Radiation Proctitis

Question: Treatment of radiation Proctitis with persistent bleeding
Answer: first sucralfate enemas then argon beam coagulation, then resection

Anal Cancer

Question: What is the treatment of Anal Cancer?
Answer See Below:
Anal Canal (above Dentate) - usually chemoradiation

    Adenocarcinoma - same concept as rectal cancer (if T1 and small < 3cm then WLE) - if not APR

    Squamous/Basaloid (cloacogenic), mucoepidermoid - NIGRO, if recurrent then APR

    Melanoma - no difference between APR and WLE

Anal Margin (below dentate) - usually excision

    Squamous of Basal - same concept as skin cancer, WLE although made need APR if sphnicters involved

    Bowen's disease - WLE with clear margins because this is malignant

    Paget's Disease - intractable itching, positive PAS, 1/3 with concurrent rectal cancer - WLE

Anal Anatomy

Question: Lymph Drainage of upper, middle, and lower rectum?
Answer: Upper and middle rectum lymph nodes drain to inferior mesenteric nodes whereas lower rectum drains into both inferior mesenteric and internal iliac nodes

Skin Grafts

Question: How dose a STSG get adequate nutrition/oxygen supply in the first week?
Answer: imbibition (diffusion from serum), then inosculation (capillary in-growth) in 2-7d

Appendicitis

Question: Etiology in Adults? Kids?
Answer: appendicolith (adults) -  lymphoid hyperplasia (children)
Question: Management of Cecal Fistula after appendectomy?
Answer: Non-operative management (most will close with time)

Appendiceal Carcinoid

Question: What is the treatment of an appendiceal carcinoid?
Answer: > 2cm or at base of appendix = Right hemicolectomy, < 2cm and not in base = appendectomy

Aneurysms (not abdominal aortic aneursyms)

rupture risk above inguinal ligament, thrombosis/emboli below inguinal ligament - bypass and exclude
Question: When do you operate:
Answer:
    - Splanchnic - repair all (50% rupture risk)
    - Splenic - > 2cm, symptomatic, pregnant or child bearing years
    - Iliac - > 3cm, symptomatic, mycotic
    - Femoral - > 2.5cm, symptomatic, mycotic
    - Popliteal - > 2cm, symptomatic, mycotic, often bilateral, most common complication is embolism (not thrombosis or rupture), screen for AAA
    - Renal - > 1.5cm, symptomatic, mycotic, women who want pregnancy