Diverticular disease of colon

Q) False about diverticular disease of colon is 

a) 10-20% of all diverticular disease of colon develop symptoms. Rest remain asymptomatic

b) Low fiber diet is implicated in etiology

c) Sigmoidoscopy is useful tool for evaluation of diverticulitis

d) Elective colectomy in uncomplicated diverticulitis is rare and forms only 1% of cases with diverticular disease

Duodenal adenoma in FAP

Q) Surgery in FAP patient after colectomy for ampullary adenoma Stage IV
a)Classic Whipple
b) Pancreas preserving duodenectomy
c) Transduodenal excision
d) endoscopic excision


Answer is free for all

b) 

Duodenal cancers are the third most common (10%) cause of death in FAP after CRC and desmoid disease.

Duodenal adenomas  100% incidence

 tendency to progress to cancer.

The severity of duodenal adenomatosis predicts the chances of duodenal cancer,  Spigelman staging system that is based on

adenoma number, size, and histology

Patients with stage 0 disease (no adenomas) can be surveyed again in 5 years.

Stage I patients can be surveyed in 3 years;

stage II in 1 year;

stage III in 6 months

and stage IV is an indication to consider surgery. 36 % progress to cancer- Surgery is pancreas preserving duodenectomy

A Whipple is indicated for a duodenal cancer that is definitively operable

Duodenal adenomas can be treated by snare polypectomy or by transduodenal polypectomy. Ampullary adenomas can be treated by endoscopic mucosal resection or surgical ampullectomy

Ref schakelford page 1968

lymphatics of colon

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

a) Paracolic

b) Epicolic

c) Nodes along SMA/IMA

d) Para aortic
Answer to 37


37) b

Lymphatics first drain to epicolic group along the bowel wall

Then paracolic group along the marginal artery

Intermediate group along the named vessels SMA/IMA

Finally to par 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