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MRCS A(My Own) > Colo Rectal Surgery > Flashcards

Colo Rectal Surgery Flashcards

1
Q

disease spreads in a progressive distal to proximal manner in colon only

A

Ulcerative colitis

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2
Q

Mucosal change in UC

A

dysplastic transformation

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3
Q

Age of UC

A

Bimodal
B /w 15-25 & 55-65 years

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4
Q

Ulcerative colitis location

A

always starts at rectum, does not spread beyond ileocaecal valve
Continuous

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5
Q

most common extra-intestinal feature in both CD and UC

A

Arthritis

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6
Q

Unrelated to disease activity extraart8cular symptom of crohn

A

Primary sclerosing cholangitis

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7
Q

Unrelated to disease activity most common extraarticular symptom of UC

A

Uveitis

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8
Q

Extraarticular manifestation of Crohn vs UC Related to disease activity

A

Arthritis: pauciarticular, asymmetric
Erythema nodosum
Episcleritis
Osteoporosis

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9
Q

Barium enema finding of UC

A

Loss of haustrations

Superficial ulceration, ‘pseudopolyps’

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10
Q

Smoking in Crohns

A

Crohns disease is worse in smokers and smoking is an independent risk factor for disease recurrence following resection.

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11
Q

Crihn vs UC distribution

A

Crohn is transmural
UC is only mucosal

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12
Q

Macroscopic changes of UC vs Crohn

A

UC: contact bleeding
Crohn: cobblestone appearance, apthoid ulcr

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13
Q

Operation for rectal prolapse

A

Altmeir
Delormes
Rectopexy

1st two are perineal approaches

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14
Q

most commonly utilised treatment for fissure in ano

A

Topical vasodilator therapy

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15
Q

Surgical division of which sphincter for fissure

A

internal sphincter and not external

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16
Q

Rx of lower GI bleed 2° diverticular disease

A

Conservative management with close observation

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17
Q

Usual site of diverticular disease

A

between the taenia coli where vessels pierce the muscle to supply the mucosa

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18
Q

If visit in clinic with diverticular disease

A

Get Cologram

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19
Q

If visit to ER with diverticular disease then

A

Get Abd xray to rule out air
CT Abd for infective organ

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20
Q

Which Severity Classification for diverticular disease

A

Severity Classification- Hinchey

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21
Q

Severity Classification- Hinchey.

A

I= Para-colonic abscess
II= Pelvic abscess
III= Purulent peritonitis
IV= Faecal peritonitis

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22
Q

epithelial defect proximal to tip of coccyx and others too superiorly in the midline too

A

Pilonidal Sinus
In natal cleft

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23
Q

Surgery for pilonidal sinus

A
  1. Bascom Procedure
  2. Limberg procedure, Z-plasty or Karydakis procedure( these three to prevent tension free closure )
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24
Q

site in the abdomen for fluid to collect following a perforated appendix

A

Pelvis

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25
Q

Appendicitis few features

A

•Peri umbilical abdominal pain
• Once or twice vomiting not continuous
• Mild pyrexia( high fever typically suggests Mesenteric Adenitis)
• Diarrhea and Anorexia is rare.

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26
Q

Administration of which drug reduces wound infection rates.

A

Metronidazole

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27
Q

appendix mass without peritonitis treatment

A

Attempt conservative management for appendix mass without peritonitis

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28
Q

Ant vs Post Anal fissure

A

Post : 90%
Ant: 10% andmostly in females

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29
Q

most common complication vs most early complication of ileostomy

A

MCC is Dermatitis
Most early is Necrosis

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30
Q

loaction of ileostomy

A

right iliac fossa in a triangle between the anterior superior iliac spine, symphysis pubis and umbilicus

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31
Q

length of small bowelneeds to be taken out for ileostomy

A

2.5cm

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32
Q

At which point ileostomies should lie

A

one-third of the distance between the umbilicus and anterior superior iliac spine

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33
Q

Ileostomy output is roughly in the range of

A

5-10ml/Kg/ 24 hours

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34
Q

High output ileostomy

A

20ml/kg/24 hours

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35
Q

How to control high output ileostomies

A

•Administration of oral loperamide (up to 4mg QDS).
• Foods containing gelatine may also thicken output.

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36
Q

Fistula in IBD patients

A

management of fistula should be minimalistic like Insertion of a loose seton

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37
Q

Association of fistula in ano

A

Crohn’s disease, tuberculosis, lymphogranuloma venereum, actinomycosis, rectal duplication, foreign body and malignancy

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38
Q

sphincter saving operation for fistula only 10%

A

Ano-rectal advancement flaps

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39
Q

Ligation of the intersphincteric tract procedure

A

Best for intersphincteric fistula

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40
Q

/useful agent in reducing the output from pancreatic fistulae

A

Octreotide

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41
Q

Most fistula arises from

A

diverticular disease and Crohn’s

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42
Q

High vs low output fistula

A

high (>500ml) or low output (<250ml)

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43
Q

Issue with enteroenteric or enterocolic fistula

A

bacterial overgrowth may precipitate malabsorption syndromes.

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44
Q

If a colocutaneous fistula with no distal obstruction then

A

Provide local wound care and await spontaneous resolution

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45
Q

Genes involved in adenoma-carcinoma sequence in colorectal cancer?

A

C-myc
APC
p53
K-ras

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46
Q

(HNPCC) or Lynch syndrome genes

A

IGF1
MCC
DCC
c-yes
bcl-2

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47
Q

Characteristic of an adenoma which indicates it’s malignant nature

A

Increased size
Villous architecture
Dysplasia

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48
Q

Large bowel obstruction

A

Right hemi plus ileo colic anastomosis

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49
Q

Left colon obstruction surgery

A

Sub total colectomy and anastomosis
Left hemicolectomy with on table lavage and primary anastomosis
Left hemicolectomy and end colostomy formation

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50
Q

which surgery for colon below peritoneal re flections

A

Loop Colostomy

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51
Q

Ist line Rx of right sided colonic cancers

A

ght sided colonic cancers should proceed straight to surgery.

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52
Q

High vol andhigh fistula RX

A

TPN . + Octreotide

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53
Q

R x ofrectal cancer

A

Total Mesorectal Excision

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54
Q

Site of fissures in IBD

A

Ant wall

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55
Q

most marked finding on examination of UC

A

Proctitis

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56
Q

Mostcommon site of Perianal fistula

A

inter-sphincteric

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57
Q

Acute colonic pseudo-obstruction mostly occurs in

A

Left colon

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58
Q

Mostcommon sute of volvulus

A

Sigmoid colon

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59
Q

Xray finding of volvulus

A

dilated sigmoid colon, loss of haustra and U shape

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60
Q

If focaltenderness in obstructive bowel on examination indicates

A

Ischemia

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61
Q

tense, tympanic abdomen which is not painful.

A

colonic pseudo-obstruction (Ogilvies syndrome

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62
Q

Cellular process in a polyp

A

Dysplasia

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63
Q

No of polyps in FAP

A

More than 100

64
Q

High risk findings of polyps

A

High risk findings

More than 2 premalignant polyps including 1 or more advanced colorectal polyps

OR

More than 5 pre malignant polyps

65
Q

If failed colonoscopy then 2hat procedu4e to undertake

A

CT colonography

66
Q

If a sigmoid stricture with large bowel obstruction then

A

Laprotomy and Hartmann
No coloanal anastomosis

67
Q

Patients who do not respond to supportive measures with Colonic pseudo-obstruction should be treated with

A

attempted colonoscopic decompression and/ or the drug neostigmine

68
Q

Colon tumour in a patient from a HNPCC family

A

panproctocolectomy rather than segmental resection

69
Q

anastomosis to heal the key technical factors

A

adequate blood supply, mucosal apposition and no tissue tension

70
Q

Defuction of tumor by stomq

A

Can be done in rectal ones but not in colon

71
Q

Postresection chemo for colon cancer
Chemo is

A

a combination of 5FU and oxaliplatin is common

72
Q

Extraintestinal manifestation of inflammatory bowel disease

A

: A PIE SAC

Aphthous ulcers
Pyoderma gangrenosum
Iritis
Erythema nodosum
Sclerosing cholangitis
Arthritis
Clubbing

73
Q

Fistula in ano Rx

A

Lay open: if low, no sphincter involvement or no IBD.
Seton: if complex, high or IBD.

74
Q

Rx of Acutely thrombosed haemorroids

A

usually conservative and consists of stool softeners, ice compressions and topical GTN or diltiazem to reduce sphincter spasm

75
Q
  1. Large Chronic internal hemorrhoids Rx
  2. Large external hemorrhoids Rx
A
  1. stapled haemorroidopexy
  2. Milligan Morgan style conventional haemorroidectomy.
76
Q

Milligan Morgan style conventional haemorroidectomy.

A

three haemorroidal cushions are excised, together with their vascular pedicle

77
Q

the most efficient and definitive treatment for fissure in ano is

A

lateral internal sphincterotomy.

78
Q

Chronic fissure > 6/52: triad

A

Ulcer
Sentinel pile
Enlarged anal papillae

79
Q

Diverticulitis vs diverticulosis

A

Diverticular disease bleeds are classically painless, whilst
diverticulitis associated bleeds are often painful, secondary to the localised inflammation.

80
Q

Common organism for Ano rectal abscess

A

Ecoli
Staph aureus

81
Q

Which prolapse Rx has riskof anastomotic leak

A

Altmeirs procedure

82
Q

Fe deficiency anemia in elderly

A

Right colon involvement
Anemia as occult blood loss

83
Q

More common site of Angio dysplasia

A

Rightside of colon

84
Q

Bleeding from cancer

A

1st sign in mostcases
Usually present only when the disease is advanced.

85
Q

significant haemorrhag in UC Patients especiallywith failed medical Rx

A

sub total colectomy

86
Q

Indications for surgery in lower GI bleeding

A

Patients > 60 years
Continued bleeding despite endoscopic intervention
Recurrent bleeding
Known cardiovascular disease with poor response to hypotension

87
Q

Anal fissures are associated with:p which diseases

A

Sexually transmitted diseases (syphilis, HIV)
Inflammatory bowel disease (Crohn’s up to 50%)
Leukaemia (25% of patients)
Tuberculosis

88
Q

Probing fistula during infection

A

Don’t do it
Increase chances of complication

89
Q

Some points regarding fistula in ano

A

Typically probed by Lockhart Mummery probes
May respond to Infliximab if complicated Crohn disease

90
Q

1st test to perform if suspected colorectal cancer

A

Colonoscopy

91
Q

Diverticulosis is mostly diagnosed

A

Incidentally

92
Q

Acute abdominal pain with more Localized in Leftiliac fossa
Diagnosis

A

Acute Diverticulitis

93
Q

1St line investigation For complicated VS uncomplicated diverticular disease

A

Complicated: CT abd and Pelvis
Uncomplicated: flexible sigmoidoscopy

94
Q

Bleeding 2° varices
Rx’

A

IV Terlipressin ( a vaso constrictor )

95
Q

Montreal Score
Mayo Score of
Ulcerative colitis

A

The Montreal score can be used for quantifying disease extent and the Mayo score for disease severity.

96
Q

definitive diagnosis for ulcerative colitis is via

A

colonoscopy with biopsy*.

97
Q

Acute vs elective surgical treatment of UC

A

Acute: segmental resection(subcolectomy) withstoma
Elective: Panproctocolectomy is curative

98
Q

absolute indication for a proctocolectomy in UC

A

Dysplastic transformation of the colonic epithelium with associated mass lesions

99
Q

DVT in IBD

A

Patients with IBD have a high incidence of DVT and appropriate thromboprophylaxis is mandatory

100
Q

Indications for surgery in Crohns

A

complications such as fistulae, abscess formation and strictures.

101
Q

Ileoanal pouch in which IBD

A

In UC and not Crohns

102
Q

commonest disease site for crohns

A

Terminal ileum

103
Q

Severe perianal and / or rectal Crohns may require

A

proctectomy

104
Q

The presence of pain and the sentinel tag suggests a

A

posterior fissure in ano.

105
Q

Diff between hemorrhoids and fissure pain

A

anal fissures and hemorrhoids is that anal fissures tend to only show symptoms during bowel movements, while hemorrhoids tend to be painful throughout the day.

106
Q

Obstructed defecation+chronic constipation
Straining during bowel movement

A

Solitary rectal ulcer syndrome

107
Q

Which colonic polyp type carry the highest risk of malignant transformation

A

Villous adenomas .

108
Q

PRx of colorectal liver metastasis

A

chemotherapy followed by surgical resection as it’s treatable

109
Q

Nocturnal diarrhea and incontinence are symptoms of

A

IBD

110
Q

painless, profuse rectal bleeding of dark blood in patients taking clopidogrel
Rx

A

Diverticular bleed
As they are mostly present in benign setting

111
Q

commonest type of fistula I ano

A

Intersphincteric fistulas are the commonest type

112
Q

left hemicolectomy for Crohn’s then development of which kind of fistula

A

Colovesicall fistula

113
Q

colovesical v S ileovesical fistula

A

Colovesical fistulae primarily result from sigmoid diverticular disease. Ileovesical fistulae are most likely associated with Crohn disease.

114
Q

Granulomatous (non-caseating) vs non granulomatous microscopic change in IBD

A

G: In Crohns
Non G: In U C

115
Q

Microscopic Changes of UC

A

non-granulomatous inflammation of the mucosa and submucosa, crypt abscesses and goblet cell hypoplasia.

116
Q

which Caecal diameter suggest s impending Perforation

A

A caecal diameter of 12cm or more

117
Q

which Caecal diameter suggest s impending Perforation

A

A caecal diameter of 12cm or more

118
Q

Type of cancer in anus

A

Squamous cell Ca

119
Q

Anal cancer is linked to which infection strongly

A

HPV 16 infection

120
Q

Lymphatic spread from anus below dentate line

A

Inguinal nodes

121
Q

Most common surgery for UC and Crohn

A

UC: Proctocolectomy with Ileal Pouch-Anal Anastomosis (IPAA)
Crohn: laparoscopic ileo-cecal resection,

122
Q

Goodall rule

A

For all fistula in 3.75cm or 3cm radius of anus
Except those ant fistula which are more than 3.75cm away from anus and drain in post midline direction curved form

123
Q

If severe anal pain with unable to perform -DRE
If fever is also present along with these symptoms then

A

Go f9r abscess rather than fissure

124
Q

Chances of synchronous tumor in colorectal Ca

A

5 %

125
Q

ER vs elective surgery for UC

A

ER: Sub total colectomy, end ileostomy and a mucous fistula.
Elective: Pan proctocolectomy, an ileoanal pouch

126
Q

Anal cancer is strongly associated

A

HPV infection

127
Q

Commonest tumor in colon

A

Adenocarcinoma

128
Q

first and 2nd line Rx of Non metastatic Anal Cancer

A

First line: Combined chemoradiotherapy.
2nd line: Radical abdominoperineal excision of the anus and rectum

129
Q

Differentiate b/w Diverticular bleed and Angio dysplasia

A

Div Bleed: Mostly on left colon
Angio: Mostly on right side

130
Q

Angiodysplasia diagnostic points

A

Brisk bleeding
small erythematous lesion in the right colon on colonoscopy
No other symptoms

131
Q

Rectal prolapse is associated with

A

Associated with childbirth and rectal intussceception.

132
Q

Tests to perform in lower GI bleed

A

1st UGI Endoscopy
If Endoscopy -ve for blood then Perform
CT Angiogram to rule out lower GI Causes

133
Q

if life threatening lower GI bleeding

A

Selective mesenteric embolisation

134
Q

Liver association with crohn and UC

A

Crohn: PSC and gallstones
UC : only PSC

135
Q

If any major surgery and PRbleed post surgery then it can be dueto

A

An artery ligation and collateral flow may be imperfect

136
Q

Stimulant laxatives

A

senna, picosulphate

137
Q

Osmotic laxatives

A

lactulose, movicol, docusate

138
Q

Bulk forming laxatives

A

Bran
Psyllium
Methylcellulose

139
Q

when to give chemo in colon Ca

A

When nodes are involved

140
Q

when to give chemo in colon Ca

A

When nodes are involved

141
Q

Which haemorrhoids are impalpable

A

Uncomplicated grade 1 or 2 haemorrhoids are usually impalpable

142
Q

Anal Ca features

A

squamous cell cancer
pruritus ani
bright red rectal bleeding

143
Q

If a rectal obstruction 2° Ca
Which surgery to do

A

Formation of loop colostomy in ER setting

144
Q

CAUSES OF PRURITIS ANI:

A

Systemic (DM, Hyperbilirubinaemia, aplastic anaemia)

Mechanical (diarrhoea, constipation, anal fissure)

Infections (STDs)

Dermatological

Drugs (quinidine, colchicine)

Topical agents

145
Q

If tuMor is close to anal verge then surgery to Perform is

A

Abdomino-perineal excision of colon and rectum

146
Q

Patients with T1, 2 and 3 /N0 rectal disease on imaging

A

do not require irradiation and should proceed straight to surgery.

147
Q

Sigmoid volvulus may present

A

an asymmetrical mass in an elderly patient. It may contain a fluid level, visible on plain films

148
Q

Extra colonic diseases and of Gardners

A

skull osteoma, thyroid cancer and epidermoid cysts

149
Q

Extra colonic diseases and of Gardners

A

skull osteoma, thyroid cancer and epidermoid cysts

150
Q

Extra colonic diseases and of Gardners

A

skull osteoma, thyroid cancer and epidermoid cysts

151
Q

Gardners syndrome features .

A

Autosomal dom
APC gene
Multiple Polyps = High malignancy chance
Desmoid tumors in 15%

152
Q

Lynch Syndrome has which Ca

A

colonic and/ or endometrial cancer

153
Q

Li-Fraumeni Syndrome has

A

osteosarcomas and leukaemias
P53 mutation

154
Q

criteria of diagnosis of Li-Fraumeni Syndrome

A

Individual develops sarcoma under 45 years
*First degree relative diagnosed with any cancer below age 45 years and another family member develops malignancy under 45 years or sarcoma at any age

155
Q

Nerve damage with no soft tissue injury what will be the rate of neuron growth

A

1 mm per day

MRCS A(My Own) (28 decks)

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