Rectum

Radiation proctitis

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Q) In radiation proctitis surgery is needed in all except 

a) Pain Abdomen

b) Rectal stricture

c) Haemorrhage

d) Vesical Fistula

Free Question on management of raiation proctiitis 

Ans a, 

In radiation proctitis, surgery is typically indicated for complications that are severe or unmanageable through conservative measures. The options can be considered as follows:

  • A) Pain Abdomen: While abdominal pain can be a symptom associated with radiation proctitis, it is not an indication for surgery on its own. Pain management and other conservative treatments can be employed first.
  • B) Rectal stricture: This can cause significant obstruction and may require surgical intervention to restore normal bowel function.
  • C) Haemorrhage: Severe bleeding due to radiation proctitis may necessitate surgical intervention if it is not controlled by endoscopic or conservative measures.
  • D) Vesical Fistula: The formation of a fistula between the bladder and rectum (vesical fistula) is a serious complication that often requires surgical repair.

Acute Radiation proctitis - Occurs within 6 mths of starting the treatment

Chronic - After 6 mths, Most patients develop symptoms at a median of 8 to 12 months after completion of radiotherapy

Modified Radiation Therapy Oncology Group rectal toxicity scale

Grade 1 Mild and self-limiting Minimal, infrequent bleeding or clear mucus discharge, rectal discomfort not requiring analgesics, loose stools not requiring medications
Grade 2 Managed conservatively, lifestyle (performance status) not affected Intermittent rectal bleeding not requiring regular use of pads, erythema of rectal lining on proctoscopy, diarrhea requiring medications
Grade 3 Severe, alters patient lifestyle Rectal bleeding requiring regular use of pads and minor surgical intervention, rectal pain requiring narcotics, rectal ulceration
Grade 4 Life threatening and disabling Bowel obstruction, fistula formation, bleeding requiring hospitalization, surgical intervention required

Prevention

  1. Use of newer conformal radiation therapy techniques.
  2. Amifostine is a prodrug that is metabolized to a thiol metabolite that is thought to scavenge reactive oxygen species
  3. Placebo-controlled phase III trials have detected no benefit from either topical or oral sucralfate.

Treatment  of radiation proctitis 

Medical

  1. Butyrates
  2. ASA
  3. Sucralfate
  4. Metronidazole
  5. Short chain FA
  6. Topical formalin
  7. Hyperbaric o2

Endoscopic

  1. dilatation
  2. Heater and bipolar cautrey
  3. ND YAG
  4. APC
  5. RFA

Surgery

Diverting ostomies for severe stricture - Better for incontinence, stricture and limited benefit  for bleed

Reconstruction with Flaps -  rectourethral or rectovaginal fistula with a pedunculated gracilis or a Martius flap to facilitate healing by introducing well-vascularized healthy tissue,

Proctectomy  complicated fistulous disease, especially when accompanied by significant pain and incontinence, or in cases of severe and intractable bleeding

Rectal prolapse

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Q) Which of the following is a Perineal procedure in rectal prolapse
A. Delorme
B. Ripstein
C. Resection rectopexy
D. Frykman Goldberg procedure

Answer 

Anal canal

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 Q  True about anal canal anatomy are all except
a) Columns of morgagni above dentate line
b) Resting anal canal Pressure 5 – 20 mm Hg
c) Muscles are tubular with inner layer supplied by autonomic nerves

d) Contains columnar, transitional and squamous epithelium

Answer

Anal Fissure

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Q )  45 year old male is diagnosed with Anal fissure. What is not indicated in the management of  anal fissure

A. Inj BOTOX
B. Topical steroids
C. Topical Calcium Channel Blockers
D. Topical Nitro glycerine

Answer Premium 

Blood supply to rectum

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Q) Blood supply to rectum - all are true except
A. Inferior rectal artery pierces the levator ani to supply the distal rectum
B. Middle rectal artery is a branch of hypogastric
C. Arc of riolan is an anastomosis between ascending branch of IMA and Middle Colic Artery
D. Left Colonic Artery arises 3-4 cm distal to the IMA origin

Answer to Q14 

 

Pouch design

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Q. False statement about pouch design is-

a) S pouch is  preferred when length is  not available

b) J pouch is the  most preferred

c) W pouch has  more chances of diarrhoea than J pouch

d) Volume of the pouch is inverse proportional to the no. of bowel movements

Answer