?
Proliferation of undifferentiated cells; premalignant or malignant cells |
| What are subtypes of neoplastic polyps? | Tubular adenomas (usually pedunculated)
Tubulovillous adenomas
Villous adenomas (usually sessile and look like broccoli heads) |
| What is percentage of carcinoma in polyps? | Tubular adenoma?
5%
Tubulovillous adenoma?
20%
Villous adenoma?
40%
MOST COMMON POLYP FOUND Rectosigmoid (30%) |
| What are S&S of rectal polyps? | Bleeding (red or dark blood), change in bowel habits, mucus per rectum,
electrolyte loss, totally asymptomatic |
| What is dx and tx of rectal polyps? | Colonoscopy, endoscopic resection, if large sessile remove w/LN |
