Alimentary Tract 4

Question 1

Timing to remove Cholecystostomy Tube

Answer 1

-at least 2 weeks for drainage and tract formation to prevent biliary leak

Question 2

patient without stones and acute chole with tube drainage , does he needs surgery ?

Answer 2

NO, Percutaneous cholycystostomy can be definitive treatment

Question 3

what RF for malignant Polyps for LN invasion after polypectomy ?

Answer 3

-massive submucosal invasion
-lymphatic or vascular invasion
-poorly differentiated histology
-sessile polyps with positive resection margins
-a minimum invasion depth associated with lymph node metastasis was 1 mm

Question 4

RF for Stress Ulcer

Answer 4

-MV for at least 48 Hrs
-Brain or Spine Injury
-Coagulopathy INR > 1.5 or PLT < 50
-Severe burn ( > 35 % )

Question 5

How to treat Splenic vein thrombosis in Pancreatitis ?

Answer 5

-IF Upper GIT Bleeding from Gastric Varices > May require Splenectomy
-If Asymptomatic > Observe
-If Symptomatic > May use Anticoagulation

Question 6

what is Zenker diverticulum ?

Answer 6

-contains only mucosa and submucosa (pseudodiverticulum)

-pathophysiology > dysfunction of the cricopharyngeus muscle > pulsion diverticulum through > Killian triangle

Question 7

How to diagnose ZD

Answer 7

-Esophagogram
If cant do it > US
-EGD if Suspecting malignancy
(Risk of perforation the ZD)

Question 8

Tx of ZD

Answer 8

-Left Cervical Excision
division of the cricopharyngeus muscle onto the cervical esophagus > the critical step

larger diverticulum > resected with a stapling device

smaller diverticulum > diverticulopexy by suturing the diverticulum to the prevertebral fascia

Question 9

Other Tx options

Answer 9

A transoral > rigid or flexible endoscopy

the common wall between the esophagus and diverticulum is divided, creating a common channel.

division of the cricopharyngeus muscle is critical for success.

One advantage of this technique is the decreased risk of a fistula due to a leak from an open diverticulectomy

Question 10

Anal Fissure Acute vs Chronic ?

Answer 10

Acute < 6 weeks
Chronic > 6 weeks

Question 11

Anal Fissure Tx for Hypotonic Anal tone

Answer 11

Patient with hypotonic Due to previous anorectal surgeries or obstetrical trauma

Options : fissurectomy with an anocutaneous advancement flap

Question 12

role of Botulinum

Answer 12

for those who refuse lateral internal sphincterotomy
or
at risk for incontinence with a lateral internal sphincterotomy.

Question 13

what is the difference between FOBT and FIT

Answer 13

FOBT > nonspecific, detects the presence of heme from human and nonhuman sources,from both upper and lower gastrointestinal sources

FIT > detect human heme, will not detect blood from the upper gastrointestinal tract.

For these reasons, FIT is more sensitive and specific than FOBT.

Question 14

Ct Colonography Detects What size Growth ?

Answer 14

> 10 mm

Question 15

How to treat Large B cell Lymphoma in the Cecum/Ileocecum ?

Answer 15

surgery followed by systemic chemotherapy

Because large tumors involving the entire bowel wall, there is a reasonable risk of perforation

Question 16

Tumors in the Bowel wall in any part of the GIT Suggest ?

Answer 16

GIST

Question 17

How to diagnose GIST ?

Answer 17

-CT Scan Modality of Choice
-Endoscopy > Submucosal Mass with or without Central Ulceration
-If Still in Doubt > FNA or Core Bx > Benign Appearing Spindle Cells Stain for KIT

Question 18

GIST Tx ?

Answer 18

-Resection with 1 cm Margin
-No need LN Dissection

Question 19

High Risk GIST ?

Answer 19

-Size > 5 Cm
-Mitosis > 5 Per 50 hpf
-Location Outside the Stomach

Question 20

What is the Role of Imatinib ?

Answer 20

-Tyrosine Kinase Inhibitor
-Treat High Risk GIST
-Used at least 36 Months
-can Be used as NeoAdjuvant Chemo to reduce size before Sx

Question 21

when to use Neoadjuvant chemo for rectal CA

Answer 21

Clinical stage II (T3, NO, MO)
or
stage III (Tx, N+, MO)

Question 22

what is the current recommendation for a T2N0M0 Rectal CA

Answer 22

Radical resection with a complete mesorectal excision

Question 23

What is Whitehead Procedure ?

Answer 23

-Circumferential incision in the anal canal to facilitate removal of all hemorrhoid tissue of the distal rectum. The proximal rectal mucosa is then reapproximated by suturing it to the cut inferior edge of the anus.

mucosal eversion (ectropion) with stenosis is associated with the Whitehead procedure

Question 24

key quality indicator for screening colonoscopy

Answer 24

-Intubation of the cecum > 90% of all cases , 95% of healthy cases
-Photography of the cecum
-Average withdrawal time of at least 6 minutes
-Adenoma detection rate target of at least 25%.
-perforations in fewer than 1:1000
-incidence of postpolypectomy bleeding less than 1%.

Question 25

in Obstructive Colon CA, Compared with emergency resection, deployment of a SEMS as a bridge to surgery can be expected to result in

Answer 25

fewer temporary stomas

no differences in morbidity, mortality, number of radical resections, or number of primary anastomoses between the patients undergoing stenting compared to those undergoing initial resection.

Question 26

Patient With Hx of FAP, has Abdominal wall desmoid , Tx ?

Answer 26

-Surgical resection is first-line treatment for FAP-related desmoid tumors of the abdominal wall

-Radiation therapy > unresectable tumors.
-Radiation therapy > adjuvant therapy after re-resection for recurrent disease

Question 27

Carcinoid Crisis after manipulating the liver Associated with ?

Answer 27

Hypo or Hyper tension

Tx with Octreotide

Question 28

Patient with Rectal mass Causing Dilated Cecum , Tx ?

Answer 28

-Diverting loop Sigmoid Stoma
‘‘Better than Transverse loop for the Future Sx’’

-Stent In rectum > high rates of migration, proctalgia, and incontinence, and technically, there is less room for distal stent deployment

-Cecostomy Tube > effective in decompressing the cecum, but generally very morbid, clog easily, and do not provide durable proximal diversion