Rectum

Perioperative steroid management in IBD

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Q) All are true  regarding perioperative management Of IBD on steroid except

a) Minor procedure needs only routine steroidal dose supplementation
b) Major procedures  needs Hydrocort 100-150 mg tds
3.Chronic steroid use causing adrenal failure that  presents with hypotension, vomiting, fever, lethargy
4.All cases of UC need supraphysiological dose of steroid.

Pouchitis Disease severity index

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Q) Pouchitis disease activity index includes all except (AIIMS 2019)

a)  Fever
b)  Malaise
c)  Fecal urgency
d)  Bleeding PR

Pouchitis is commonly asked in AIIMS and JIPMER MCH exams. Previous year questions are here and here 

Ans b ) Malaise, Clinical data includes Frequency, urgency and rectal bleed

Summary of the PAS

Range
I. Clinical
 1. Stool frequency (0, 2, 4, 6)
 2. Fecal urgency (0, 3)
 3. Rectal bleeding (0, 3)
Maximal clinical subscore: 12
II. Endoscopic findings
 1. Oedema (0, 1)
 2. Granularity (0, 1)
 3. Friability (0, 1, 2)
 4. Erythema (0, 2, 3)
 5. Mucosal flattening (0, 2)
 6. Ulcerations/erosions (0, 2, 3)
Maximal endoscopic subscore: 12
III. Histological Acute inflammation
 1. Polymorphonuclear infiltration (0, 1, 2, 3)
 2. Ulcerations/erosions (0, 1, 2, 3)
Chronic inflammation
 1. Mononuclear infiltration (0, 1, 2, 3)
 2. Villous atrophy (0, 1, 2, 3)
Maximal (total) histological subscore: 12
Maximal total PAS: 36

 

ELAPE (Extra Levator Abdomino perineal Excision)

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Q) What is not true about  extra levator Abdomino Perineal Resection (APE) (AIIMS 2019) 

a) Anal canal dissected from levator

b) Patient  in prone jack knife position

c) Specimen is resected en block with sacrum

d) Entire levator is resected along with mesorectum

FAP

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Q) False regarding FAP

a) Mean age of development of cancer is 40

b)50% population develop gastric polyp and duodenal adenoma

c) 2nd most common cause of death is desmoid

d) 

AIIMS November MCQs

Cancer lower rectum

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Q) False statement about management of cancer rectum

a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement 

b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment.

c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop

d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake

Pouchitis after IPAA in ulcerative colitis

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NEET SS - Pouchitis Question

Free Question: NEET SS Surgery

Q: Which of the following is NOT a risk factor for pouchitis post-IPAA in ulcerative colitis?

Explanation Ans A :
Pouchitis is a common complication of Ileal Pouch Anal Anastomosis (IPAA) for Ulcerative Colitis, with an incidence up to 50%.

✅ Smoking is protective against pouchitis.

Risk factors include: - Extra-intestinal manifestations (e.g. arthritis) - ANCA positivity - NOD2insC mutation - NSAIDs and PPI use post-op - Extent of colitis and thrombocytosis

🔗 Ref: Wiley Journal Article

lymphatics of colon

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Q ) Which of the following group of lymph nodes  lymphatics of the colon first drain to?

a) Paracolic

b) Epicolic

c) Nodes along SMA/IMA

d) Para aortic

Ans ) b

Lymphatics first drain to epicolic group along the bowel wall

Then it goes to  paracolic group along the marginal artery

Intermediate group along the named vessels SMA/IMA

Finally to para aortic 

Colon and upper 2/5 of rectum --- Para aortic

Lower 1/5 of rectum and anal canal - Superficial inguinal lymph nodes

Ref Sabiston-1317

Technique of CME

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Q) All are true regarding complete mesorectal excision except

a) Introduced by Hobeninger

b) It is based on ligation of central artery

c) Increases yield of lymph nodes and has decreased recurrence

d) Line of resection is below Toldt's fasica