General Surgery: Colon, Rectum, & Anus

Front 1

Is the anus involved in Ulcerative Colitits (UC)?

Back 1

No

Front 2

Are there skip lesions in UC?

Back 2

No, it’s continuous

Front 3

Which anatomic structure is always involved in UC?

Back 3

Rectum
*Usually does not involve the ileum

Front 4

Signs & symptoms of UC

Back 4

1) Bloody diarrhea (chronic)
2) Abdominal pain
3) Fever
4) Weight loss

Front 5

Microorganism causing infection that may mimic appendicitis

Back 5

Yersinia enterocolitica
*Causes acute ileitis, RLQ pain, and diarrhea

Front 6

Diagnostic test for UC

Back 6

Flexible sigmoidoscopy

Front 7

Backwash ileitis

Back 7

Seen in UC when there’s proximal colonic involvement and terminal ileum is affected by ulceration

Front 8

Medical treatment of UC

Back 8

1) Sulfasalazine (SE: affects sperm count and motility)
2) Mesalamine (Sulfa + 5-ASA)
3) Steroids
**If medical tx fails, total proctocolectomy must be performed

Front 9

Extraintestinal manifestations of inflammatory bowel disease

Back 9

1) Arthritis
2) Eye involvement (uveitis, iritis)
3) Apthous ulcers
4) Erythema nodosum
5) Pyoderma gangrenosum
6) Ankylosing spondyliitis / sacral ileitis
7) Primary sclerosing cholangitis (UC)

Front 10

Surgical indications for UC

Back 10

1) Hemorrhage
2) Toxic megacolon
3) Failed medical management
4) Cancer prophylaxis in long-standing disease

Front 11

Diverticuli

Back 11

Herniations of mucosa through the colon wall at sites where arterioles enter the muscular wall

Front 12

MC symtpom of Diverticulosis

Back 12

Hemorrhage
*Usually presents as bright red blood per rectum

Front 13

Diverticulitis

Back 13

Infection and inflammation of colonic serosa
*Results from small perforations in diverticulum with fecal contamination

Front 14

Symptoms of Diverticulitis

Back 14

1) LLQ pain
2) Abdominal pain
3) Fever
4) Chills
5) Alterations in bowel habits
*Usually not associated with bleeding

Front 15

MCC of bowel obstruction in pregnancy

Back 15

Sigmoid volvulus

Front 16

Plain radiographs of abdomen with volvulus

Back 16

Shows U-shaped loop in lower abdomen

Front 17

Often both diagnostic and therapeutic for sigmoid volvulus

Back 17

Sigmoidoscopy

Front 18

Why is sigmoid resection done following volvulus reduction and bowel compression?

Back 18

There is a 40% rate of recurrence without operative intervention

Front 19

Which is the MC site of colonic rupture?

Back 19

Cecum

Front 20

Branches of the superior mesenteric artery

Back 20

1) Ileocolic
2) Right colic
3) Middle colic

*Supplies colon from cecum to splenic flexure

Front 21

Branches of inferior mesenteric artery

Back 21

1) Left colic
2) Sigmoidal
3) Superior rectal

*Supplies descending and sigmoid colon and upper rectum

Front 22

Provides collateral blood flow between superior and inferior mesenteric arteries

Back 22

Arc of Riolan

Front 23

Dentate line

Back 23

Squamocolumnar junction between the rectum and the anus
Surrounded by muscular sphincter

Front 24

Innervation of external anal sphincter

Back 24

Inferior rectal branch of pudendal nerve
Perineal branch of 4th sacral nerve

Front 25

True or False: Adenomatous polyps of the colon have no significant malignant potential.

Back 25

False; they have significant malignant potential

Front 26

Overall incidence of carcinoma in Tubular adenomas

Back 26

15%

*Increasing size results in increased incidence of cancer

Front 27

Do Villous adenomas have more or less propensity for malignant change compared to tubular adenomas?

Back 27

More; they are generally larger

Front 28

The degree of malignant potential in Tubulovillous adenomas is directly related to...

Back 28

The percentage of the villous component

Front 29

Benign lesions of the colon & rectum

Back 29

1) Hyperplastic polyps
2) Inflammatory polyps
3) Juvenile polyps or hamartomatous polyps

Front 30

Peutz-Jeghers Syndrome

Back 30

Autosomal dominant syndrome
Multiple hamartomatous polyps
Melanin deposits in buccal mucosa, palms and feet

Front 31

Treatment of adenomatous polyps

Back 31

Colonoscopic resection with pathologic examination for foci of carcinoma

*F/u colonoscopy in 3 - 5 years for complete resection

Front 32

Genetic risk factors associated with adenocarcinoma of the colon

Back 32

1) Nonpolyposis inherited colon cancer (Lynch Syndrome)
2) Familial adenomatous polyposis syndromes (FAPs)
3) Many familial colon cancers

Front 33

Characteristics of Lynch Syndrome

Back 33

1) Right-sided colon cancer in young patients w/o multiple polyps
2) Autosomal dominant
3) Chromosome 18

*Type I: Colon cancer only
*Type II: Several cancers

Front 34

Characteristics of FAPs

Back 34

1) Multiple colonic polyps by age 30
2) Autosomal dominant
3) Chromosome 5 (q21): APC gene

Front 35

Phenotypic subtypes of FAPs

Back 35

1) Familial polyposis coli
2) Gardner's syndrome (epidermal inclusion cysts, colonic polyps, osteomas)
3) Turcot syndrome (colonic polyps and brain tumors)

Front 36

Protective factors against adenocarcinoma of the colon

Back 36

1) High fiber diet
2) Aspirin
3) Selenium
4) Thioesters
5) Carotenoids

Front 37

The colon can be inspected by:

Back 37

Digital rectal exam - distal 8 cm
Flexible sigmoidoscopy - distal 60 cm
Proctosigmoidoscopy - distal 20-25 cm (done in office)
Colonoscopy - entire colon and distal ileum

Front 38

Resection approaches after surgical treatment of colon cancer

Back 38

1) Resection with primary anastomosis
2) Resection with creation of colostomy

**Reanastomosis of bowel after colostomy at or after 6 weeks

Front 39

Current chemotherapeutic agents for colon adenocarcinoma

Back 39

1) 5-Fluorouracil
2) Levamisole

Front 40

Indications for chemotherapy for colon adenocarcinoma

Back 40

Stage III colon cancer

Front 41

True or False: Radiation therapy is important in the treatment of colonic adenocarcinoma

Back 41

False; it is generally not used

Front 42

Abdominoperineal resection

Back 42

Used for lower rectal lesions

*Anal canal below level of sphincter is excised along with the rectum with formation of sigmoid colostomy

Front 43

True or False: Radiation therapy is important in the treatment of rectal tumors

Back 43

True;
Preoperatively: reduce tumor mass
Postoperatively: decrease rate of recurrence

Front 44

Presentation of SCC of the anus

Back 44

1) Pruritus
2) Bleeding
3) Palpable mass

Front 45

Cecal volvulus may present with symptoms of what intestinal disorder?

Back 45

Small bowel obstruction

**Accounts for less than 20% of colonic volvulus

Front 46

Plain radiographs of cecal volvulus

Back 46

Kidney bean-shaped, air-filled cecum located in LUQ

Front 47

Treatment of choice to avoid recurrence of cecal volvulus

Back 47

Right hemicolectomy

**Operative detorsion with cecopexy associated with recurrence

Front 48

Anal fissure

Back 48

Split in the anoderm
Either anterior or posterior (90%) midline

Front 49

Recurrent or lateral anal fissures raise suspicion of what disease?

Back 49

Crohn's disease

Front 50

Symptoms associated with fissures

Back 50

1) Painful defecation
2) Bleeding from rectum

*Pain in fissure causes internal sphincter spasm and further tearing

Front 51

Treatment of anal fissures

Back 51

90% heal with stool softners, laxatives, and warm sitz baths

*Surgical repair may include sphincterotomy

Front 52

Signs & Symptoms of anorectal abscess

Back 52

1) Severe anal pain
2) Fever
3) Urinary retention
4) (Occasionally) Sepsis
5) Palpable mass on DRE

Front 53

MCC of anal fistula

Back 53

Spontaneous drainage of anorectal abscess

Front 54

Goodsall's Rule

Back 54

Fistulae with external opening posterior to bisecting line have internal openings in the midline.
Those anterior to the line have internal openings connecting via a straight line.

Front 55

Pilonidal Disease

Back 55

Sinus or abscess formation in the skin over the sacrococcygeal junction
May be 2ndary to hairs driven into the skin
Acute infection: pain and swelling
Treated with I&D

Front 56

Internal hemorrhoids

Back 56

Found above the dentate line, covered by mucosa
Rarely cause pain
Painless bleeding and prolapse

Front 57

External hemorrhoids

Back 57

Distal to dentate line, covered by sensate squamous epithelium
Perianal pain, itching, and swelling

Front 58

Treatment of hemorrhoids

Back 58

1) Fiber diet, stool softeners, no straining
2) Rubber-band ligation (insensate internal hemorrhoids)
3) Sclerosis and cryosurgery
4) Excisional hemorrhoidectomy (symptomatic external hemorrhoids)

Front 59

Rectal prolapse

Back 59

Complete intussusception of the rectum through the anus

**Involves all layers of the rectum

Front 60

Treatment of rectal prolapse

Back 60

Rectopexy (fixation of the rectum)

Front 61

Crypt abscesses: Crohn's or UC?

Back 61

UC