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MRCS > Colorectal > Flashcards

Colorectal Flashcards

1
Q

What are the histological features seen in Crohns

A

Granulomas (non-caseating)

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2
Q

What is the management of a patient with UC presenting with acute colitis

A

Medical mx= steroids for 5-7 days

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3
Q

What is the management of a patient with UC and colitis who is not responding to steroids

A

Emergency: subtotal colectomy with end ileostomy and mucocutaneous fistula

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4
Q

Management of crohns with ano rectal sepsis?

A

Very min resection if needed!!

Drain infection +/- seton to facilitate drainage

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5
Q

T/F: all colonic adenomas are metaplastic

A

FALSE: colonic adenomas are DYSPLASTIC

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6
Q

Why should colonic polyps not be resected in the presence of CRC during endoscopy

A

To avoid seeding

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7
Q

T/F: all colonic adenomas >1cm have malignant potential

A

FALSE:

Colonic adenomas >2cm have malignant potential

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8
Q

Patient presents with:
Painful PR bleeding on defecation
Skin tag present
Bright red blood

Diagnosis?

A

Fissure in ano

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9
Q

Conditions associated with fissure in ano

A

Crohns
TB
internal rectal prolapse

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10
Q

Management of obstruction due to diverticular stricture

A

Colonic resection

If malignant- stent

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11
Q

Management of volvulus

A

Initial max: untwist- flexi sig

If ischaemic: surgical
If recurrent: resection

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12
Q

Causes of LBO

A

Tumours
diverticular disease
volvulus

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13
Q

Mx of right sided colonic tumour causing LBO

A

RESUSCITATE
right hemi +/- extend to transverse
ileocolic anastamosis

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14
Q

Mx of left sided colonic tumour causing LBO

A

RESUSCITATE
left hemi + anastamosis

OR

Left hemi + end colostomy

OR

colonic stent

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15
Q

Mx of rectosigmoid tumour causing LBO

A

resection + loop colostomy

distal sigmoid= high anterior resection

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16
Q

What are the 4 types of fistulae

A

enterocutaneous
enterocolonic
enterovesical
enterovaginal

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17
Q

Management of a high output fistula

A

octerotide + TPN

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18
Q

Define Goodsall’s rule

A

For perianal fistulae:

if the outer opening of a fistula is anterior to the imaginary transverse line drawn across the perineum= the internal fistula opening (into the anal canal) is along the same radial path (fistula track is a straight line)

If the outer fistula opening is posterior to the imaginary transverse line= the fistula tract will follow a curved line and open at the posterior midline

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19
Q

Indication for surgical mx of UC

A

Dysplastic lesions found
UC requiring maximal therapy
Prolonged courses of steroids

20
Q

In elective settings, what would be the surgical mx of UC

A

Panproctocolectomy + end colostomy/ ileoanal pouch

21
Q

In emergency settings, what would be the surgical mx of UC

A

subtotal colectomy + end ileostomy +/- mucous fistula (if rectum is very odematous)

in emergency settings rectum should not be resected

22
Q

Indications for surgical Mx of Crohns

A

Complications of crohns:
abscess, fistula, strictures

23
Q

What is the surgical management of crohns:

If stricture
if perianal fistulae
if perianal/ rectal crohns
if terminal ileal crohns

A

Resection should be minimized to prevent shot bowel syndrome

If stricture= stricturoplasty
if perianal fistulae= seton drainage
if perianal/ rectal crohns= protectomy
if terminal ileal crohns= limited ileal resection

24
Q

Commonest type of cancer in the:
anus
rectum
colon

A

Anus= SCC
rectum + colon= adenocarcinoma

25
Q

What is commonly associated with chronic straining and constipation

A

solitary rectal ulcer

26
Q

What is seen in histology of lesion associated with chronic straining and constipation

A

mucosal thickening
collagen and fibrosis in the lamina propria

27
Q

What are the surgical management options for rectal prolapse and their associated complications

A

Delorme’s = high recurrence rate
Altemier’s= anastamotic leak
Rectopexy= constipation post-op

28
Q

Where are fissure in ano usually sited

A

posteriorly

29
Q

If fissure in ano present atypically what investigations should be carried out

A

Atypical= anteriorly sited/ multiple

colonoscopy, EUA + biopsies

*for ?Cancer/ IBD/ prolapse

30
Q

What are the different management options for fissure in ano

A

1- stool softeners
2- GTN/ diltiazem top
3- botox injection
4- surgical:

men= laternal internal sphincterotomy
women= manometry (caution with sphincterotomy as when combined with post-vaginal birth pelvic floor damage, can cause faecal incontinence)

31
Q

What is the commonest complication of ileostomy

A

dermatitis

32
Q

What is the earliest complication of ileostomy

A

necrosis

33
Q

Where are ileostomies usually sited

A

RIF (in the triangle between ASIS, pubic symphysis and umbilicus, 1/3 of the way b/w the umbilicus and ASIS)

34
Q

How much output would be considered high output for an ileostomy

A

normal 5-10ml/kg/24hr

high >20ml/kg/24hrs

35
Q

initial mx of high output ileostomy

A

-loperamide + add gelatin to food to thicken

36
Q

management options for colonic pseudo-obstruction

A

Usually due to electrolyte imbalances

1- correct electrolytes + supportive care
2- decompress with rigid sigmoidoscope/ oral neostigmine

*neostigmine can cause symptomatic bradycardia= give in monitored environment

37
Q

Complication of chronic pilonidal abscess

A
38
Q

Management of acute pilonidal abscess/ sinus

A

I&D

39
Q

Definitive mx of pilonidal abscess and when should this be done

A

Bascoms procedure- excising the pit and obliterating the cavity underneath

Karydakis procedure- wide excision of the natal cleft so that the surface is recontoured once the wound is closed

40
Q

rectal cancer mx if:
-T1/2/3, N0
-T4
-rectal Ca presenting with obstruction

A

-surgical resection
-chemo-radiotherapy
-defunctioning loop colostomy

41
Q

colon ca mx if:
-any stage
-high recurrence risk
-presenting with obstruction

A

-surgical resection
-resection + post-op chemo
-resection/ stent

42
Q

Anal Ca mx:
-1st line
-2nd line

A

-chemoradiotherapy
-salvage radical AP excision of anus and rectum (for NON-metastatic ca)

43
Q

What are the extra-intestinal manifestations of crohns

A

A PIE SAC

Apthous ulcers
pyoderma gangrenosum
erythema nodosum

sclerosing cholangitis
arthritis
clubbing

44
Q

What is the transition from polyp to cancer called

A

adenoma-carcinoma sequence-where oncogenes are activated and tumour suppressor genes are DE-activated to gradually form cancerous cells

45
Q

What are the genes involved in the transformation of a polyp to a carcinoma

A

APC
c-myc
bcl-2
K-RAS
MCC
DCC
c-yes

p53 deletions

46
Q

What are the extra-intestinal manifestations common to both crohn and UC

A

Arthritis
PSC*
uveitis*
episcleritis**
pyoderma gangrenosum
erythema nodosum
clubbing
osteoporosis

*more common in UC
** more common in crohns

47
Q

What is the most common extra-intestinal feature in both CD and UC

A

Arthritis

MRCS (22 decks)

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