Middle And Lower G.I. System

Question 0

Strangulated obstruction? Signs and symptoms? Eventually leads to? Surgery when?

Answer 0

Obstruction with compromised blood supply

Fever, leukocytosis, constant pain, eventually leading to peritonitis and sepsis

Emergency surgery

Question 1

Signs of mechanical intestinal obstruction? Management? Surgery when?

Answer 1

#Colicky abdominal pain
#Protracted vomiting
#No passage of gas or cc
#High-pitched bowel sounds early on, then no bowel sounds

NPO, and NG suction, IV fluids

If conservative management is unsuccessful – within 24 hours (if complete obstructions) or within a few days (partial obstruction)

Question 2

Mechanical obstruction caused by hernia – when surgery?

Answer 2

Emergently after proper rehydration if incarcerated

Electively if hernia can be manually reduced

Question 3

Carcinoid syndrome? Diagnosed with?

Answer 3

Diarrhea, Flushing, wheezing, right-sided valvular damage of heart (prominent jugular venous pulse)

24 hour urine collection for 5-HIAA

Question 4

Carcinoid syndrome – why 24 hour urine collection as opposed to blood test after attack?

Answer 4

Sample taken after attack will be normal

Question 5

Cancer of right colon versus left colon – presentation? Biopsy with? Treatment?

Answer 5

Anemia versus bloody bowel movements (Blood coating stool)

Colonoscopy with biopsy versus flexible proctosigmoidoscopy with biopsies

Right hemicolectomy versus left hemicolectomy or preop chemotherapy/radiation (If rectal)

Question 6

Descending order of probability for malignancy of polyps?

Nonmalignant polyps?

Answer 6

Familial polyposis (Gardner) >familial multiple inflammatory polyps >villous adenoma >adenomatous polyp

Juvenile, Peutz-Jegher, isolated inflammatory, hyperplastic

Question 7

Surgical indications for chronic UC?

Answer 7

#Longer than 20 years
#Interference with nutritional status
#Multiple hospitalizations
#Toxic megacolon
#High-dose steroids

Question 8

Most common cause of pseudomembranous enterocolitis? Treatment? Surgery when?

Answer 8

Cephalosporins

Metronidazole or vancomycin

Colectomy if Unresponsive to treatment, with white blood cell count over 50,000 and serum lactate over five

Question 9

Test in all anorectal disease?

Answer 9

Proctosigmoidoscopy to rule out cancer

Question 10

Internal versus external hemorrhoid management?

Which becomes painful and itchy if prolapsed?

Answer 10

Rubber band ligation versus conservative treatment/surgery

Internal hemorrhoids

Question 11

Anal fissure – demographic? Course? Complication? Typical location? Like we pathogenesis? Treatment?

Answer 11

Young woman; pain so intense that they avoid bowel movements and become constipated

Constipation; posterior in the midline

Tight sphincter; still softeners, topical nitroglycerin, Botox, sphincterotomy

Question 12

treatment for ischiorectal abscess? Complication if diabetic?

Answer 12

Incision and drainage

Necrotizing soft tissue infection

Question 13

Fistula in ano? Physical exam findings? Management?

Answer 13

Permanent track forms after ischiorectal abscess drainage

Cord-like tract

Fistulotomy

Question 14

Squamous cell carcinoma of the anus – demographic? Metastases to what nodes? Diagnosed with? Management? Surgery when?

Answer 14

HIV positive and homosexuals

Inguinal nodes

Diagnosis with biopsy

Nigro chemoradiation; surgery if residual tumor