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Gastrointestinal and genitourinary systems
Published in Helen Butler, Neel Sharma, Tiago Villanueva, Student Success in Anatomy - SBAs and EMQs, 2022
24 Which of the following statements is correct with regard to Meckel's diverticulum? It is present in approximately 25% of the population.It presents with left upper quadrant pain and haematemesis.Perforation of Meckel's diverticulum may be mistaken for acute appendicitis.It lies 2 cm proximal to the hepatic flexure of the transverse colon.It is located in the distal colon and is a common cause of melaena.
Colonoscopy
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Ian D. Sugarman, Jonathan R. Sutcliffe
The transverse colon may sometimes be pushed down by the instrument into a deep loop, which makes it difficult and painful to reach the hepatic flexure. Once again, the correct maneuver is to withdraw the instrument to shorten this loop. If necessary, withdrawal may need to be repeated several times, the instrument advancing a few centimeters on each withdrawal (“paradoxical movement”) until the loop is straightened. Keeping the colon deflated also helps to shorten the hepatic flexure region, making it easier both to reach and to pass. In addition, an assistant pushing the transverse colon upwards and straightening this loop out is often helpful.
Mesenteric and peritoneal anatomy
Published in John Calvin Coffey, Rishabh Sehgal, Dara Walsh, Mesenteric Principles of Gastrointestinal Surgery, 2017
J. CALVIN COFFEY, PETER DOCKERY, BRENDAN J. MORAN, BILL HEALD
At the hepatic flexure, the colonic component of the flexure separates from the posterior abdominal wall and the right colon becomes the transverse colon. The mesenteric component of the flexure (i.e., the confluence between the right and transverse mesocolon) is attached to the posterior abdominal wall at its base, while the body of the confluence detaches and fans out to reach the mesenteric border of the intestinal tract. Although this series of conformational changes is complex, conceptualization is greatly aided by
Air under the diaphragm—perforation or Chilaiditi sign?
Published in Baylor University Medical Center Proceedings, 2022
Shobha Mandal, Sneha Singh, Barun Kumar Ray, Rahul Kumar Thakur, Anish Kumar Shah, Victor Kolade
Chilaiditi sign is a rare radiographic presentation in which the colon is interposed between the liver and the abdominal wall. Hepatic flexure of the colon is usually involved; however, the small bowel has been implicated in a small number of cases.1 The prevalence of Chilaiditi syndrome in the general population is 0.025% to 0.28%.2–4 It is more common in men than in women, with a ratio of 4:1. Increased incidence is seen in individuals >60 years.5 Initially, congenital anomalies like the absence of falciform or suspensory ligament were assumed to cause this syndrome.3 Cirrhosis, diaphragmatic paralysis, obesity, and procedures like colonoscopy were also believed to cause it.3,6 As this syndrome is not frequently reported, any air or gas around the diaphragm and liver is presumed to be of surgical pathology and invasive intervention may result.
Stage-specific survival differences between colon cancer subsites: a population-based study
Published in Acta Oncologica, 2021
Heigo Reima, Jaan Soplepmann, Kaire Innos
The diagnostic approach, indications for surgery, adjuvant treatment, and follow-up regimens are similar for different colon cancer subsites and no differences in tumour biology are known between the RCC subgroups. Therefore, the likely explanation for reduced survival in stage III hepatic flexure cancer patients could be the surgical factor. Lymphatic drainage of hepatic flexure differs from the other subsites and more complex surgery is required for proper lymphadenectomy. Caecal and ascending colon cancers tend to metastasise into the ileocolic lymph nodes while transverse colon cancer may spread to the lymph nodes along the middle colic artery and metastases have also been observed in the lymph nodes of gastroepiploic-omental region, infrapyloric and infrapancreatic areas [14]. However, hepatic flexure cancer is located between these lymph node regions and can spread towards all abovementioned pathways. Recommended surgical approach is therefore different and adequate lymph node clearance is more difficult to attain in hepatic flexure cancer. Hohenberger et al. [14] have reported excellent survival rates achieved by the standardised technique of complete mesocolic excision (CME), where the extent of the surgical procedures was determined by the location of cancer and the pattern of potential lymphatic spread. Regardless of that, some surgeons could be tempted to perform standard right hemicolectomy also for hepatic flexure cancer. Suboptimal surgery may result in regional and/or distant recurrence and reduced survival among stage III patients of this specific location.
Urine as a biological modality for colorectal cancer detection
Published in Expert Review of Molecular Diagnostics, 2020
Subashini Chandrapalan, Ramesh P Arasaradnam
The right colon with its two physiological valves (ileocecal valve and hepatic flexure) acts as a ‘functional bio-chamber’ in which the complex interaction between the gut microbiota, colonocytes, and undigested fiber produces VOCs [42]. This process is heavily influenced by the external factors such as diet, environment, medication, and lifestyle. Any changes to these factors can modify the chemical nature of the volatolome produced [43]. As such, for example, a change in dietary practice or heavy drinking can result in an altered fermentation process and unique volatolome pattern for that individual. This unique volatolome may contain compounds that are carcinogenic in nature. e.g. N nitrosamines. It is noteworthy at this point that the overall chemical nature of this composite volatolome (i.e. the ‘VOC signature’), has greater significance than the impact of their individual chemical components.