General Surgery Board Review Gastrointestinal Surgery Flashcards

Which factor best defines resectability of colorectal liver metastases (CRLM)?

Answer: Ability to achieve R0 resection with adequate future liver remnant volume

Modern criteria define CRLM resectability as the ability to achieve negative margins (R0) while leaving adequate functional liver remnant (≥25–30% of total liver volume) — number and size are no longer absolute contraindications.

A T3N1M0 colon cancer corresponds to which AJCC stage?

Answer: Stage IIIB

T3N1M0 colon cancer is Stage IIIB: T3 indicates invasion through the muscularis propria into pericolorectal tissues, N1 indicates 1–3 positive regional nodes, and M0 indicates no distant metastasis.

A patient with Crohn's disease has an ileosigmoid fistula. What is the standard surgical approach?

Answer: Resection of the diseased terminal ileum with simple closure or repair of the sigmoid defect

The diseased bowel (terminal ileum in Crohn's) is the source of the fistula; resection of the affected ileum with closure of the 'innocent bystander' sigmoid defect is the standard surgical approach.

Which operation is preferred for a patient with toxic megacolon from ulcerative colitis who fails 48–72 hours of maximal medical therapy?

Answer: Subtotal colectomy with end ileostomy

Subtotal colectomy with end ileostomy is the preferred emergency operation — it removes the diseased colon quickly, preserves the rectum for future IPAA, and avoids pelvic dissection in a sick patient.

The most common cause of significant lower GI bleeding in patients over 60 years of age is:

Answer: Diverticulosis

Diverticulosis accounts for approximately 40–55% of significant lower GI bleeding episodes in elderly patients; most bleeds stop spontaneously but can be massive.

Peutz-Jeghers syndrome is characterized by which combination of features?

Answer: Hamartomatous GI polyps, mucocutaneous melanin pigmentation, and increased GI and extraintestinal cancer risk

Peutz-Jeghers syndrome (STK11/LKB1 mutation) presents with hamartomatous polyps throughout the GI tract, perioral and buccal melanin spots, and elevated lifetime risks of GI, breast, pancreatic, and gynecologic cancers.