colon/rectum

Question 1

Treatment for severe UC is NEVER?

Answer 1

surgery

Question 2

Extraintestinal manifestations of Crohn’s disease most commonly occur in those with what?

Answer 2

ileal disease

Question 3

extra intestinal manifestations of Crohn’s disease most likely to resolve with medical/surgical therapy?

Answer 3

Erythema nodosum

Question 4

extra intestinal manifestations of Crohn’s disease most likely NOT to resolve with medical/surgical therapy?

Answer 4

ankylosing spondylitis
pyoderma gangrenosum
uveitis
primary sclerosis

Question 5

best way to diagnose a fistula from diverticulitis

Answer 5

CT abd/pelvis

Question 6

indications for adjuvant chemo in stage II cancer

Answer 6

T4 disease
lymph-vascular or perineurial invasion
insufficient lymph node sample
poor differentiation
elevated CEA levels
Proficient MMR

Question 7

MC complication after proctocolectomy and pouch for IBD?

Answer 7

Pouchitis
treat with IV abx first not surgery

Question 8

screening colonoscopy for UC starts when?

Answer 8

10 years after disease dx regardless of age

Question 9

when do patients with FAP get prophylactic proctocolectomy?

Answer 9

20 years old

Question 10

when should FAP get screening EGD?

Answer 10

25 years old

Question 11

when should FAP get screening flex sig?

Answer 11

teenager

Question 12

For Crohn’s disease, infliximab is good for

Answer 12

perianal fistula

Question 13

treatment of Crohn’s disease with strictures

Answer 13

resection (first)
stricturoplasty with recurrence to save on bowel length

Question 14

the most common cause of severe GI bleeding in older patients

Answer 14

diverticular disease
usually self resolving

Question 15

MC viral sexually transmitted infection in US

Answer 15

condylomata acuminata

Question 16

pre op albumin less than what is risk for anastomotic leak

Answer 16

less than 3.5

Question 17

MC genetic defect involved with colon cancer

Answer 17

APC gene

Question 18

For SCC of the anus local regional recurrent/persistence after chemoradiation is

Answer 18

20%

Question 19

anal melanoma express

Answer 19

s-100
HMB-45
Melan A

Question 20

important prognostic factor of anal melanoma

Answer 20

perineurial invasion

Question 21

treatment for recurrent anal SCC after chemorads

Answer 21

salvage APR

Question 22

treatment for anal melanoma

Answer 22

local excision

Question 23

treatment for anal adenocarcinoma

Answer 23

APR with adjuvant chemorads

Question 24

HIV patient with large soft cauliflower like mass

Answer 24

verrucous carcinoma treat with WLE

Question 25

Which anorectal abscesses will need REUA?

Answer 25

complex abscesses: intersphincteric, supralevator, horseshoe abscesses

Question 26

what is the greatest risk to I&D of perirectal abscess?

Answer 26

recurrent abscess, 40% within first year

Question 27

most common cause of I&D failure of perirectal abscess

Answer 27

incomplete drainage or unidentified fistula

Question 28

where is a perianal abscess

Answer 28

in the perianal space, superficially at the anal verge and continuous with the ischioanal fossa laterally

Question 29

where is an ischioanal abscess

Answer 29

in the ischioanal space with a superior boundary of the elevator ani muscle, medial boundary of the external anal sphincter, and laterally of the pelvic side wall (may communicate bilaterally via the deep postnatal space resulting in horseshoe abscess)

Question 30

Where is an intersphincteric abscess

Answer 30

in the intersphincteric place between the internal and external sphincter muscles

Question 31

where is a supralevator abscess?

Answer 31

in the extraperitoneal supralevator space bounded medially by the rectum and laterally by the pelvic side wall require imaging

Question 32

how do you drain a horseshoe abscess

Answer 32

modified Haney procedure opening the deep postanal space with sphincter sparing posterior midline incision, placement of seton via the internal opening, make bilateral counter incisions to drain the ischioanal fossae with setons

Question 33

T/F: abscess drainage with concomitant fistulotomy may be performed with caution for simple anal fistulas

Answer 33

true

Question 34

what kind of abscess is number 1?

Answer 34

supralevator

Question 35

what kind of abscess is number 2?

Answer 35

horse shoe

Question 36

what kind of abscess is number 3?

Answer 36

ischiorectal

Question 37

what kind of abscess is number 4?

Answer 37

intersphincteric

Question 38

what kind of abscess is number 5?

Answer 38

perianal abscess

Question 39

the dentate line represents the border between, what?

Answer 39

embryonic endoderm and ectoderm

Question 40

at the dentate line there are columns of ?

Answer 40

Morgagni that contain anal crypts at their bases

Question 41

the anoderm is the border between the?

Answer 41

anoderm and skin (has hair, sweat glands, sebaceous glands

Question 42

the internal anal sphincter is a continuation of the?

Answer 42

rectal circular smooth muscle

Question 43

the external anal sphincter is a continuation of?

Answer 43

levator ani muscles

Question 44

what are the most common anorectal abscess?

Answer 44

perianal abscess located just beneath the skin of the anal canal and do not transverse the external anal sphincter

Question 45

what are the parks classification of anal fistulas?

Answer 45

Types 1-4

Question 46

what are complex fistulas?

Answer 46

fistulas involving more than 30% of the external anal sphincter with multiple tracts, fistulas involved with Crohn's disease, malignancy, or radiation usually cannot be managed with fistulotomy

Question 47

which anorectal abscesses can be drained in clinic?

Answer 47

superficial perianal and simple ischiorectal abscesses with an elliptical or cruciate incision

Question 48

when is a seton usually used for fistulas?

Answer 48

high transsphincteric fistula, supersphincteric fistula, female patients with anterior fistulas, advanced Crohn's disease

Question 49

what is the LIFT procedure?

Answer 49

ligation of intershpincteric fistula tract - tract is identified in the plane between the internal and external sphincter and ligated

Question 50

what is an endoanal advancement flap?

Answer 50

used to obstruct the internal opening of the fistula to eliminate the source of fistula drainage

Question 51

when are antibiotics used for perirectal abscess/fistula

Answer 51

immunosuppressed, signs of infection, signs of cellulitis, prosthetic valves, heart transplant patients, prior endocarditis

Question 52

how do you do an internal sphincterotomy?

Answer 52

place a small scalpel into the intersphincteric groove and divide the internal sphincter by turning the scalpel medially

Question 53

what is the most accurate imaging study to order for patient with complex fistula?

Answer 53

MRI

Question 54

when is a rigid proctoscopy used?

Answer 54

accurate measurement of the distance from anal verge and exact location of a rectal tumor

Question 55

colon anastomotic leaks are most likely to happen after which POD?

Answer 55

afer POD 3: dip in anastomotic strength due to collagen degradation coupled with lower level of tensile strength which scar is still maturing