Perioperative steroid management in IBD

Q) All are true  regarding perioperative management Of IBD on steroid except

a) Minor procedure needs only routine steroidal dose supplementation
b) Major procedures  needs Hydrocort 100-150 mg tds
3.Chronic steroid use causing adrenal failure that  presents with hypotension, vomiting, fever, lethargy
4.All cases of UC need supraphysiological dose of steroid.

Pouchitis Disease severity index

Q) Pouchitis disease activity index includes all except (AIIMS 2019)

a)  Fever
b)  Malaise
c)  Fecal urgency
d)  Bleeding PR

Pouchitis is commonly asked in AIIMS and JIPMER MCH exams. Previous year questions are here and here 

Ans b ) Malaise, Clinical data includes Frequency, urgency and rectal bleed

Summary of the PAS

I. Clinical
 1. Stool frequency(0, 2, 4, 6)
 2. Fecal urgency(0, 3)
 3. Rectal bleeding(0, 3)
Maximal clinical subscore: 12
II. Endoscopic findings
 1. Oedema(0, 1)
 2. Granularity(0, 1)
 3. Friability(0, 1, 2)
 4. Erythema(0, 2, 3)
 5. Mucosal flattening(0, 2)
 6. Ulcerations/erosions(0, 2, 3)
Maximal endoscopic subscore: 12
III. Histological Acute inflammation
 1. Polymorphonuclear infiltration(0, 1, 2, 3)
 2. Ulcerations/erosions(0, 1, 2, 3)
Chronic inflammation
 1. Mononuclear infiltration(0, 1, 2, 3)
 2. Villous atrophy(0, 1, 2, 3)
Maximal (total) histological subscore: 12
Maximal total PAS: 36


Cancer lower rectum

Q) False statement about management of cancer rectum

a) Relative to ERUS, pelvic MRI is more accurate in its ability to detect lymph node involvement 

b) Rectal cancers located in the upper third of the rectum are exempt from neoadjuvant treatment.

c)  TME is typically performed 2-3 weeks after completion of CRT before fibrosis develop

d) ERAS  include early mobilization, transition to oral pain control, and resumption of oral food intake