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Frcs > Colorectal Surgery > Flashcards

Colorectal Surgery Flashcards

1
Q

Follow up scans for colorectal cancer

A

Normally 6 then 18minths with 6 monthly CEA levels for 3 years

Following chemo - 6month scan occurs at end of chemo

Following liver resection - 6 monthly for 2 yrs

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2
Q

Scoring system is for polyps

A

Haggis level determines the level of invasion within the polyp

Kikuchi level determine the degree of sun mucosal invasion in the colonic wall

Paris type - morphology of the polyp

Kudo groups - pit pattern

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3
Q

What is the most comman extracolonic manifestation of FAP

A

Adenoma toys duodenal polyps

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4
Q

Treatment of Anal SCC

A

Radial chemoradiotherapy

AIN 3 - risk of progression to invasive and 6 months follow ups required

AIN 1-2. Discharge

Is reoccurrence consider APER

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5
Q

Endoscopic changes in UC -early

A

Loss of the mucosal vascular pattern occurs as a result of mucosal oedema which obscures the underlying vessels. More advanced changes include; erythema, contact bleeding, ulceration and pseudopolyps

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6
Q

What percentage of FAP is not inherited

A

25%

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7
Q

Radiotherapy for rectal cancer

A

Rectal cancer if <15cm from distal margin to sphincters

Short course radio should be followed 4-8wrrks by surgery (chemo can extend time) - Stockholm 3 trial

For bulky nodes in mesotectum or the threatened CRM

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8
Q

Low pressure anal fissure

A

Medical tx
Advancement flaps

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9
Q

Uc vs campylobacter infection

A

The histological changes seen in both UC and Campylobacter infection are identical and therefore stool testing for this should be conducted in all cases of suspected UC

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10
Q

Pouchitits

A

Establish diagnosis with endoscopy and symptoms

Initial tx is metronidazole for 2/52 or cipro

If relapses quickly or 3 relapses in a year consider long term cipro or VSL 3 (probiotic)

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11
Q

5 yr survival rate for salvage APER for anal SCC

A

40%

Up to 75% for non salvage patients (respond to chemo rad)

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12
Q

Amount of serosa that can have mesentry removed on ilesotomy

A

5cm before risk of necrosis

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13
Q

Anal fissure

A

Medical treatment has not been shown to be superior to surgery (lateral internal sphincterotomy)

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14
Q

Sensitivity for Ct colonoscopy

A

93% sensitive and 97% specific

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15
Q

Types of fistula in abo

A

Intersphincteric (70%)
Trans-sphincteric (25%)
Suprasphincteric (4%)
Extrasphincteric (1%)

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16
Q

CMV histology

A

Intra cytoplasmic inclusions

Hematoxylin and eosin stains may reveal classic findings, which include giant cells with cytomegaly and large ovoid or pleomorphic nuclei containing basophilic inclusions (owl’s eyes, halo rim).

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17
Q

Histology in UC

A

Alteration of crypt architecture. Branching crypts with marked deviation of the crypt axis from the perpendicular; variation in crypt size and/or shape; shortened crypts, with bases of crypts elevated off the muscularis mucosae

Dense neutrophilic infiltrates and neutrophils in crypts (crypt abscesses)

Ulceration may be identified, although fissuring is often absent

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18
Q

Histology in Crohn’s disease

A

Areas of chronic inflammation, comprising increased lamina propria plasma cells and lymphocytes, in association with chronic architectural distortion with patchy, mild to severe, neutrophilic inflammation, including neutrophilic cryptitis, crypt abscesses, or erosions/ulcers

Skip lesions

Granulomas

Sub mucosal fibrosis

Fissuring

19
Q

Radiation enteritis

A

Disordered crypts
Endarteritis obliterans
Fibrosis of the lamina propria
Ulceration and fistulation

20
Q

Infective colitis

A

Increased cellularity in the lamina propria
Neutrophilic infiltrates
Loss of crypts

21
Q

Collagenous collitis

A

Normal crypts with lymphocytic infiltrates and collagen deposition in the lamina propria

22
Q

Solitary rectal ulcer histology

A

Fibromuscular obliteration
Surface ulceration
Little inflammatory activity

23
Q

Earliest complication of ilesotmy

A

Necrosis

24
Q

Fistula in a 6month year old

A

Low fistulae in ano are not uncommon in the first year of life. There is seldom any significant associated pathology, especially if the child is otherwise well. They seldom involve the sphincter and are best laid open, which children seem to tolerate well. Detailed imaging (which in this age group requires anaesthesia) is not appropriate at this stage.

25
Q

Bowel cancer screening

A

FIT based screening is every 2 years. In studies comparting annual with 2 yearly screening, there was no mortality difference between the groups.

26
Q

Genetic cancers with eye signs

A

Congenital hypertrophy of the retinal pigment epithelium is strongly associated with FAP. As such, a colonoscopy is the usual investigation of choice.

Improve

27
Q

Comman complication after staples haemorroidectony

A

Urgency is the commonest side effect of stapled haemorroidectomy

28
Q

Haemorrhoids - high fibre diet

A

Suitable for minor haemorrhoidal symptoms and disease
Low risk

29
Q

Rubber band ligation

A

Bands are applied to the base of the haemorrhoidal cushion above the dentate line

Mucosal necrosis and subsequent fibrosis will tend to result in elevation of the haemorroids to their normal locatio

Only likely to succeed if the underlying cause is addressed

30
Q

Injection sclerotherapy

A

Injection of 5% phenol in almond oil at the base of the haemorroid

Deep or ineffective injection may result in pelvic sepsis or prostatitis

31
Q

Milligan - Morgan haemorrhoidectomy

A

Involves excision of the haemorrhoidal tissue

Good for large volume prolapsed haemorrhoids

Excessive tissue excision may result in anal stenosis

Pain may be reduced by post operative oral metronidazole

32
Q

Stapled haemorrhoidopexy

A

Use of circular stapler to excise the haemorrhoidal base and surrounding mucosa

Will elevate the cushions into the anorectum and reduce symptoms
Urgency occurs in up to 20% (though usually resolves in the first 6 months)

Large skin tags may be less effectively addressed with this technique

Urgency is a comman side effect

33
Q

Doppler guided haemorrhoidal artery ligation

A

Uses doppler device to identify the haemorrhoidal vessel that is then underrun

Additional sutures placed to hitch up the haemorrhoidal complex

Low morbidity technique. However, equipment is expensive

34
Q

Infective vs IBD

A

Oak. Early in Hx is more likely to be infective

35
Q

FAP

A

More than 100 adenomatous polyps affecting the colon and rectum. Duodenal and fundic glandular polyps

APC (over 90%)

36
Q

Gardner syndrome

A

As FAP but with desmoid tumours and mandibular osteomas

APC

37
Q

Turcots syndrome

A

Polyposis and colonic tumours and CNS tumours

APC +MLH1 and PMS2

38
Q

HNPCC

A

Colorectal cancer without extensive polyposis. Endometrial cancer, renal and CNS

MSH2, MLH1, PMS2 and GTBP

Mnemonic 3-2-1 for HNPCC.
3 individuals, 2 generations and one must be younger than 50 yrs.

39
Q

Peutz-Jeghers syndrome

A

Hamartomatous polyps in GI tract and increased risk of GI malignancy

LKB1 andSTK11 (in up to 70%

40
Q

Cowden disease

A

Also known as multiple hamartoma syndrome. Rare autosomal dominant condition with incidence of 1 in 200,000.. It is characterised by multiple mucocutaneous lesions, trichilemmomas, oral papillomas and acral keratosis. Most often diagnosed in third decade of life. Breast carcinoma may occur in up to 50% of patients and conditions such as fibrocystic disease of the breast may occur in 75% of women. Thyroid disease occurs in 75% and may include malignancy. Endoscopic screening will identify disease in up to 85% although the small bowel is rarely involved. There is a 15-20% risk of developing colorectal cancer and regular colonoscopic screening from age 45 is recommended.

PTEN (85%)

41
Q

MYH associated polyposis

A

Autosomal recessive, multiple adenomatous polyps in GI tract, those in colon having somatic KRAS mutations

MYH

42
Q

What is the commonest extra intestinal manifestation of ulcerative colitis

A

Activity related polyarthropathy is seen in up to 20% of patients with ulcerative colitis

43
Q

Optimal length of end ileostomy

A

2.5cm

Frcs (15 decks)

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