Colon And Small Bowel Surgery

Front 1

a. What are the signs of a small bowel obstruction?

Back 1

i. Diffuse abdominal pain
ii. Distension
iii. N/V
iv. Feculent emesis
v. High pitched bowel sounds

Front 2

b. What is the most common cause of SBO in a patient with a history of surgeries?

Back 2

i. Adhesions

Front 3

c. What is the most common cause of SBO in a patient with no history of surgeries?

Back 3

i. Hernia

Front 4

d. What is the most common cause of colon obstruction in a patient with no history of surgeries?

Back 4

i. Mass

Front 5

e. How do you dx an SBO?

Back 5

i. Hx
ii. Flat and upright abdominal x-ray→ SB distension with air fluid levels
iii. CT with oral contrast→ Lack of air in colon and rectum
iv. CBC, CMP, lactate

Front 6

f. What should you look for in a CMP and CBC in a suspected SBO?

Back 6

i. CMP→ increased ALP
ii. CBC→ High WBCs can indicate ischemia

Front 7

g. How do you manage an SBO?

Back 7

i. NPO
ii. NG tube
iii. IV fluids
iv. Pain control

Front 8

h. When should you go to the OR for an SBO?

Back 8

i. Fevers
ii. Increased WBC
iii. Peritoneal signs, increasing pain
iv. Increasing lactate
v. Signs of perforation/strangulation/ischemia
vi. Failure to progress in 48 hours
vii. Sepsis

Front 9

a. What is the key gene mutation in the genesis of CRC?

Back 9

i. APC mutation

Front 10

b. How often should you do an FOBT to screen for CRC?

Back 10

i. Every year

Front 11

c. How often should you do a flex sig to screen for CRC?

Back 11

i. Every 5 years

Front 12

d. How often should you do a flex sig+FOBT?

Back 12

i. Every 5 years

Front 13

e. How often should you do a DCBE to screen for CRC?

Back 13

i. Every 5-10 years

Front 14

f. When should everybody get a colonoscopy?

Back 14

i. 50 y/o

Front 15

g. What is the characteristic appearance of colon cancer on a barium enema?

Back 15

i. Apple-core lesion

Front 16

h. What are the pros of a barium enema?

Back 16

i. Examines entire colon
ii. Relatively low cost

Front 17

i. What are the cons of a barium enema?

Back 17

i. Never studied as a screening test
ii. Interval between exams unknown

Front 18

j. What are the pros of a colonoscopy?

Back 18

i. Examines entire colon
ii. Removal of polyps in the exam
iii. Well-tolerated with sedation

Front 19

k. What are the cons of a colonoscopy?

Back 19

i. Expensive
ii. Risk of perforation in sigmoid
iii. Requires high level of training

Front 20

a. What is the most common site of metastasis from CRC?

Back 20

i. Liver

Front 21

b. How can you treat CRC mets in the liver?

Back 21

i. Partial hepatectomies
ii. Radio frequency ablation

Front 22

c. When should a polyp be removed?

Back 22

i. Don’t need to resect if no inflammation in the stalk

Front 23

d. What are adequate margins for a colonoscopic polypectomy?

Back 23

i. Greater than 2mm

Front 24

e. How many lymph nodes need to be resected for proper staging?

Back 24

i. At least 12

Front 25

e. How many lymph nodes need to be resected for proper staging?

Back 25

i. At least 12

Front 26

f. What margins do you need for a colonic tumor excision?

Back 26

i. At least 5 cm

Front 27

g. What is a proper TME?

Back 27

i. Removing all extracolonic lymph nodes basins without “coning in” on specimen

Front 28

h. What is stage 0?

Back 28

i. Local surgery
ii. Removal of polyps or large tumors

Front 29

i. What is stage 1?

Back 29

i. Surgery followed by observation

Front 30

j. What is stage 2?

Back 30

i. Surgery followed by chemo or observation

Front 31

k. What is stage 3?

Back 31

i. Surgery followed by chemo

Front 32

l. What is stage 4?

Back 32

i. Surgery
ii. Chemo
iii. Radiation
iv. Targeted therapy

Front 33

a. What portion of the colon is most often affected by diverticula?

Back 33

i. Sigmoid

Front 34

b. Where is the most common site of diverticular bleeding?

Back 34

i. Right side

Front 35

c. What is Hinchey stage 1?

Back 35

i. Localized pericolic abscess

Front 36

d. What is Hinchey stage 2?

Back 36

i. Large mesenteric abscess

Front 37

e. What is Hinchey stage 3?

Back 37

i. Free perforation

Front 38

f. What is Hinchey stage 4?

Back 38

i. Free perforation causing fecal peritonitis

Front 39

g. What is conservative management of diverticulitis?

Back 39

i. NPO/bowel rest
ii. IV fluids
iii. Antibiotics
iv. Pain management
v. CT/US

Front 40

h. When is surgery required for diverticulitis?

Back 40

i. Severe complicated diverticulitis
ii. Abscess formation Hinchey 3 or 4
iii. Severe sepsis
iv. Diffuse peritoneal signs
v. Failed conservative management

Front 41

i. What is a Hartman procedure?

Back 41

i. Take out sigmoid at level of diverticulum
ii. Divert
iii. Ostomy

Front 42

j. What should you not perform in an acute diverticulitis?

Back 42

i. Primary anastomosis

Front 43

k. What is a primary complication of diverticulitis?

Back 43

i. Fistula formation

Front 44

l. What are the most common fistulae in diverticula?

Back 44

i. Men→ colovesicular
ii. Women→ colovaginal

Front 45

a. What is a predisposition for volvulus?

Back 45

i. Narrow-based mesentery

Front 46

b. What is the most common site for volvulus?

Back 46

i. Sigmoid

Front 47

c. What are the sx of volvulus?

Back 47

i. Abdominal distension
ii. Severe pain and tenderness
iii. Bean-shaped loop of large bowel in pelvis

Front 48

d. How do you manage volvulus?

Back 48

i. IV fluids
ii. Sigmoidoscopy
iii. Flatus tube

Front 49

e. What are your options if decompression fails or if peritonitis appears in tx of volvulus?

Back 49

i. Sigmoid colectomy and primary anastomosis
ii. Hartman’s procedure

Front 50

a. What are the symptoms of cecal volvulus?

Back 50

i. Colicky abdominal pain
ii. Vomiting
iii. Comma-shaped section

Front 51

b. How do you manage cecal volvulus?

Back 51

i. Colonoscopic decompression
ii. Laparotomy normally required
iii. Ischemia→ right hemicolectomy