Passmed Colorectal Surgery

Question 1

Which procedure is done for above the anal verge?

Answer 1

Abdomoinoperineal excision which is for tumours in the distal one third of rectum
OR
Within 5 cm from anal verge.

Question 2

Which resection is done for lower rectum?a

Answer 2

Anterior resection for tumours at least 8cm AWAY from anal verge

Question 3

What is first line treatment for haemorrhoids?

Answer 3

High fibre and fluid diet and topical emollient

Question 4

What is second line for haemorrhoid?

Answer 4

Rubber ligand

Question 5

How to differentiate from SBO and LBO?

Answer 5

LBO will have more constipation and distention and bowel habit changes

SBO will have more vomiting

Question 7

What is the most common cause of LBO?

Question 8

What causes left iliac fossa pain with a similar past history that responded to antibiotics?

Answer 8

Diverticulitis

-> management with co-amoxiclav if stable and IV antibiotics with signs of sepsis or inability to tolerate oral intake

Question 9

What is a strong risk factor for anal squamous carcinoma?

Answer 9

HPV type 16

Question 10

What is the presentation of anal cancer?

Answer 10

Perianal pain, bleeding and palpable mass

Question 11

What is the indication for surgical involvement in sigmoid Volvos?

Answer 11

repeated failed attempts at decompression
necrotic bowel noted at endoscopy
suspected (or proven) perforation or peritonitis

Question 12

What to do in volvulus for patients without bowel obstruction?

Answer 12

Flexible sigmoidoscopy

Question 13

What to do for sigmoid volvulus in patients with bowel obstruction?

Answer 13

Urgent laparotomy

Question 14

What is the anal verge?

Answer 14

Opening of anus

-> cancers here are managed with abdominperineal resection

Question 15

What procedure is reccomended for cancaers involving anal sphincter?

Answer 15

Abdominoperineal resection which is very low rectal tumour

Question 16

What procedure is performed to deduction the colon with high risk anastomosis?

Answer 16

Anterior resection, a loop ileostomy is performed because it is furthest away from the anastomosis

Question 17

What causes prudish oedematous perianal mass?

Answer 17

Haemorrhoids that have thromboses that cause anorectal pain and tender mass on examination

Question 18

What is a fleshy protuberance that is slightly [igmented and itches/bleeds?

Answer 18

Genital wart

Question 19

What is a ilonoidal sinus?

Answer 19

A pilonidal sinus typically presents with cycles of being asymptomatic and periods of pain and discharge from the sinus. It occurs as a result of hair debris creating sinuses in the skin. If they are close to the anus, they may cause anal pain.

Question 20

Which stoma is flush to the skin surface?

Answer 20

Colostomy

Question 21

Which stoma is made after panproctocolectomy?

Answer 21

End ileostomy iwith liquid or semi liquid output

Question 22

What does haustra on abdominal X ray indicate?

Answer 22

Large bowel obstruction

Question 23

What does valvular conniventes on abdominal X ray indicate?

Answer 23

Small bowel obstruction
-> valvular ceonniventes are mucosal folds of the small intestine

Question 24

How many openings do loop colostomies have?

Answer 24

Two openings
One for stool to pass through and one for mucus

Question 25

How many openings do end colostomy have?

Answer 25

Flush to the skin with one opening

Question 26

What is a proctoscopy?

Answer 26

Visualises anus and rectum

Question 27

What is second line for haemorrhoids?

Answer 27

Topical GTN must be ineffective for 8 weeks THEN consider referral for surgery to remove sphincter or use of botulinum toxin

Question 28

What procedure is done for volvulus?

Answer 28

Location of the volvulus, e.g a faecal volvulus will have a right hemicolectomy

Question 29

How is LBO obstruction managed?

Answer 29

Hartmann’s procedure with formation of temporary end colostomy LBO obstruction is associated with left sided cancer

Question 30

What does pericolic fat stranding on imaging indicate?

Answer 30

Diverticular disease

Question 31

what to do before colorectal referral?

Answer 31

Request FIT test

Question 32

How is a diverticulitis flare managed?

Answer 32

IV ceftriazone and metronidazole

Question 33

What causes sudden disproportionate abdominal pain with history of afib?

Answer 33

Acute Mesenteric ischaemia

Question 34

What do high pitched tinkling bowel sounds indicate?

Answer 34

Intestinal obstruction that is mechanical

Question 35

What is the investigation for haemorrhoid?

Answer 35

Sigmoidoscopy

Question 36

What causes obstructed defaecation and passing mucous and pelvic pain?

Answer 36

Rectal intussusception, demonstrated by defaecation pro to gram

Question 37

How is acute mesenteric ischaemia managed?

Answer 37

Caused by thrombi from afib so immediate laparotomy to excise non viable necrotic bowel for unstable patients

Question 38

What causes low grade fever and left lower quadrant pain in elderly patient?

Answer 38

Diverticulitis

Question 39

How are upper rectum tumours managed?

Answer 39

Anterior resection

Question 40

How are lower ectal tumours managed?

Answer 40

Abodmino[erineal resection

Question 41

What marker monitors for recurrence of colorectal cancer?

Answer 41

Carcinoembryonic antigen which is also useful for metastatic disease

Question 42

WHAT IS THE initial management of chronic anal fissure?

Answer 42

Pharmacological agents to relax sphincter to promote healing like: Topical GTN Topical diltiazem (CCB)

Question 43

When is an end colostomy indicated?

Answer 43

Indications of perforation like peritonitis, so perform Hartmann’s with end colostomy

Question 44

Which type of fistula is at risk with diverticular disease?

Answer 44

Colovesical fistula

Question 45

What is the best investigation for acute surgical patient with bowel obstruction?

Answer 45

CT abdominal and pelvis

Question 46

What should be avoided in anal fissure?

Answer 46

Topical steroids which provide temporary pain and inflammation relief but can lead to skin thinning

Question 47

What causes absolute constipation with abomdinal distention?

Answer 47

Paralytic ileum

Question 48

How can paralytic ileum be differentiated from mechanical obstruction?

Answer 48

Paralytic ileum will have a complete absence of bowel sounds Mechanical obstruction will have tinkling sounds

Question 49

How does solitary rectal ulcer present?

Answer 49

Chronic constipation and repeated straining leading to episodic bleeding and ulcer

Question 50

How should solitary rectal ulcer be managed?

Answer 50

Mandatory biopsy to exclude malignancy -> treatment ofc used at correcting underlying constipation

Question 51

What are the benefits of epidural analgesia?

Answer 51

Faster return of normal bowel function

Question 52

What causes painful rectal bleeding in young patients?

Answer 52

Fissure in and

Question 53

What causes severe pain in perianal region with spiking temperatures?

Answer 53

Perianal abscess

Question 54

What is the most appropriate stoma for anterior resection?

Answer 54

Loop ileostomy

Question 55

How are thromboses haemorrhoids managed?

Answer 55

If OVER 72 hours, then analgesia and stool softeners with ice packs

Question 56

When are thromboses haemorrhoids managed with surgery?

Answer 56

Presenting in first 73 hours of acute thrombosis

Question 57

What to do for active diverticular bleed?

Answer 57

Active observation

Question 58

What to do for Diverticular strictre in colon?

Answer 58

Laparotomy

Question 59

What causes post prandial pain with CVD risk factors?

Answer 59

Chronic mesenteric ischaemia

Question 60

How are patients with diverticulitis flares managed?

Answer 60

Oral antibiotics at home -> lack of improvement in 72 hours is an indication for IV ceftriazone and metronidazole

Question 61

What is the most common location of ischaemic colitis?

Answer 61

Splenic flexure and rectosigmoid region

Question 62

What are the features of a Rostock bag?

Answer 62

Spouted and contains urine

Question 63

How to differentiate haemorrhoid from fissure other than appearance?

Answer 63

Fissure will have fresh blood