Fall 08 Fall 13 Colon & Rectal Surgery Oral Boards Study Guide Allen Kamrava Colon and Rectal Surgeon, Cedar Sinai Medical Center Los Angeles Colon and Rectal Surgical Associates INTRODUCTION The year following fellowship can be exhausting. For many, we are relocating to what will hopefully be a permanent location. We are transitioning into our new practices, and soon operating on patients where we are the ones responsible if any complications were to occur. At the same time, we are building a network of practitioners whom we rely on and hope that they reflexively will rely on us as well. The written board exam quickly approaches and soon thereafter the oral board examination. It is incredibly difficult to set time aside to study. In fact, I would say the most difficult time I ever had preparing for examinations was once I was within my own practice. You are juggling numerous responsibilities and the very last thing you want to deal with is yet another exam. I spent time during my fellowship, as well as during my first year of practice, re-reading both the ASCRS textbook and the textbook “Improved Outcomes in Surgery.” The latter of the textbooks, “Improved Outcomes” to me proved to be an invaluable read for preparation for this exam, and I would urge anybody who is considering what to read to consider this text. It is by no means voluminous and instead focuses on exactly these questions. As prior, the notes below are my own notes. And thus, they are chalk full of typos and errors. Some may be ridiculous. I haven’t spent time proofreading these notes – in this regards, they are a “first draft” of notes. Nevertheless, I compiled below all the topics and notes I thought necessary to prepare for my oral boards for CRS. Other than having read the texts to make these notes, these notes constituted my preparation for the orals examinations. I provide them because I do believe there is little to guide the residents/fellows in this regard. I do not think that by themselves, these notes will suffice for a well rounded understanding of the topics in hand. These notes absolutely will not suffice for the written exam, as they lack the detail and many of the topics necessary to pass that specific exam. As always, I cannot thank enough my wife Dalia, who has supported me through all of this. Especially on the days and nights I was absolutely fed up with sitting and reading, she pushed me forward. And my 2 daughters, for the time with me they have unknowingly given up. I will be repaying you both, in interest, from here on forward. If you have any thoughts or concerns, please let me know. I wish you all the best. Allen Kamrava, M.D. TABLE OF CONTENTS Anal Cancer ...................................................................................................................................................................................... 1 Anal Stricture ................................................................................................................................................................................... 3 Anastomatic Leak ............................................................................................................................................................................ 4 Appendiceal Tumors ........................................................................................................................................................................ 5 Carcinoid .......................................................................................................................................................................................... 6 Colon Cancer .................................................................................................................................................................................... 7 Colonic Volvulus ............................................................................................................................................................................ 12 Constipation .................................................................................................................................................................................. 14 Medical Mgmt of Inflammatory Bowel Disease ............................................................................................................................ 16 Crohn’s ........................................................................................................................................................................................... 19 Diverticulitis ................................................................................................................................................................................... 20 Endometriosis ................................................................................................................................................................................ 22 Familial Adenomatous Polyposis ................................................................................................................................................... 23 Fecal Incontinence ......................................................................................................................................................................... 25 Fissure ............................................................................................................................................................................................ 27 Fistula-in-Ano ................................................................................................................................................................................ 28 GI Bleed ......................................................................................................................................................................................... 30 Hemorrhoids .................................................................................................................................................................................. 31 HNPCC - Hereditary Nonpolyposis Colon Cancer .......................................................................................................................... 33 Ileostomy Complications - Ischemia .............................................................................................................................................. 34 IPAA Complications ....................................................................................................................................................................... 36 Polypectomy .................................................................................................................................................................................. 38 Pediatric Anorectal Conditions ...................................................................................................................................................... 40 Pelvic Floor Disorders .................................................................................................................................................................... 42 Pilonidal Disease ............................................................................................................................................................................ 43 PreSacral Tumors ........................................................................................................................................................................... 44 Pruritis Ani ..................................................................................................................................................................................... 46 Rectal Cancer ................................................................................................................................................................................. 47 Abdominoperineal Resection ........................................................................................................................................................ 50 Adjuvant Therapy for Colorectal CA .............................................................................................................................................. 51 Indications and Outcomes for Treatment of Recurrent Rectal CA and Colorectal Liver and Lung Metastasis ............................. 52 Radiation Proctitis ......................................................................................................................................................................... 54 Rectal Prolapse (Rectal Procidentia) ............................................................................................................................................. 55 RectoVaginal Fistula ...................................................................................................................................................................... 56 Solitary Rectal Ulcer Syndrome ..................................................................................................................................................... 58 2 Sexually Transmitted Diseases ...................................................................................................................................................... 59 Trauma ..........................................................................................................................................................................................