NWSCRS 2016 Thursday

1. Transanal Hemorrhoidal Dearterialization (THD) vs Suture Ligation for Prolapsing Internal Hemorrhoid Disease69 Y.O Female with blood in stool. What is the first step?

Hemorroidectomy

Colonoscopy

Follow up in 6 months

None of the above

2. Optimal Closure of the Perineal WoundWhich perineal closure has the most favorable short term and long term complication rate?

Primary closure

VRAM flap

Gracilis Flap

VAC dressing

3. Role of Estrogen Therapy in Treating Estrogen Receptor positive Colon Cancer: Study in an Orthotopic Murine ModelThe following hormones are known to have an effect on colorectal cancer tumor growth

Estrogen

Progesterone

Insulin-Like Growth Factor

Thyroxine

4. CPG Questions Which of the following is the primary purpose of a Clinical Practice Guideline?

An algorithmic approach to surgery

Guidance in all circumstances for patients

A legal resource

Improving specific health care outcomes

5. TAMIS Repair of Rectovaginal FistulaFlap characteristics that may improve post-operative healing of a rectovaginal fistula include all of the following EXCEPT:

Thickness of flap tissue

Avoiding tension of tissue used for flap

Use of a narrow based flap

Blood supply to the flap

6. CPG Questions Which of the following will downgrade the quality of evidence from a randomized controlled trial?

Dose response

High risk of bias

Large treatment effect

Presence of plausible cofounders

7. Management of Metastatic Rectal CancerOptimal timing of rectal resection after short course radiation therapy is:

1-2 weeks following treatment

4-6 weeks following treatment

8-10 weeks following treatment

>12 weeks following treatment

8. Short and Long term outcomes after BioLiftWhat was the most common type of fistula-in-ano in our review?

Suprasphincteric

Intersphincteric

Transsphincteric

Anovaginal

9. Prognosis of Small Bowel Adenocarcinoma in Crohn's Disease Patients Compares Favorably to De Novo Small Bowel AdenocarcinomaWhen should you intervene surgically for obstructing symptoms in Crohn's patients, which is often the presentation for Crohn's-associated SBA?

Immediately, prior to medical treatment

Failure to improve and/or persistent symptoms after short-term high dose steroids

Single stricture disease

During acute inflammatory phase

10. Is there a role for local excision in patients with large neuroendocrine tumors of the rectum or anus? Results from the National Cancer Database65 year old man presents with a 2-cm rectal mass. Work up is concerning for involvement of surrounding organs and regional nodes. Biopsy reveals high grade rectal neuroendocrine tumor. Which is most strongly associated with a decreased survival?

Age of the patient

Local invasion to surrounding structures

High tumor grade

Metastasis to regional nodes

11. 20 Years' Experience in a VA SCI Colorectal ClinicA patient C4-5 ASIA A (complete) SCI has bleeding with bowel care and bothersome anal tags, and he displays a full rosette of both internal and external hemorrhoids on exam. Which of the following is the recommended goal for a ligation procedure?

One internal hemorrhoid at a time

Up to 3 internal hemorrhoids at a time

As many internal hemorrhoids as may be symptomatic

As many internal and external components as may be symptomatic