Colorectal

Question 1

What are 2 life threatening acute conditions associated with Ulcerative Colitis

Answer 1

Toxic Megacolon
Colonic Perforation

Question 2

In which direction does inflammation spread in Ulcerative Colitis

Answer 2

From the rectum proximally

Question 3

What part of the bowel is affected in Ulcerative Colitis

Answer 3

Predominantly the large bowel but you can develop backwash ileitis

Question 4

What histological findings do you find in Ulcerative Colitis

Answer 4

Crypt abscesses
Goblet Hypoplasia
Non granulomatous inflammation
Pseudopolyps (develop after repeated ulceration and healing)

Question 5

What is the most common clinical manifestation of Ulcerative Colitis

Answer 5

Proctitis (inflammation confined to the rectum)

Question 6

What are the symptoms of proctitis

Answer 6

Rectal bleeding
Mucus Discharge
Tenesmus
Increased frequency and urgency

Question 7

What is the grading system for Ulcerative Colitis and what are the parameters

Answer 7

Truelove and Witt
Frequency of stool
Blood in stool
Pyrexia
Anaemia
Pulse >90
ESR >30

Question 8

What are the extra-intestinal symptoms of Ulcerative Colitis

Answer 8

MSK - enteropathic arthritis, osteoporosis, clubbing
Eyes - uveitis, scleritis
Skin - erythema nodusum
Hepatobiliiary - Primary Sclerosing Cholangitis

Question 9

What are the causes of appendicitis

Answer 9

Faecolith obstruction
Lymphoid hyperplasia
Malignancy - appendiceal neuroendocrine or caecal adenocarcinoma

Question 10

How do you identify McBurneys point

Answer 10

2/3 along the way from the umbilicus and the ASIS

Question 11

What clinical signs can you elicit for appendicitis

Answer 11

Rebound tenderness at McBurneys point
Rovising sign - RIF tenderness on palpation of LIF
Psoas sign - RIF tenderness on extension of the hip (suggestive of retrocaecal appendix position)

Question 12

How should a phelgmon be managed?

Answer 12

Initial course of antibiotics and an interval lap appendectomy at a later date once the inflammation has settled

Question 13

How do you classify acute vs chronic fissure in ano

Answer 13

Acute <6 weeks
Chronic >6 weeks

Question 14

What are the main risk factors for fissures in ano

Answer 14

Chronic diarrhoea
Constipation
IBD
Dehydration

Question 15

In what position do most anal fissures present?

Answer 15

90% present on the posterior midline

Question 16

What features of fissures suggest a systemic underlying cause?

Answer 16

Position in the anterior position
Multiple fissures

Question 17

What medical management can you consider for fissures?

Answer 17

Laxatives
Lidocaine topical
Rectal diltiazem or rectal GTN

Question 18

When do you consider surgical management for fissures? and what are the two main surgical options?

Answer 18

8 weeks post conservative management failure

Botox injection or a lateral sphicterectomy - to allow the sphincter to relax and allow fissure healing

Question 19

What is the disease process in the formation of an anorectal abscess

Answer 19

Plugging of the anal ducts - which normally drain the anal glands which secrete mucus to aid the passage of stool