lymphatics of colon

Q ) Which of the following group of lymph nodes do lymphatics of the colon first drain to?

a) Paracolic

b) Epicolic

c) Nodes along SMA/IMA

d) Para aortic
Answer to 37


37) b

Lymphatics first drain to epicolic group along the bowel wall

Then paracolic group along the marginal artery

Intermediate group along the named vessels SMA/IMA

Finally to par aortic 

Colon and upper 2/5 of rectum --- Para aortic

Lower 1/5 of rectum and anal canal - Superficial inguinal lymph nodes

Ref Sabiston-1317

Acute diverticulitis

Q) False regarding the management of Acute Diverticulitis. Sigmoid colon inflammation and Fat stranding in CT with initiation of IV antibiotics,

a) Outpatient treatment

b) Do a colonoscopy after the resolution of acute symptoms

c) Elective Colectomy to be done

d) IV antibiotics

Answer Free  c

Sigmoid diverticulitis can be complicated and uncomplicated

Complicated means diverticulum associated with abscess, perforation, obstruction, fistula 

This question is about an uncomplicated acute diverticulitis 

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Hyperbaric oxygen

 Hyperbaric oxygen therapy in radiation proctitis all are true except
A. Indicated in acute radiation proctitis but not in subacute or chronic radiation proctitis
B. Oxygen increases the growth of residual tumor and hence tumor should be completely
resected
C. Complications include Parkinsonism, barotrauma
D. Usually 30-40 sessions are required for treatment


Answer free for all

a

Hyperbaric oxygen overcomes chronic tissue hypoxia in radiation damaged tissues and with repeated sessions induces growth of regenerative tissue, capillaries, and epithelium. Successful therapy may take multiple sessions.
 18 to 60 treatments

Ref Shackelford page 2211

HBO treatments for hypoxic wounds are usually delivered at 1.9 to 2.5 atm

for sessions of 90 to 120 minutes each. Treatments are given once daily, five to six times per week and should be given as an adjunct to surgical or medical therapies. Clinical evidence of wound improvement should be noted after 15 to 20 treatments. Read More ...

Familial Adenomatous polyposis

Q. All are false about adenomatous polyposis syndrome except
A. 25% do not have family history
B. Attenuated FAP has less than 100 polyps and delayed onset (50-55 yrs)
C. More than 20 rectal polyps have to be operated as there is high risk of Carcinoma
D. Attenuated FAP don’t have extracolonic manifestations and carry APC mutation

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