SCORE

Question 1

Immunocompromised from kidney transplant. Has diverticulitis and gets better on IV abx. What to do next?

Dc home?
Scope?
Surgery? When?

Answer 1

Needs surgery this admission.

Question 2

Pt with 12yr h/o UC. Colonoscopy demonstrates moderately inflamed mucosa with scattered ulcers and friability. The disease activity extends from the rectum to the mid-descending colon. Biopsies show features consistent with active ulcerative colitis, but multiple biopsies also demonstrate atypia and mild dysplasia.

What to do next?

Answer 2

Medical therapy and rpt colonoscopy when the disease is in remission.

Reactive atypia often occurs in the presence of active inflammation from ulcerative colitis. The histologic distinctions between reactive atypia and dysplasia are subtle and often difficult to discern pathologically. Reactive atypia resolves with remission of the acute inflammation and is not associated with an increased risk for cancer. Dysplasia, on the other hand, is associated with an increased risk for colorectal cancers in patients suffering from ulcerative colitis and can be an indication for surgical removal of the colon and rectum. To be confident of the diagnosis, repeat biopsy should be performed after resolution of acute inflammation. Operation would be indicated if the patient fails to respond to medical therapy, or if high-grade dysplasia is seen on the repeat colonoscopy with biopsy. Currently, no difference is noted between hand-sewn and stapled anastomoses.

Question 3

Anal fissure midline vs lateral? What’s the difference

Answer 3

Run of the mill fissure should be in the midline.

Lateral fissures should be biopsied