Lower Abdomen

Question 1

Right hemicolectomy indications for carcinoid appy

Answer 1

The operative treatment of appendiceal carcinoid tumors includes completion hemicolectomy for all tumors >2 cm and for tumors between 1 and 2 cm in the presence of:

Mesoappendiceal invasion

Positive or unclear margins

Higher grade

Angioinvasion

Mixed histology (goblet cell carcinoid, adenocarcinoid)

Question 2

Hemicolectomy recs for appy

adeno

mucinous

carcinoid

Answer 2

all adenos except T1

Question 3

For all females with abdominal pain check this

Answer 3

bHCG

Question 4

When to use a hot snare for polyp

Answer 4

1cm

Question 5

What genetic stuff should you look for in GIST results

Answer 5

exon 9 - need sunitinib

Question 6

full GIST workup

Answer 6

endo u/s with FNA
CT CAP

Question 7

1cm adeno ca of appendix comes back…. what next

Answer 7

colonoscopy, CT CAP

Question 8

2 techs for passing scope if difficult to pass

What to do if cant pass at all

Answer 8

reduce loops
abdominal pressure
Stiffen scope and turn flexures

CT colonoscopy

Question 9

colonoscopy follow up criteria for:

1-2 tub adenos <1cm
>10 adenomas
Piecemeal
>10mm adenoma
High grade dyplasia

Answer 9

7-10
1y
6m
3y
3y

Question 10

what is the colonoscopy prep to describe

Answer 10

Split dose poly ethyleneglycol solution in evening and morning

Question 11

high risk gist features

Answer 11

> 10 cm
10 mitotic index(per 50 HPFs)

Question 12

3 s/s of gastric cancer

Answer 12

anemia/melena
Early satiety
weight loss

Question 13

Siewart 2 class and treatment

Answer 13

1cm above GEJ and 2cm below

total gastrectomy

Question 14

Staging for gastric ca

Answer 14

CT CAP
PET
EUS

Question 15

s/s indicative of IBD

Answer 15

bloody bms, frequent stools, pain, incontinence

Question 16

when assess for ibd initially you need to rule out what

Answer 16

c diff, cancer, infection

Question 17

ibd ddg

Answer 17

celiac
colitis
panc insuff
crohns
uc

Question 18

definition of fulminant colitis

Answer 18

10 BM per day in hospital with no pain relief and rising wbc, peritonitis

Question 19

Go to op for fulminant uc

Answer 19

total with end ileostomy

hartman pouch remains

Question 20

Going to OR for UC emergently, what other preop stuff should be done

Answer 20

iv access
ivf
Abx
tap blocks

Question 21

2nd op for UC

Answer 21

Jpouch after completion proctectomy

Question 22

medical crohns management

Answer 22

Question 23

medical uc managment

Answer 23

Question 24

ibd big gun med

Answer 24

infliximab

Question 25

Stage 1 colon ca cutoff

Answer 25

musculature

Question 26

stage 3 colon cancer begins with ….

Answer 26

nodes

Question 27

Risk strat for stage 2 colon cancer

why does this matter

Answer 27

dMMR or MSI - High w/…

Question 28

polyposis genes tested for

Answer 28

APC
MLH1
PTEN
STK11

Question 29

first abx step for c diff

Answer 29

oral vanc

Question 30

Emergent surgery for c diff

Answer 30

Subtotal colectomy with ileostomy

Question 31

when should a loop ileostomy be performed for LAR for rectal ca?

Answer 31

preadjuvant radiation

Question 32

conservative stuff for fissure

meds?

Answer 32

miralax, sitz bath, avoid caffeine

lidocaine ointment
Diltiazem

Question 33

second tier for fissure treatment

Answer 33

botox injection

Question 34

final tier for fissure treatment? Risk factors?

Answer 34

lateral sphincterotomy ; incontinence

Question 35

what anatomic position of anal fissure is expected? what if its not?

Answer 35

midline; crohns

Question 36

fissure surgery if incontinent

Answer 36

anal advancement flap

Question 37

why would someone prefer mastectomy for DCIS

Answer 37

no rads
lower recurrence

Question 38

Post op stuff for DCIS

Answer 38

receptor treatment
mammogram
re-excision if needed