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GI workbook Questions > 10. GI malignancies & Imaging > Flashcards

10. GI malignancies & Imaging Flashcards

0
Q

Whats the likely further surgical intervention if a appendiceal tumour is:
Less than 1cm
More than 2cm

A

Appendicectomy

Right hemicolectomy

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1
Q

Whats the most common type of appendiceal tumour?

A

Carcinoid

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2
Q

Whats the common metastatic location for appendiceal tumour?

A

Liver

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3
Q

Once metastasised, what characteristic symptom of appendiceal tumours might a patient suffer from?

A

Carcinoid syndrome:
Flushing, diarrhoea, heart valvular lesions, cramping, telangiectasia, peripheral oedema, wheezing, cyanosis, arthritis, pellagra

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4
Q

Describe the patterns & spread of caecal adenocarcinoma

A

Direct spread thru bowel wall

Lymphatic spread to mesenteric nodes

Via portal venous sys to liver

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5
Q

4 risk factors for dev adenocarcinoma of large bowel

A

Low residue diet
Slow transit time
High fat intake
Genetic disposition

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6
Q

Why might a patient with caecal adenocarcinoma is not suffering obstructive symptoms

A

Contents of colon still watery/fluid

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7
Q

In which part of colon is a tumour more likely to produce obstructive symptoms?

A

More distal portions: stool more formed

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8
Q

What is tenesmus & how can a tumour produce this symptom?

A

Sensation of incomplete defacation, so continually trying to empty bowel

Tumour in rectum can elicit stretch response

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9
Q

What are the common locations for colonic cancer & typical assocated symptoms?

A

Caecum/ascending colon (30%): anaemia
Sigmoid (25%): obstructive symptoms, overt bleeding
Rectum (20%): tenesmus, overt bleeding, pain
Descending colon (15%)
Transverse (10%)

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10
Q

Whats the location of pathology for a patient with central/right sided abdo pain, vomiting & blood mixed in stools

A

Embryological mid gut

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11
Q

What is intussusception & what symptoms does it cause?

A

Pathological process: one section of bowel invaginates into adjoining distal piece of bowel
Quickly leads to intestinal obstruction

Causes colicky pain, nausea, vomiting, lethargy
Red currant jelly stools can occur when ischaemia of bowel sloughs of & causes bleeding of bowel mucosa

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12
Q

What types of malignant tumours can affect the small bowel

A

Adenocarcinomas: most prevalent at proximal small bowel
Lymphoma of small bowel
Gastro-intestinal stromal tumours
Carcinoid tumours

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13
Q

3 possible diagnoses of:
Mild generalised abdo pain for a few days
diarrhoea
vomiting
Mild diffuse tenderness ln palpation of abdomen
Decreased bowel sounds
Dehydration

A

Food poisoning
Gatroenteritis
Early appendicitis
Small bowel obstruction

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14
Q

List 3 features of a plain X ray that determine small intestine evident?

A

Central position
Transverse mucosal bands (valvulae conniventes)
Size of dilated loops (smaller diameter than large bowel)

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15
Q

Why might 2 xrays showing small bowel obstruction present differently?

A

Supine vs erect xray
Erect allows gas filled loops to appear in upper abdomen: air/fluid levels appear
More distal small bowel obstructions appear with more fluid levels

16
Q

Whats your initial treatment of someone with small bowel obstruction

A

Nil by mouth & NG tube (to reduce gastric aspirate & encourage passing of flatus)
IV fluids
Antibiotics (to cover predominantly gram negative anaerobes)

17
Q

What imaging modality might be used to image small bowel obstruction

A

Erect X ray

CT abdo (superior to Xray in complete obstruction): 
reveals site of obstruction & potential signs of bowel ischaemia
But low sensitivity for low grade/incomplete obstruction
18
Q

What might have occurred if a patient with small bowel obstruction develops abdominal guarding & temperature

What is the treatment

A

Perforated bowel
Developing peritonitis

Surgical intervention
Antibiotics

19
Q

What are the causes of small bowel obstruction in the following areas:
Extrinsic
Bowel wall lesions
Intra-luminal

A

Adhesions, hernias, volvus

Tumours, CD (thickening of bowel wall)

Foreign bodies, food bolus, meconium (CF), gallstones, intussusception

20
Q

What are the causes of large bowel obstruction (most - least prevalent)

A

Malignancies
Diverticular disease
Volvulus

21
Q

What features on a plain X ray help differentiate between small & large bowel obstruction

A

Position of dilated loops (SBO more central, LBO more peripheral)

Size of dilated loops (SBO >3cm 5cm)

Number of loops (SBO-many, LBO-few)

Bowel markings (small- valvulae go all the way across, large-haustra only partially across)

22
Q

What features of the history can differentiate btw small & large bowel obstruction?

A

Small: early onset vomiting & before constipation, colicky pain more frequent (2-3m)

Large: later onset vomiting & after constipation, colicky pain less frequent (5+min)

23
Q 
What mechanisms lead to the signs/symptoms of pancreatic cancer:
Pale stools
Dark urine
Jaundice
Weight loss
Back pain
A

Compression of common bile duct: build up of bile, normally broken down in colon to stercobilinogen (gives faeces colour)

Reabsorption of bilirubin from blocked bile duct back into bloodstream. Bilirubin soluble from conjugation

Hyperbilirubinaemia from blocked flow of bile

Bile & pancreatic enzyme release into duodenum aids absorption & digestion fats
Effects from cancer associated anorexia

Retroperitoneal position of pancreas

24
Q

Which part of pancreas most likely to be affected in pancreatic cancer

A

Head

25
Q

Risk factors of pancreatic disease

A

Smoking
Chronic pancreatitis
Diabetes at least 5yrs duration

26
Q

What are the merits of transcutaneous ultrasound scan

A

Non-invasive
Painless
Inexpensive
No radiation

27
Q

What portion of GI anatomy can be viewed with ultrasound?

A

Biliary tree

Good for screening intra or extra hepatic bile duct dilation

28
Q

What potential therapeutic advantage does endoscopic retrograde cholangiopancreatography (ERCP) over other investigative techniques

What potential side effects does it have?

A

Uses endoscope to introduce contrast medium into biliary tree & pancreatic sys
Can pass forceps & diathermy instruments thru endoscope
Can potentially enlarge sphincter of oddi
Can potentially remove gallstones from common bile duct

Infections (cholangitis), perforation of biliary tree, pancreatitis, haemorrhage

29
Q

What imaging techniques can be used to diagnose cancer in biliary tree

A

CT, MRI

30
Q

Give 3 reasons why pancreatic cancer has such a poor prognosis

A

Vague & late presentation

Local spread can involve many structures

Resection complicated & largely unsuccessful in curing

GI workbook Questions (10 decks)

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