Small Bowel/Colon

Question 1

Describe Crohn’s disease (location, depth)

Answer 1

Location: small bowel/distal ileum (80%), limited to colon (20%), rectum sparing (50%), perianal (33%), mouth/gastroduodenal predominance (5-15%)

Depth: transmural infllmation of GI tract

Question 2

List extra-intestinal manifestations of Crohn’s disease (9)

Answer 2

Extra-intestinal manifestations: arthritis, arthropathy, anterior uveitis, B12 deficiency, venous/arterial thromboembolism, secondary amyloidosis, calcium oxalate/uric acid kidney stones.

Question 3

Short bowel syndrome (SBS): symptoms? indication for surgery? surgical procedures?

Answer 3

symptoms: diarrhea, bloating, weight loss (loss of absorption and bacterial overgrowth)

Indications for surgery: plateau in advancement of enteral nutrition and medical intervention failed

Surgical procedures:
LILT/Bianchi procedure vs. STEP

Question 4

What is the LILT or Bianchi procedure for short bowel syndrome?
Are there any requirements?

Answer 4

Longitudinal intestinal lengthening and tapering (LILT; aka. Bianchi procedure) involves longitudinal division of the bowel along a midline intervascular plane (found by separating mesenteric blood vessels into two leaves when entering onto the bowel wall)

Requires small bowel diameter 4 to 5cm [evaluate via CT scan]

Question 5

What is the STEP for short bowel syndrome?

Are there any requirements?

Answer 5

A Serial Transverse Enteroplasty Procedure (STEP) is when a GIA stapler is used to partially divide a segment of dilated small bowel, the GIA stapler is applied perpendicular to the long axis of the bowel with 2 cm left uncut

Requires small bowel diameter 4 to 5cm [evaluate via CT scan]

Question 6

Colon polyp that comes back as adenocarcinoma on colonoscopy, Per NCCN, what are the requirements to proceed with observation with periodic colonoscopy instead of resection?

Answer 6

Must have all 3

1) single specimen with invasive disease
2) completely resected with favorable histology (Grade I or II and NO evidence of angiolymphatic invasion)
3) clear margins (at least 2mm)

Question 7

What is the criteria for genetic testing for CDH1 in hereditary diffuse gastric cancer (HDGC)?

Answer 7

Any of the following:
1) Two gastric cancer cases in a family, one confirmed DGC < 50 y/o
2) Three confirmed cases of DGC in first or 2nd degree relatives regardless of age
3) DGC diagnosed < 40 with family history
Personal or family history of DGC AND lobular breast cancer diagnosed <50 y/o

Question 8

Patient with FAP… had total abdominal colectomy with ileorectal anastamosis…. what is appropriate postop surveillance?

Answer 8

Yearly endoscopic surveillance (colonoscopy) with EGD from 1 to 4 years (depending on if any polyps found)

Question 9

What pre-operative studies are required prior to surgical intervention for pelvic organ prolapse in a patient with concern for a cystocele and rectocele?

Answer 9

colonoscopy and defecography

Question 10

What is the neural control of the external anal sphincter?

Answer 10

Voluntary control VIA
1 ) Inferior rectal branches of the internal pudendal nerve
2) Perineal branches of the fourth sacral nerve

Question 11

At what age do you start EGD screening for FAP patients?

Answer 11

20 to 25 y/o OR when colonic polyps first appear