Q) Newest treatment for anal incontinence?
a. Sacral nerve stimulation
b. Artificial sphincter.
c. Repair of sphincter
d. Gluteus maximus graft
Sacral nerve stimulation is the newest modality in treatment for anal incontinence. In it electrodes are placed via the sacral foramina. The nerve supply of anal sphincter is similar to lower extremity so their stimulation can lead to contraction of various foot muscles.
Others are all older methods
Shackelford page 1779
Q) Most common pathological finding on defecography studies is
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Discuss what is defecography? Diseases diagnosed by it
Q) CEA surveillance in normal person whose father and brother had colon cancer is helpful in
a) CEA is highly sensitive in picking up the diagnosis of colon cancer
b) HIGH preoperative CEA is predictive of unresectability in colon cancer
c) Increase in CEA after surgery is indicative of tumor recurrence
d) CEA is present in normal colonic mucosa
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Q) 75 year old man complains of obstipation for 2 days. He has taken laxatives but continues to have worsening pain and distension associated with vomiting. He underwent b/l knee replacement 2 weeks back. He was on Inj fentanyl for pain control. He is on antihypertensives and lipid lowering agents for the past 15 years.
On examination he is afebrile, oriented, pulse rate of 100 min/, BP 120/60 and abdomen is distended with mild tenderness. There are no signs of peritonitis, bowel sounds are sluggish.
TLC is 6,500, and potassium is 3.2 . All other blood tests are normal. X ray abdomen and CT abdomen shows dilated large bowel loops and oral contrast upto splenic flexure.
What is the probable diagnosis
a) Ischemic colitis
b) CMV colitis
c) Colonic Pseudoobstruction
d) Caecal volvulus
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Q) All of the following are seen in both ulcerative colitis and crohn's disease except
a) Aphthous ulcer
b) Pseudo polyp
c) Rectal disease
d) Obstructive symptoms
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Q) False statement about Hirchsprung's disease is:
a) Male and Female have equal incidence
b) In approximately 8% of the patients entire colon is affected
c) After surgery constipation is the most common problem
d) Down syndrome can be seen in up to 3-5% patients
Hirchsprung's disease is a developmental disorder characterized by absence of ganglion cells in both Auerbach's and Meissner's plexus and males are more frequently affected than females
Absence of these ganglion cells lead to a very tight anal sphincter with resultant constipation.
This aganglionosis which is similar to Achalasia cardia begins at anorectal junction and involves rectosigmoid in 80% and entire colon in 8% of cases.
Various surgical options like Duhamel, Swenson and Soave procedures can be done and in all constipation is a common problem
Down's syndrome is associated in 5%
Ref: Sabiston 20th edition page 1876