Colorectal Surgery

Question 1

What are the main differences between Chron’s Disease and Ulcerative Collitis?

Answer 1

Continuous (UC) v Skip lesions (CD)
Colon moving proximally (UC) v Anywhere in GIT (CD)
Limited to mucosa (UC) v Affects entire wall (CD)

Question 2

Which type of IBD is premalignant?

Answer 2

UC may be premalignant (10% risk for every 10 years)

CD is rarely premalignant

Question 3

What are the extraintestinal features of IBD?

Answer 3

Skin changes, arthritis, anaemia, fever, liver disease (UC), fistulas (CD)

Question 4

What are the Dukes Staging criteria for colorectal cancer and the 5-year survival rate of each?

Answer 4

A: confined to mucosa/submucosa (90%)
B: invading tissue but no LNs (60%)
C: LN involvement (30%)
D: distant spread (5-10%)

Question 5

What are the cardinal features of bowel obstruction?

Answer 5

Vomiting, pain, constipation, abdominal distention

Question 6

What are some differentials for swelling of Virchow’s node?

Answer 6

Gastric cancer, arm infection, lymphoma

Question 7

What percentage of appendices are:

(a) Retrocaecal
(b) Pelvic
(c) Ileal

Answer 7

(a) 75%
(b) 20%
(c) 5%

Question 8

What are the features of Right v Left bowel cancer?

Answer 8

Right (caecum, ascending, transverse colon): anaemia, mass, less likely to obstruct
Left (descending, sigmoid colon, rectum): obstruction/change in bowel habit, bright red blood, tenesmus

Question 9

Which two genetic conditions are associated with colon cancer?

Answer 9

Familial adenomatous polyposis (FAP): thousands of polyps at young age
Human Non-Polyposis Colorectal Cancer (HNPCC): associated with FHx endometrial + breast cancer

Question 10

Is diverticular disease more common in the left or right bowel?

Answer 10

Left (greater pressure)

Question 11

What are the differentials for lower GI bleeding?

Answer 11

Haemorrhoids
Anal fissure
Carcinoma
Diverticular disease
Polyps
Infective colitis
IBD

Question 12

What are the risks/complications of colonoscopy?

Answer 12

Soreness around anus
Abdominal discomfort/bloating
Reaction to sedative
Bleeding (2%)
Perforation (1/1000)
Miss the diagnosis and need to repeat procedure

Question 13

What are haemorrhoids?

Answer 13

Vascular cushions covered in layer of mucosa, containing branch of superior rectal artery and tributary of superior rectal vein (definition is controversial)

Question 14

What are the common causes of paralytic ileus?

Answer 14

GI surgery
Peritonitis
Medications: opioids, antimuscarinics
Hypothyroidism
SCI above T5

Question 15

What factors are considered in the Alvarado score for appendicitis?

Answer 15

M - Migration to RLQ
A - Anorexia
N - Nausea / vomiting
T - Tenderness in RLQ (2)
R - Rebound tenderness
E - Elevated temperature elevated 37.3 or higher
L - Leukocytosis (2)
S - Shift left of leukocytes / neutrophilia

Question 16

When is CT enteroclysis performed?

Answer 16

To investigate mural disease in Chron’s disease, small bowel obstruction and unexplained GI bleeding