I can handle Sx, Dx, Tx and that's about it.

Question 1

Hemorrhoids.

Answer 1

• BRBPR or ASx
• PE+DRE+scope (all 3!)
• Ext: hydrocortisone supp/cream
• Int: sclerotherapy –> rubber band lig –> hemorrhoidectomy
• Ext strangulated: wide excision & evacuation

Question 2

Anal fissures.

Answer 2

• Anal pain at rest/bleeding.
• HxPE.
• Sitz bath/stool soft+lax –> surg (advancement flap)

Question 3

Anal abscesses.

Answer 3

• Constant pain not associated with BM; pus; fever
• Depends on location (U/S or CT int; DRE/PE ext)
• Drain it or else could get sepsis! Also Cipro+Flagyl or Augmentin.

Question 4

Anal fistula.

Answer 4

• Intermittent pain worse with BM; smelly drainage; visible/palpable inflam/cord
• HxPE unless complex, then image.
• Fistulotomy or advancement flap in OR.

Question 5

Pilonidal disease.

Answer 5

• ASx, or pain on sitting/infection signs/possible fever
• HxPE
• I & D packed with gauze

Question 6

Hernias.

Answer 6

• R heaviness/fullness esp at night; bulge
• HxPE
• If Sx onset within 6hr it’s a surg emerg!; (ideally lap) mesh repair >2cm

Question 7

Colonic polyps.

Answer 7

• ASx, or BRBPR/bowel habit change
• COLONOSCOPY +/- Bx.
• f/u scope.

Question 8

HNPCC (Lynch Syndrome).

Answer 8

• R colonic polyps +/- extracolonic malignancies
• Colonoscopy and FamHx
• Colectomy and f/u scopes qyr

Question 9

FAP.

Answer 9

• > 100 adenomatous polyps ~16yo; fundus gland polyps; extracolonic CA; colon CA.
• FamHx, flex sig, colonoscopy, genetic test.
• Colectomy + f/u scopes biyr-qyr

Question 10

Familial Juvenile Polyposis.

Answer 10

• ASx, or painless bleed/rectal prolapse/failure to thrive
• FamHx + genetic test + colonoscopy
• Monitor.

Question 11

Peutz-Jeghers Syndrome.

Answer 11

• Dark skin discolorations; breast/balls CA
• FamHx + genetic test + colonoscopy
• Monitor with double-scope (EGD/Colon) + PE

Question 12

CRCa.

Answer 12

• Hematochezia, bowel changes (if L, most are)
• Screen everyone >50yo (45yo AA) with colonoscopy q10yr.
• Dx COLONOSCOPY.
• SURG, + chemo if stage III-IV.

Question 13

Metastatic CRCa.

Answer 13

• Wt loss + Ascites + Cachexia!
• PET/CT mets to peritoneum, liver, lung, lymph node (dissect 12+ LN)
• SURG + chemo/rad, +/- monoclonal antibody

Question 14

Anal CA.

Answer 14

• Rectal bleeding + condylomata + DRE mass
• Anoscopy + Rigid proctosig + Endoscopy with Bx
• Surg; palliative only if IV

Question 15

UC.

Answer 15

• bloody diarrhea + rectal bleeding + LLQ pain, +/- extracolonic stuff
• Scope with Bx: diffuse, mucosal, colorectal, friable.
• 5-ASA –> Budesonide (or prednisone) –> hospitalize and IV steroids –> monoclonal antibodies –> cyclosporine –> colectomy.

Question 16

Crohn’s.

Answer 16

• Intermittent lo-fever + watery diarrhea + RLQ pain + perianal stuff
• FamHx + Scope with Bx: FATASS (Fistulas, Abscesses, Transmural, Adhesions, Sinus tracts, Strictures)
• 5-ASA and supportive (loperamide, BAS) –> short-course Budesonide –> MTX or azathioprine –> TNF-a blockers –> anti-integrin (Vedolizumab)

Question 17

Celiac.

Answer 17

• Nutritional deficiencies –> hormonal/neuro/MSK Sx
• IgA; Duodenal Endoscopy + Bx (no villi, hypertrophic crypts)!
• Gluten-free diet.