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(COLON, RECTUM, AND ANUS (CHAPTER 29)) - Coggle Diagram
COLON, RECTUM, AND ANUS (CHAPTER 29)
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- Intestinal Malrotation and Colonic Nonfixation
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- Imperforate Anus and Associated Fistulas
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- Fluid and Electrolyte Exchanges
- Water, Sodium, Potassium, Chloride, Bicarbonate, and Ammonia Absorption
- Energy Source for Colonic Mucosa
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- Colonic Microflora and Intestinal Gas
- Bacterial Composition (Anaerobes, Aerobes)
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- Intestinal Gas Components (N2, O2, CO2, H2, Methane)
- Motility, Defecation, and Continence
- Motility (Low-amplitude vs. High-amplitude propagated contractions (HAPCs))
- Defecation (Rectoanal Inhibitory Reflex, Sampling Reflex)
- Continence (Rectal Compliance, Sphincter Tone, Puborectalis Muscle)
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- History (Medical, Surgical, Obstetrical, Family, Medications)
- Physical Examination (Abdomen, Anus, Digital Rectal Exam)
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- Transanal Endoscopic Microsurgery (TEM)
- Transanal Minimally Invasive Surgery (TAMIS)
- Flexible Sigmoidoscopy and Colonoscopy
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- Plain X-Rays and Contrast Studies (Gastrografin, Barium Enema)
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- Computed Tomography Colonography (Virtual Colonoscopy)
- Magnetic Resonance Imaging (MRI)
- Positron Emission Tomography (PET/CT)
- Scintigraphy to Assess Gastrointestinal Bleeding (Tagged RBC Scan)
- Single Photon Emission Computed Tomography (SPECT/CT)
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- Endorectal and Endoanal Ultrasound
- Physiologic and Pelvic Floor Investigations
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- Neurophysiology (Pudendal Nerve Terminal Motor Latency, EMG)
- Rectal Evacuation Studies (Balloon Expulsion Test, Video Defecography)
- Fecal Occult Blood Testing (FOBT) and Fecal Immunohistochemical Testing (FIT)
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- Tumor Markers (Carcinoembryonic Antigen - CEA)
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- Evaluation of Common Symptoms
- Pain (Abdominal, Pelvic, Anorectal Pain, Proctalgia Fugax)
- Lower Gastrointestinal Bleeding (Acute and Occult)
- Constipation and Obstructed Defecation (Slow-transit vs. Outlet obstruction)
- Diarrhea and Irritable Bowel Syndrome
- Incontinence (Neurogenic vs. Anatomic Causes)
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- Mesenteric Clearance Technique
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- Minimally Invasive Techniques of Resection (Laparoscopy, HAL, Robotic)
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- Total and Subtotal Colectomy
- Total Proctocolectomy (Brooke Ileostomy)
- Restorative Proctocolectomy (Ileal Pouch–Anal Anastomosis - IPAA)
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- Extended Low Anterior Resection (Coloanal Anastomosis)
- Hartmann’s Procedure and Mucus Fistula
- Abdominoperineal Resection (APR)
- Extralevator Abdominoperineal Resection (ELAPE)
- Anastomotic Configuration
- End-to-End, End-to-Side, Side-to-End, Side-to-Side
- Hand-Sutured Technique (Single or Double Layer)
- Stapled Techniques (Linear, Circular, Double-staple technique)
- Ostomies and Preoperative Stoma Planning
- Preoperative Stoma Siting
- Temporary Ileostomy (Loop Ileostomy, Divided Loop)
- Permanent Ileostomy (End Ileostomy)
- Complications of Ileostomy
- Complications of Colostomy
- Function After Segmental Colectomy
- Function After Low Anterior Resection (Colon J-pouch)
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- Functional Outcome After IPAA
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- Anesthesia Considerations
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- Regional Anesthesia (Epidural, Spinal, Caudal)
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- Positioning (Supine, Lithotomy, Prone Jackknife)
- Bowel Preparation (Mechanical, Oral Antibiotics)
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- Epidemiology (Ulcerative Colitis, Crohn’s Disease, Indeterminate Colitis)
- Etiology (Environmental, Genetic, Immune)
- Genetic Variants (NOD2, ATG16L1, IRGM)
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- Pathology and Differential Diagnosis
- Ulcerative Colitis (Mucosal process, Continuous involvement)
- Crohn’s Disease (Transmural process, Skip lesions)
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- Extraintestinal Manifestations
- Principles of Nonoperative Management
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- Immunomodulating Agents (Azathioprine, Cyclosporine, Methotrexate)
- Biologic Agents (Anti-TNF-α)
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- Diagnosis (Proctoscopy, Barium Enema)
- Indications for Surgery (Emergent vs. Elective)
- Colorectal Carcinoma Risk and Surveillance
- Emergent Operation (Total Abdominal Colectomy)
- Elective Operation (Total Proctocolectomy, IPAA)
- Indications for Surgery (Acute Inflammatory Phase, Chronic Fibrotic Process)
- Ileocolic and Small Bowel Crohn’s Disease
- Stricturoplasty Techniques
- Crohn’s Colitis (Fulminant Colitis, Toxic Megacolon)
- Anal and Perianal Crohn’s Disease
- Management Principles (Setons, Advancement Flaps)
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- Terminology (Diverticulosis, Diverticulitis)
- Pathophysiology (False/Pulsion Diverticula)
- Inflammatory Complications (Diverticulitis)
- Uncomplicated Diverticulitis
- Complicated Diverticulitis
- Hinchey Staging System (Stage I–IV)
- Treatment of Abscess (Percutaneous Drainage)
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- Fistulas (Colovesical, Colovaginal, Coloenteric)
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- Giant Colonic Diverticulum
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- Epidemiology (Risk Factors)
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- Environmental and Dietary Factors
- Inflammatory Bowel Disease
- Other Risk Factors (Cigarette Smoking, Pelvic Irradiation)
- Pathogenesis of Colorectal Cancer
- Genetic Defects (Oncogenes, Tumor Suppressor Genes)
- Loss of Heterozygosity Pathway (LOH)
- Microsatellite Instability Pathway (MSI)
- CpG Island Methylation Pathway (CIMP)
- Classification (Neoplastic, Hyperplastic, Hamartomatous, Inflammatory)
- Neoplastic Polyps (Tubular, Villous, Tubulovillous, Serrated)
- Malignant Degeneration Risk (Size and Type)
- Complications of Polypectomy
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- Hamartomatous Polyps (Juvenile, Peutz-Jeghers, Cronkite-Canada, Cowden’s syndrome)
- Inflammatory Polyps (Pseudopolyps)
- Inherited Colorectal Carcinoma
- Familial Adenomatous Polyposis (FAP)
- Screening and Surveillance
- Extraintestinal Manifestations (Desmoid tumors, Gardner’s Syndrome, Turcot’s Syndrome)
- Attenuated Familial Adenomatous Polyposis (AFAP)
- Amsterdam I & II Criteria
- Extracolonic Malignancies
- Familial Colorectal Cancer (Nonsyndromic)
- Prevention: Screening and Surveillance
- Fecal Occult Blood Testing (FOBT) and Fecal Immunohistochemical Testing (FIT)
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- FOBT/FIT and Flexible Sigmoidoscopy Combination
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- Air-Contrast Barium Enema
- Computed Tomography Colonography (Virtual Colonoscopy)
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- Routes of Spread and Natural History
- Local Invasion (Obstruction)
- Regional Lymph Node Involvement
- Distant Metastasis (Liver, Lung, Carcinomatosis)
- Staging and Preoperative Evaluation
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- Staging (TNM Classification/AJCC)
- Prognostic Factors (Nodal Involvement, Radial Margin)
- Preoperative Evaluation (Endorectal Ultrasound, MRI, CT, PET)
- Therapy for Colonic Carcinoma
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- Stage I: The Malignant Polyp (T1, N0, M0)
- Stages I and II: Localized Colon Carcinoma
- Stage III: Lymph Node Metastasis (Adjuvant Chemotherapy)
- Stage IV: Distant Metastasis (Metastasectomy, Palliative Care)
- Therapy for Rectal Carcinoma
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- Local Therapy (Transanal Excision, TEM, TAMIS, Ablative Techniques)
- Total Mesorectal Excision (TME)
- Pelvic Exenteration and Sacrectomy (for Recurrence)
- Stage I: Localized Rectal Carcinoma
- Locally Advanced Rectal Cancer (Stages II and III)
- Neoadjuvant Chemoradiation (Long course vs. Short course)
- Nonoperative Management ("Watch and Wait")
- Stage IV: Distant Metastasis
- Follow-Up and Surveillance
- Treatment of Recurrent Colorectal Carcinoma
- Salvage Surgery (Intraoperative Radiation Therapy)
- Minimally Invasive Techniques for Resection
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- Laparoscopic TME (Rectal Cancer)
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- Neuroendocrine Tumors (Carcinoid Tumors)
- Mixed Adenoneuroendocrine Carcinomas
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- Leiomyoma and Leiomyosarcoma
- Gastrointestinal Stromal Tumor (GIST)
- Retrorectal/Presacral Tumors
- Congenital Lesions (Developmental Cysts, Teratomas)
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- Anal Canal and Perianal Tumors
- Squamous Intraepithelial Lesions (HSIL, LSIL)
- Epidermoid Carcinoma (Squamous cell carcinoma, Cloacogenic carcinoma)
- Verrucous Carcinoma (Buschke-Lowenstein Tumor)
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- Extramammary Perianal Paget’s Disease
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- Rectal Prolapse and Solitary Rectal Ulcer Syndrome
- Rectal Prolapse (Procidentia, Internal Prolapse, Mucosal Prolapse)
- Surgical Therapy (Abdominal vs. Perineal)
- Solitary Rectal Ulcer Syndrome and Colitis Cystica Profunda
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- Transverse Colon Volvulus
- Congenital Megacolon (Hirschsprung’s Disease)
- Acquired Megacolon (Infection/Chagas’, Chronic Constipation)
- Colonic Pseudo-Obstruction (Ogilvie’s Syndrome)
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- Pseudomembranous Colitis (Clostridium difficile Colitis)
- Other Infectious Colitides (Bacterial, Parasitic, Fungal, Viral)
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- Internal Hemorrhoids (First-degree to Fourth-degree)
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- Treatment (Medical Therapy, Band Ligation, Sclerotherapy, Excision)
- Operative Hemorrhoidectomy
- Closed/Open Hemorrhoidectomy
- Stapled Hemorrhoidopexy (PPH)
- Doppler-Guided Artery Ligation
- Complications of Hemorrhoidectomy
- Symptoms and Findings (Acute vs. Chronic Fissures)
- Treatment (Medical, Botulinum Toxin, Surgical/Sphincterotomy)
- Anorectal Sepsis and Cryptoglandular Abscess
- Relevant Anatomy (Perianal, Intersphincteric, Ischiorectal Spaces)
- Abscess Types (Perianal, Ischiorectal, Intersphincteric, Supralevator)
- Perianal Sepsis in the Immunocompromised Patient
- Necrotizing Soft Tissue Infection of the Perineum
- Diagnosis (Goodsall’s Rule)
- Classification (Intersphincteric, Transsphincteric, Suprasphincteric, Extrasphincteric)
- Treatment (Fistulotomy, Seton Placement, Endoanal Advancement Flap, LIFT)
- Classification (Low, Middle, High)
- Etiology (Obstetric Injuries, Trauma, Radiation, Crohn’s)
- Treatment (Endorectal Advancement Flap, Transabdominal Approach)
- Pruritus Ani (Etiology, Treatment)
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- Sexually Transmitted Diseases (STDs)
- Bacterial Infections (Proctitis, Syphilis)
- Parasitic Infections (Amebiasis, Giardia)
- Viral Infections (Herpes Simplex Virus, Human Papillomavirus/Condyloma Acuminata)
- Treatment (Drainage, Excision, Flap Closure)
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- Penetrating Colorectal Injury
- Management of Colonic Injury (Primary Repair vs. Diversion)
- Management of Rectal Injury
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- Colonoscopic Perforation (Microperforation, Postpolypectomy Syndrome)
- Anal Sphincter Injury and Incontinence
- Surgical Repairs (Wrap-around Sphincteroplasty, Gracilis Muscle Transposition, Artificial Anal Sphincter, Sacral Nerve Stimulation)
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- Human Immunodeficiency Virus (HIV)
- Gastrointestinal Symptoms and Opportunistic Infections (CMV, C. difficile)
- Increased Malignancy Risk (Kaposi’s Sarcoma, Anal Dysplasia)
- Immunosuppression for Transplantation
- Complications (Infection, Graft-versus-host disease)
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- Neutropenic Enterocolitis (Typhlitis)
- Perianal Pain and Infection
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