Colorectal

Question 1

Endoscopic features of UC

Answer 1

Progressive inflammation from dentate line
Erythema
Oedema
Fragility
Loss of vascular pattern
Ulcerations
If severe: cobblestoning and pseudopolyps

Question 2

Extra-intestinal manifestations of IBD:

Answer 2

Eyes: uveitis (UC), episclerosis, conjunctivitis
Skin: erythema nodosum, pyogenic granulosum
Aphthous ulcer (crohns)
Joints: anakylosis spondylitis, sacroilitis, peripheral acute arthopathy
Hepatic: PSC (UC), hepatitis (crohns)
Amyloidosis (crohns)

Question 3

What gene mutations cause lynch?

Answer 3

MLH1
MSH2
MSH6
PMS2
Deletion of EPCAM

Question 4

Low anterior resection syndrome (LARS)

Answer 4

Defined as at least one symptom and one consequence after sphincter sparing resection

Symptoms:
- variable, unpredictable bowel function
- altered stool consistency
- increased stool frequency
- emptying difficulties
- urgency
- incontinence
- soiling

Consequences:
- toilet dependence
- preoccupation with bowel function
- dissatisfaction with bowels
- strategies and compromises
- impact on mental and emotional wellbeing
- impact on social and daily activities
- relationships and intimacy
- roles, commitments and responsibilities

Question 5

Treatment of LARS

Answer 5

Pelvic floor exercises and biofeedback training
Loperamide
sSRI - for postprandial urgency or incontinence
Antibiotics - for gas and bloating ?SIBO
Transanal irrigation
Sacral nerve stimulation
Defunctioning

Question 6

Pathophysiology of LARS

Answer 6

Colonic dysmolitity
- due to denervation of colonic conduit, increase bowel transit

Neorectal reservoir dysfunction
- decrease functional capacity of reservoir
- denervation
- both surgery and radiotherapy contribute

Anal sphincter dysfunction

Question 7

Fistula

Reasons for non-healing

Answer 7

FRIENDS

Foreign body
Radiation
Inflammatory bowel disease
Epithelialised
Neoplasm
Downstream obstruction
Short track

Question 8

Operative principles of TME (pelvic part)

Answer 8

Dissection in avascular plane into pelvis (ant to pre-sacral fascia, outside enveloping visceral fascia)
Division of middle rectal vein/artery and lymphatics anteriolaterally
Inclusion of all pelvic fat and lymphatics (or 5cm below in mid-high tumour)

Roles:
Good CRM
LN dissection

Question 9

Cryptoglandular theory

Answer 9

Obstruction of anal gland ducts
Stasis
Bacterial overgrown
Abscess formation, with extension into tissues outside the sphincter

Question 10

Characteristics of lynch related colon cancers

Answer 10

PMRCT

P - poorly differentiated
M - mucinous/signet ring
R - right sided
C - crohns like
T - tumour lymphocytes

Question 11

Bowel screening

Answer 11

60-74 for everyone
From 50 for pacific and Māori in some regions

Biannual

Used FIT
- faecal immunochemistry test
- antibody to human hemoglobin protein
- more specific and sensitive then FOB