colorectal

Question 1

what is the criteria for toxic megacolon

Answer 1

1. Colonic dilatation >6cm
   + 3 of - temp>38, N >10.5, P>120, anaemia
   +1 of dehydration, altered mental state, electrolyte disturbance, hypotension

Question 2

What is the modified Ryan scheme for tumour response in rectal cancer

Answer 2

Regression of rumour post Neoadjuvant treatment

0- no viable calls
1- single/rare cells
2 - residual cancer but more than rare cells
3- extensive residual cancer

Question 3

What is parks classification of anal fistula

Answer 3

1. intersphinteric
2. trans-sphinteric
3. Supra-levator
4. extra-sphinteric

Question 4

What factors contribute to anal continence

Answer 4

1. anal sphincter tone
2. Ano-rectal angle - puborectalis
3. Anal cushions

Other factors for continence - rectal compliance, stool consistency

Question 5

What is the PCI

Answer 5

peritoneal carcinomatosis index
13 sections which score 1-3
>31 poorer results

Question 6

What are the types of pseudomyxoma peritoneii

Answer 6

3 types
Acellular/low grade (LAMN)
High grade - micnous adenocarcinoma
HIgh grade with signet cells - worst prognosis - adeno with signet cells - unlikely cytoreductive surgery + HIPEC would be effective

Question 7

types of caecal volvulus

Answer 7

1. axial (twist along long axis)
2. Loop volvulus - ileum and caecum moves to LUQ
3. Caecal Bascule - folds on itself to RUQ

1 and 2 make up 80%

Question 8

how to classify small bowel diverticulum

Answer 8

1. Location (duodenum 80%, jejunoileal 17%, throughout 3%)
2. Intraluminal vs extraluminal
3. Congenital vs acquired (mekel’s)