Colorectal

Question 1

Gastric volvulus

Answer 1

triad of vomiting, pain and failed attempts to pass an NG tube

Question 2

FIT test indicated

Answer 2

patients aged ≥ 50 years with any of the following:

abdominal mass
change in bowel habit
iron-deficiency anaemia

Question 3

Diverticula are most commonly found

Answer 3

sigmoid colon

Question 4

lateral anal fissure

Answer 4

suggests secondary cause (e.g. Crohns)
2ww referral to colorectal surgeons

Question 5

fulminant UC (megacolon) surgery

Answer 5

sub total colectomy; rectum left in situ

Question 6

right hemicolectomy indications

Answer 6

Caecal, ascending or proximal transverse colon cancer

Question 7

colovesical fistula

Answer 7

Diverticulitis symptoms + pneumaturia or faecaluria

Question 8

left hemicolectomy indications

Answer 8

Distal transverse or descending colon cancer

Question 9

Haartmans indications

Answer 9

perforated diverticular disease
perforated large bowel
anastomotic failure
critically unwell

Question 10

colorectal cancer tumour marker

Answer 10

Carcinoembryonic antigen

Question 11

investigation to confirm anastomosis has healed and not leaking

Answer 11

gastrogaffin enema

Question 12

loop ileostomy

Answer 12

Defunctioning of colon e.g. following rectal cancer surgery
Does not decompress colon (if ileocaecal valve competent)

Question 13

ischaemic colitis most commonly affected area

Answer 13

splenic flexure

Question 14

Haartman’s procedure

Answer 14

sigmoid colectomy and formation of end colostomy

Question 15

Rectal cancer on the anal verge

Answer 15

Abdomino-perineal excision of rectum

Question 16

Thrombosed haemorrhoid TX:
<72 hrs
>72 hrs

Answer 16

<72 hours: Analgesia and referral for excision

> 72 hours: stool softeners, ice packs and analgesia

Question 17

severe rectal crohns surgical treatment

Answer 17

proctectomy

Question 18

severe UC surgical treatment

Answer 18

(pan)proctocolectomy + end ileostomy

total colectomy + ileoanal pouch (if want to avoid stoma)

Question 19

acute anal fissure (<1 week) Tx

Answer 19

soften stool
dietary advice: high-fibre diet with high fluid intake
bulk-forming laxatives are first-line - if not tolerated then lactulose should be tried
lubricants such as petroleum jelly may be tried before defecation
topical anaesthetics
analgesia

Question 20

chronic anal fissure Tx

Answer 20

topical GTN
sphincterectomy

Question 21

indications for surgical involvement in sigmoid volvulus

Answer 21

repeated failed attempts at decompression,
necrotic bowel noted at endoscopy
suspected (or proven) perforation or peritonitis

Tx= urgent midline laparotomy

Question 22

unruptured sigmoid volvulus Tx

Answer 22

rigid sigmoidoscopy with rectal tube insertion

Question 23

caecal volvulus Tx

Answer 23

right hemicolectomy

Question 24

diverticular bleeds Ix

Answer 24

active observation- settle spontaneously

Question 25

Haartmans - what is it

Answer 25

high anterior resection with end colostomy + rectal stump (as opposed to anastomosis)

Question 26

haemorrhoids vs anal fissure

Answer 26

anal fissure painful rectal bleeding

Question 27

Nocturnal diarrhoea and incontinence

Answer 27

IBD (proctitis)

Question 28

loop colostomy

Answer 28

To defunction a distal segment of colon

Question 29

Acute mesenteric ischaemia Tx

Answer 29

immediate laparotomy is usually required, particularly if signs of advanced ischemia e.g. peritonitis or sepsis

Question 30

rectal vs anal cancer type

Answer 30

rectal= adenocarcinoma
anal= squamous