Colorectal

Question 1

Most common site of metastasis of Colon Cancer

Answer 1

Liver

Question 2

Symptoms of Colorectal cancer

Answer 2

Melena/Hematochezia
Alternating constipation and diarrhea
Pencil thin stools
Tenesmus
Loss of weight
Anemia Sx

Question 3

Causes of pyoderma gangrenosum

Answer 3

1. IBD
2. Haem malignancy
3. Granulomatosis with polyangiitis
4. IgA?

Question 4

What investigation after strep bovis endocarditis

Answer 4

Colonoscopy as it’s a/w colon cancer

Question 5

Modified and original Amsterdam criteria

Answer 5

3 2 1 rule

3 relatives with Colon(OG) or non colon(modified) Ca
2 successive generations
1 diagnosed before age 50

Question 6

Risk factors for anal SCC

Answer 6

1. HIV and HPV infection
2. Immunocompromise
3. Receptive anal intercourse
4. Smoking

Question 7

T staging of Colon and Rectal ancer

Answer 7

Tis: Carcinoma in situ, intramucosal
T1: Invades submucosa
T2: Invades muscularis propria
T3: Invades into pericolorectal tissues
T4a: Invades through parietal peritoneum
T4b: Invades or adheres to surrounding organs

Question 8

Type of IBD that causes lead pipe appearance

Answer 8

UC

Question 9

Hinchey classification

Answer 9

1a: pericolonic phlegmon
1b: abscess
2: retroperitoneal abscess
3: Purulent peritonitis
4: Feculent peritonitis

Question 10

Main features of Crohn’s disease

Answer 10

1. Transmural with skip lesions,cobblestone
2. Mouth to anus
3. Strictures, fistulation and malabsorption

Question 11

Type of IBD a/w rose thorn appearance and string of pearls(Sign of Cantor) on barium enema

Answer 11

Crohns
-deep linear ulcerations

Question 12

Dx of short gut syndrome

Answer 12

1. Malnutrition
2. <100cm

Question 13

diagnosis of Gardner’s syndrome

Answer 13

FAP + Extraintestinal manifestations

Question 14

Definition of high output stoma

Answer 14

> 1litre

Question 15

FAP vs attenuated FAP vs Gardners

Answer 15

Gardner’s : FAP + extraintestinal
FAP: CRC before 40yo
Attenuated FAP: CRC after 40yo

Question 16

What is Chilaiditi syndrome

Answer 16

Transposition of bowel between liver and diaphragm
- May mimic pneumoperitoneum

Question 17

Options for treatment for obstructed Colorectal Ca

Answer 17

3S
-stent
-stoma
-surgical excision

Question 18

Spigelman classification is for

Answer 18

Familial adenomatous polyposis

Question 19

What to look for in a DRE for rectal tumor

Answer 19

1. Location of tumor
2. Distance of tumor from anal verge
3. Mobility
4. Ability to get over tumor
5. Whether tumor can be cannulated
6. Anal tone for sphincter involvement

Question 20

Invx for newly diagnosed Rectal Ca

Answer 20

1. MRI Rectum
2. TransRectal US
3. CT AP

Question 21

Most common site of mets for low rectal tumor

Answer 21

Lung: Venous return in via inferior rectal artery which goes to IVC then lung

Question 22

Colorectal cancer T staging

Answer 22

Tis: Carcinoma in situ, intramucosal
T1: Invades submucosa
T2: Invades muscularis propria
T3: Invades through muscularis propria into subserosa/ pericolorectal tissues
T4a: Invasion through parietal peritoneum
T4b: Invasion/ Adherence to adjacent structures/organs

Question 23

Mx for anal fistula

Answer 23

1. Cutting seton placed
2. After fistula migrates to external sphincter, fistolotomy

Question 24

Mx for anal fistula

Answer 24

1. Cutting seton placed
2. After fistula migrates to external sphincter, fistolotomy

Question 25

Reason for spouting ileostomy

Answer 25

Contents are liquid, will swirl around and cause dermatitis

Question 26

Spot recognition of operation creating an end colostomy with midline laparotomy

Answer 26

Hartmann's procedure

Question 27

Spot recognition of operation creating an ileal conduit and an end colostomy

Answer 27

Pelvic exenteration

Question 28

Principles of treating enterocutaneous fistula

Answer 28

1. Sepsis 2. Nutrition 3. Rule out distal obstruction 4. Reduce fistula output( Loperamide, fybogel)

Question 29

What is a subtotal colectomy

Answer 29

Total colectomy sparing the sigmoid colon

Question 30

Classification systems for perianal fistulas

Answer 30

1. Park 2. Goodsall rule

Question 31

Key numbers for fecal calprotectin test

Answer 31

<100: IBD unlikely —> normal FC has a high negative predictive value 100-250: refer gastro >250: urgent referral to gastro

Question 32

Sites of biopsy for suspected IBD

Answer 32

Terminal ileum Ascending Colon Transverse Colon Descending Colon Rectum