9. Lower GI Flashcards
Most common type of colonic cancer?
Adenocarcinoma. Commonly coming from polyps.
Related to peutz-jeugers syndrome.
Risk factors for colonic cancer?
AGe Obesity IBD (esp UC) Acromegaly Poor fibre diet Males Limited activity
How does colonic cancer normally present?
Change in bowel habits
Rectal bleeding mixed in the stool that is not bright red
Weight loss (FLAWS)
Tenesmus and anaemia poss
Investigations for colonic cancer?
Bloods - FBC for anaemia and LFTs for mets
Colonoscopy and biopsy to visualise
Double contrast barium enema see apple core lesion (OSCE)
CT chest/abdo/pelvis for staging
How to manage colorectal cancer?
Surgical excision with/without neoadjuvant chemo/radiotherapy.
Commonly metastasises to liver, lung, bone and brain.
What is Crohn’s disease?
A disease characterised by transmural (all layers) inflammation of GI tract affecting anywhere from the mouth to the anus, it has skip lesions.
What can the chronic inflammation cause?
Non-caseating granuloma formation.
Risk factors for crohn’s?
FHx Smoking OCP Diet high in refined sugars Genetics Ashkenazi jewish
How does crohn’s present?
Crampy or constant pain Right lower quadrant/peri-umbilical pain Diarrhoea with mucus, blood or pus Nocturnal diarrhoea possible Peri-anal lesions
(weight loss, fatigue and oral lesions)
Extra-intestinal manifestations of crohns?
Arthropathy
Skin lesions - aphthous ulcers, pyoderma gangrenosum (red and purple) and erythema nodosum (red).
Ocular symptoms - uveitis, episcleritis
Examination of crohn’s?
Abdominal tenderness/mass
Aphthous ulcers
Peri-anal lesions like skin tags etc.
Crohn’s investigations?
FBC, iron studies, vitamin levels for malnourishment
CRP and ESR for inflammation
Plain AXR for bowl dilation
CT bowel wall thickening (often on ileocaecal valve) and skip lesions
Bowel series (barium enema and xray) with rose thorn ulcer (deep ulcerations) and string sign of kantor (fibrosis and strictures)
Colonoscopy and biopsy gold-standard. Gold standard, cobblestone appearance.
How to manage crohn’s?
Want to induce remission
- Steroids, IV, oral or topic (pred)
- Immunomodulators (oral or IV) (azathioprine)
- Biologic therapy (infliximab/adalimumab)
- Surgery (obstruction or really bad)
Once remission occurs, take away the steroids!
What is ulcerative colitis?
Diffuse inflammation of colonic MUCOSA ONLY. Only affecting rectum and colon. Starts from rectum and can spread.
Associated with HLA-B27 (also related to ankylosing spondylitis)
Risk factors for UC?
FHx
HLA-B27
Not-smoking
How does UC present?
Bloody diarrhoea
Rectal bleeding and mucus
Abdo pain and sometimes cramps
Tenesmus
Extra-intestinal manifestations of UC?
Peripheral arthritis Ankylosing spondylitis Erythema nodosum Pyoderma gangrenosum Episcleritis more common than uveitis
Blood on DRE, abdo tenderness and pallor.
Investigations for UC?
FBC for anaemia LFTs for primary sclerosing cholangitis CRP and ESR Faecal calprotectin pANCA
Plain AXR dilated bowel
Lead pipe appearance on an xray as haustra are lost
Colonoscopy and biopsy shows continuous erythema (gold).
Goblet cell depletion and crypt abscesses
What may thumb printing show?
Toxic megacolon which may occur in UC.
How to manage UC?
Remission
- Mesalazine (5-ASA)
- Steroids
To maintain give Immunosuppressive (+/-Biologics Another biologic type) Ciclosporin Total colectomy
Complications of UC?
Toxic megacolon
Primary sclerosing cholangitis
Colorectal adenocarcinoma
Perforation
What is coeliac’s disease?
A systemic autoimmune disease caused by gluten peptides known as gliadin.
It causes villous atrophy and hypertrophy of intestinal crypts.
Risk factors for coeliac’s
FHx
IgA deficiency
T1DM
Other immune disorder
Coeliac disease presentation
Diarrhoea
Bloating
Pain
Dermatitis herpetiformic on elbows
