Colorectal

Question 1

Diverticular disease differentials

Answer 1

colonic cancer

pelvic abcess

Question 2

Diverticulosis management

Answer 2

Asymptomatic in 95%
no treatment
increase dietary fibre

Question 3

What not to do in acute attack of diverticulitis

Answer 3

colonoscopy/sigmoidoscopy

Question 4

Acute diverticulitis

Answer 4

IV abx

can normally go home if no complications

Question 5

Perforation

Answer 5

A–> E ileus, peritonitis, shock

surgery

Question 6

stricture

Answer 6

hartmanns if obstructed

Question 7

Abcess

Answer 7

<5cm heal with abx and supportive care
>5cm needs draining
all pelvic abcesses need drainage

Question 8

Fistula

Answer 8

surgery but if not fit manage symptoms

ABx for recurrent UTIs

Question 9

uncomplicated but symptomatic diverticulae

Answer 9

Mebeverine

Question 10

inhibiting polyp growth

Answer 10

low dose aspirin (ulcer risk)

Question 11

CEA

Answer 11

tumor marker, used to monitor treatment

Question 12

CRC surgery

Answer 12

wide resection of growth and regional lymphatics

Question 13

right hemicolectomy

Answer 13

caecal, ascending, proximal transverse tumors
temporary: end ileostomy
ileo-colic anastamosis

Question 14

left hemicolectomy

Answer 14

distal transverse/descending colon tumours

temp end ileostomy/before colo-colic anastamosis

Question 15

high anterior resection (sigmoid colectomy)

Answer 15

sigmoid tumors

Question 16

Anterior resection

Answer 16

low sigmoid/high rectal tumors
colo rectal anastamosis acheived @ first operation
maybe covered by temp. loop ileostomy

Question 17

AP (abdominoperineal ) resection

Answer 17

tumors low in rectum
permenant colostomy
no anastamosis

Question 18

Hartmann’s

Answer 18

palliation

perforation

Question 19

endoscopic stenting

Answer 19

palliative

Question 20

Radiotherapy

Answer 20

pre-op in rectal cancer
high risk of dvt, pathological fractures, fistula formation
post op only if high recurrence risk

Question 21

Chemotherapy

Answer 21

adjuvant 5 FU and folic acid
reduces mortality
palliation if metastatic disease

Question 22

Anal carcinoma treatment

Answer 22

radio + chemo (5FU and mitomycin/cisplatin)
75% retain normal anal function
surgery for small tumors not affecting sphincter

Question 23

Management of obstructing colonic cancer

Answer 23

A--E
IVI, NGT
analgesia
FBC, u&E, amylase
AXR
erect CXR
catheterise to monitor fluid status
consider early CT
stents in palliation

Question 24

Causes of SBO

Answer 24

adhesions
gall stone ileus
hernia
Crohns
intussception
caecal mass

Question 25

Causes of LBO

Answer 25

carcinoma of colon diverticular disease sigmoid volvulus constipation

Question 26

contrast enema

Answer 26

differentiates obstruction and pseudo obstruction | gastrograffin may have therapeutic effect

Question 27

differentiating ileus + paralytic ileus

Answer 27

SBO: bowel sounds, no air in colon on AXR | Paralytic ileus: Diffuse air fluid levels, air in colon

Question 28

constipation IX

Answer 28

fbc, u+e, tfts, calcium, esr | then endoscopy

Question 29

1st degree haemorrhoids

Answer 29

``` laxative analgesia avoid opioids (constipation) avoid NSAIDS if rectal bleeding topical haemorrhoidal preparations for short term relief ```

Question 30

Non-surgical | if 1st degree medical management fails/for 2nd/3rd degree

Answer 30

rubber band ligation (up to 3 haemorrhoids in 1 visit) Injection sclerotherapy w/ phenol oil infrared coagulation/photocoagulation

Question 31

Surgical haemorrhoid treatment

Answer 31

heamorrhoidectomy only if symptomatic stapled haemorrhoidectomy haemorrhoidal artery ligation

Question 32

Perianal haematoma management

Answer 32

evacuated under LA/resolve spontaneously with analgesia - hot baths and reassurance if already discharging/resorbing when seen

Question 33

anorectal abcess

Answer 33

I&D to prevent fistula formation/rupture

Question 34

pilonidal sinus

Answer 34

excise sinus tract, primary closure, pre-op abx give hygenie + hair removal advice if complex, laid open and packed /use skin flaps to cover

Question 35

perianal wart

Answer 35

podophyllin paint cryotherapy surgical excision

Question 36

investigation fistula in ano

Answer 36

v painful, under anaesthetic | endoanal USS

Question 37

Goodsall's rule

Answer 37

o If the external opening of the fistula is in the anterior half of the anal canal, the fistula opens in a straight path directly into the canal o If the external opening is in the posterior half, it will open at the midline of the posterior wall of the anal canal, with a curved track

Question 38

exception to Goodsall's rule

Answer 38

anterior fistulas >3cm away from anus, can drain like posterior ones w/curved track

Question 39

Fistula in ano management

Answer 39

I+D of abcess low fistulae = laid open, heal by secondary intention, division of sphincters = no risk to continence High fistulae- need a seton suture --> tighthened over time to maintain continence

Question 40

Fissure management

Answer 40

``` small may heal spontaneously -LA ointment, lubricant laxative shallow warm bath rectal GTN/botox high fibre and fluid intake bulk forming laxative last line = sphincertotomy ```