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Block 32 GI and surgery > Altered Bowel Habit > Flashcards

Altered Bowel Habit Flashcards

1
Q

what is acute diarrhoea?

A

3 or more loose stool in 24 hours and/or stools that are more frequent than normal for the individual lasting <14 days and/or stool weight

acute <14 days
persistent >14 days
chronic >4 weeks

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2
Q

what is chronic diarrhoea?

A

chronic diarrhoea is the presence of more than 3 loose stools per day for more than 4 weeks

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3
Q

what are the differentials for acute diarrhoea?

A 
Rotavirus 
Norovirus
Enteric adenovirus
Campylobacter
Shigella
Salmonella
E.coli
C.diff
Vibrio cholerae 
Staphylococcus aureus 
Bacillus cereus
Clostridium perfingens
Listeria 
Giardia 
Entamoeba histolytica
Microsporidiosis 
Medications 
Ulcerative colitis 
Crohn’s disease
Irritable bowel syndrome
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4
Q

what are the differentials for chronic diarrhoea?

A 
Ulcerative colitis
Microscopic colitis 
Viral, bacterial, parasitic, HIV enteropathy
Irritable bowel syndrome
Drug effects
Faecal impaction
Coeliac disease
Crohn’s disease
Bile salt malabsorption
Brush border enzyme deficiency 
Small intestinal bacterial overgrowth 
Pancreatic insufficiency 
Alcohol 
Hyperthyroidism 
Diabetes mellitus 
Radiation enteritis/colitis 
Eosinophilic enteritis 
Chronic ischaemic colitis 
Surgical bypass or resection
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5
Q

what are the diagnostic features of rotavirus?

A

Children in day care centres. Fever, vomiting, diarrhoea-watery, yellow, no blood or mucus

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6
Q

what is the incubation period of rotavirus?

A

2 days

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7
Q

what are the diagnostic features of norovirus?

A

Consumption of shellfish, prepared foods, salads, sandwiches, fruit.
Nausea, abdominal cramps followed by diarrhoea and vomiting, it is watery, moderate, no blood or mucus, fever, malaise, myalgia, headache

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8
Q

what is the incubation period of norovirus?

A

12-48 hours

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9
Q

what are the diagnostic features of enteric adenovirus?

A

Common in infants, older adults and immunocompromised people. Secondary to contaminated food. Common in daycare centres and institutions. Mild, self-limiting diarrhea with no fever

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10
Q

what is the incubation period of enteric adenovirus?

A

3-10 days

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11
Q

what are the diagnostic features of campylobacter?

A

Ingesting of undercooked poultry, raw milk or cheese. Diarrhoea either watery profuse or bloody with mucus. Resolve after 5-7 days. Crampy periumbilical pain and fever. Bloody diarrhoea from 3rd say

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12
Q

what is the incubation period of campylobacter?

A

2-4 days

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13
Q

what are the diagostic features of shigella?

A

Usually in children in daycare. Eating vegetables. Fever then develop diarrhoea, watery becoming mucoid and bloody. Small in amount. 10-12 stools a day. 1/3 have fever and tenesmus.

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14
Q

what is the incubation period of shigella?

A

12 hours to 7 days (usually 1-3 days)

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15
Q

what are the diagnostic features of salmonella?

A

Usually from food and foecally contaminated water, common with pets. Nausea, vomiting, fever, diarrhoea (uto 10 days, cramping)

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16
Q

what is the incubation period of salmonella?

A

6-72 hours

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17
Q

what are the diagnostic features of E.coli?

A

Travellers, children, dysentery usually contaminated food. Profuse watery diarrhoea or bloody diarrhoea. Abdominal pain but no fever. Rare-dehydration, low BP, high HR

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18
Q

what is the incubation period of E.coli?

A

3-4 days

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19
Q

what are the diagnostic features of C.diff?

A

History of antibiotic use, hospitalisation, chemotherapy development of diarrhoea in 2-3 weeks. Acute watery diarrhoea. Can be mild or severe number of times a day and pain. ?

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20
Q

what is the incubation period of C.diff?

A

7 days

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21
Q

what are the diagnostic features of vibrio chloerae?

A

Mild disease-cannot distinguish between it and gastroenteritis. Watery diarrhoea. Severe-diarrhoea with volume loss (rice water stool), abdominal cramps

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22
Q

what is the incubation period of vibrio cholerae?

A

2-3 days

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23
Q

what are the diagnostic features of staphylococcus aureus?

A

Ingestion of beef, pork, poultry, eggs 4-6 hours before symptoms. Nausea, vomiting, later watery diarrhoea, no fever or abdominal pain

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24
Q

what is the incubation period of staphylococcus aureus?

A

1-6 hours

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25
Q

what are the diagnostic features of bacillus cereus?

A

Eating reheated rice. In 6 hours develop nausea, vomiting then followed by diarrhoea. Also consumption of beef pork and vegetables, no fever

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26
Q

what is the incubation period of bacillus cereus?

A

30 mins to 6 hours

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27
Q

what are the diagnostic features of clostridium perfingens?

A

Nausea and vomiting followed by diarrhoea 8-12 hours after eating beef, pork, poultry and home foods. No fever or abdominal pain

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28
Q

what is the incubation period of clostridium perfingens?

A

8-12 hours

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29
Q

what are the diagnostic features of listeria?

A

Eating beef, pork, poultry, milk, cheese, coleslaw, hotdogs or potato salad. Pregnancy, neonates, immunocompromised. Watery diarrhoea, moderate frequency, nausea and vomiting, mild abdominal pain, fever

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30
Q

what are the diagnostic features of giardia?

A

Travel to endemic areas. Person to person, contaminated food, water. Sudden onset watery diarrhoea, abdominal bloating, cramps, nausea, vomiting, foul smelling fatty stool, flatulence

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31
Q

what are the diagnostic features of entamoeba histolytica?

A

Gradual onset over 1-3 weeks. Abdominal pain, rare-fever and haematochezia. Abdominal tenderness, enlarged liver, electrolyte imbalance

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32
Q

what are the diagnostic features of microsporidosis?

A

Immunocompetent people, rarely chronic diarrhea (older people), immunocompromised people-diarrhoea, non bloody, watery, continuous or intermittent. Associated with crampy abdominal pain, weight loss, wasting, nausea and vomiting. Fever rare

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33
Q

describe the diagnostic features to suggest medications lead to diarhoea?

A

Recently started medication, followed by diarrhoea within says to weeks. Antibiotics, antacids, PPIs, laxatives, NSAIDs, diarrhoea is watery, no mucus or blood

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34
Q

what are the diagnostic features of ulcerative colitis?

A

Blood in stools and mucus. Extra-intestinal manifestations

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35
Q

what are the diagnostic features of Crohn’s disease?

A

Abdominal pain, fever, weight loss, diarrhoea, gradual onset, large volume watery diarrhoea suggest small bowel involvement.

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36
Q

what are the diagnostic features of Crohn’s disease?

A

Diarrhoea-small frequent loose stools, small to moderate volume preceded by urgency and common after meals, no night waking, alternate with constipation

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37
Q

what is the incubation period of microsporidosis?

A

11-15 days

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38
Q

what is the incubation period of entamoeba histolytica?

A

2-4 weeks

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39
Q

what is the incubation period of giardia?

A

1-14 days

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40
Q

what is the incubation period of listeria?

A

30 days

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41
Q

what are the diagnostic features of microscopic colitis?

A

Presence of coeliac disease-concern of lymphocytic colitis. Frequent diarrhoea and large volume. May be associated with mild abdominal pain, weight loss and fatigue

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42
Q

what are the diagnostic features of viral, bacterial, parasitic, HIV enteropathy?

A

Onset likely acute, history of travel, sick contacts, immunosuppression

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43
Q

what are the diagnostic features of faecal impaction?

A

Usual history of severe or worsening constipation, cramping, gas and abdominal pain. Examination-hard faecal mass on rectal examination

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44
Q

what are the diagnostic features of bile salt malabsorption?

A

surgical history resection

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45
Q

what are the diagnostic features of brush border enzyme deficiency?

A

Diarrhoea associated with bloating, cramping, wing and flatulence usually occurs within an hour of ingesting offending substance. Symptoms are often gradual, becoming increasing

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46
Q

what are the diagnostic features of small intestinal bacterial overgrowth?

A

History of diabetes, past surgery, coeliac or crohn’s. bloating, wind, flatulence, cramping, mild to moderate diarrhoea

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47
Q

what are the diagnostic features of pancreatic insufficiency?

A

History of pancreatitis, alcohol abuse, cystic fibrosis, onset gradual but progressive

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48
Q

what are the diagnostic features of hyperthyroidism?

A

History of other autoimmune disease, increased appetite, weight loss, heat intolerance, hair loss, fine tremor, goitre, exophthalmos, tachycardia, hypertension

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49
Q

what are the diagnostic features of diabetes mellitus?

A

Nausea and early satiety. Chronic diarrhoea is uncommon as presenting symptom of new-onset diarrhoea

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50
Q

what are the diagnostic features of radiation enteritis/colitis?

A

Radiation exposure to abdomen (men-prostate cancer and women-uterine cancer). Fresh blood in stools is common

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51
Q

what are the diagnostic features of eosinophilic enteritis?

A

Abdominal pain, nausea, vomiting, diarrhoea, history of other allergic conditions

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52
Q

what are the diagnostic features of chronic ischaemic colitis?

A

Older patients with history of vascular disease and on antihypertensives. Cramping abdominal pain and fresh blood in stools, tenderness

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53
Q

if onset of diarrhoea occurs within 6 hours of ingestion what does this suggest about the cause?

A

preformed toxins such as staph. aureus or bacillus cereus

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54
Q

why should you ask about the frequency of diarrhoea?

A

infectious cause=more frequent

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55
Q

why should you ask about the amount of stool produced?

A

toxin induced=greater volume (cholera

osmotic diarrhoea=smaller volume

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56
Q

why is it important to ask about the consistency of the stool?

A

watery=non invasive and toxin inducing pathogens

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57
Q

what does blood in the stool suggest?

A

invasive pathogens or inflammation

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58
Q

what does mucus or pus in the stool suggest?

A

colonic involvement with inflammatory process or infective pathogen

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59
Q

what does fever associated with diarrhoea suggest?

A

invasive bacteria, enteric viruses or cytotoxic organism

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60
Q

what other things is it important to ask about for a patient experiencing diarrhoea?

A 
travel
dietary history
pets
pain
nausea
vomiting
bloating
flatus
fever
tenesmus
anal itch
medications
past medical history
social history 
occupation
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61
Q

what should be part of the examination in a patient with diarrhoea?

A
  • General appearance
  • Pulse
  • Skin turgor
  • Mucous membranes (dry?)
  • Capillary refill time
  • Blood pressure
  • Orthostatic changes
  • abdominal examination may help diagnoses.
  • hyperactive, normal, or absent bowel sounds, localised or generalised abdominal tenderness, rebound tenderness, abdominal distension, enlarged liver (inSalmonella, amoebic liver abscess), or an abdominal mass.
  • Rectal examination can help in characterising stool and content, presence of mucus, or blood and faecal occult blood testing.
62
Q

what are the indications for further investigations in a patient with diarrhoea?

A

Dysentery
Moderate to severe disease
More than 7 days
High risk of spreading to others

63
Q

what stool tests are performed in patients with diarrhoea?

A
  • Presence of faecal leukocytes and positive occult blood test support diagnosis of invasive or inflammatory diarrhoea eg IBD
  • Faecal lactoferrin-distinguish inflammatory diarrhoea from non-inflammatory
  • Calprotectin-marker of faecal inflammation
  • Stool culture when; immunocompromised, multiple comorbidities, severe inflammatory diarrhoea, underlying IBD, test for stool leukocytes is positive, outbreak investifations
  • PCR tests-quicker identification of pathogen
  • Laxative screen
  • Stool weight, electrolytes and osmotic gap
64
Q

what blood tests would be used on a patient with acute diarrhoea?

A
  • FBC (haemoconcentration, anaemia, leucocytosis)
  • Serum chemistry (electrolytes, urea nitrogen, creatine, hypokalaemia, acidosis, renal dysfunction, serum albumin, lactic acid)
65
Q

what radiological tests are performed in a patient with acute diarrhoea?

A
  • Abdominal X-ray
  • CT scan of abdomen and pelvis
  • Identify ileus, perforation or megacolon
66
Q

what endoscopic investigations can be used in a patient with acute diarrhoea?

A
  • done If all other tests are negative.
  • It can distinguish IBD from infectious diarrhoea
  • Diagnose C.diff
  • Evaluate for cytomegalovirus and herpes simplex
67
Q

what should be asked for in a history in a patient with chronic diarrhoea?

A
  • Duration (more than 4 weeks)
  • Number of episodes per day
  • Waking up at night
  • Presence of blood in stools
  • Associated symptoms`
68
Q

what associated symptoms may coincide with chronic diarrhoea?

A
  • Weight loss (coeliac disease, IBD, malignancy, chronic pancreatitis, hyperthyroidism, diabetes)
  • Abdominal pain (coeliac disease, Crohn’s disease, malignancy)
  • Nausea and vomiting (small bowel Crohn’s, diabetes, faecal impaction)
  • Fresh blood or melaena (IBD, ischamia malignancy)
  • Skin changes (coeliac, IBD)
  • Steatorrhea, abdominal distension, flatulence, borborygmy, anorexia, increased infections
  • Medications: NSAIDs, laxative use, PPI, quinine, antibiotics
69
Q

what would look for on examination in a patient with chronic diarrhoea?

A

skin rashes
lymphadenopathy
blood on rectal examination

70
Q

what laboratory tests would be performed in a patient with chronic diarrhoea?

A 
FBC
Electrolytes
Glucose
Liver function tests
C-reactive protein
Thyroid function tests
Coeliac serology
IgA level
Haematinic (B12, folate, ferritin)
Faecal calprotectin-differentiate IBD from IBS
Test for parasites
71
Q

what is the role of endoscopic investigation in a patient with chronic diarrhoea?

A
  • Allows visual assessment of disease and IBD
  • Provide prognostic information
  • Histological assessment-presence of macroscopic and microscopic colitis
  • Suspected coeliac disease-gastroscopy with duodenal biopsies obtained
72
Q

what are the physiological changes causing diarrhoea?

A

During an episode of diarrhoea there is increased motility of the GI tract, with increased secretion and decreased absorption of fluids leading to loss of electrolytes

73
Q

what are the main approaches to treatment in patients with diarrhoea?

A
  • Electrolyte balance and fluids
  • Use of anti-infective agents
  • Use of spasmolytic or other antidiarrhoeal agents
  • oral rehydration
  • In campylobacter ciprofloxacin may be used
  • Opioid agonists
74
Q

give examples of opioid agonists used in treatment of diarrhoea?

A

loperamide

diphenoxylate

75
Q

how long after end of vomiting and diarrhoea should you wait before entering a clinical area?

A

48 hours

76
Q

where should communicable diseases be reported to?

A

-infection prevention and control team
Registered medical practitioners have a statutory duty to notify the ‘proper officer’ at their local council or local health protection team of suspected cases of certain infectious diseases.
-Complete a notification form immediately on diagnosis of a suspected notifiable disease. Don’t wait for laboratory confirmation of a suspected infection or contamination before notification. Consult the PHE Notifiable Diseases poster for further information.
-Send the form to the proper officer within 3 days, or notify them verbally within 24 hours if the case is urgent by phone, letter, encrypted email or secure fax machine.

77
Q

what drugs can cause constipation?

A 
Opiates
Antimuscarinics
Calcium channel blockers
Antidepressants 
iron
78
Q

what are the functional causes of constipation?

A

Irritable bowel syndrome

Idiopathic slow transit

79
Q

what are the metabolic/endocrine causes of constipation?

A

Diabetes mellitus
Hypercalcaemia
Hypothyroidism
Porphyria

80
Q

what are the psychological causes of constipation?

A

Depression
Anorexia nervosa
Repressed urge to defecate

81
Q

what are the neurological causes of constipation?

A

Spinal cord lesion

Parkinsons disease

82
Q

what are some general causes of constipation?

A

Pregnancy
Inadequate fibre intake
Immobility

83
Q

what gastrointestinal disease can cause constipation?

A
  • Intestinal obstruction and pseudo-obstruction
  • Colonic disease eg carcinoma, diverticular disease
  • Aganglionosis eg Hirschsprungs disease, Chagas disease
84
Q

what defecatory disorders can cause constipation?

A
  • Rectal prolapse, mucosal prolapse intussusception and solitary rectal ulcer syndrome
  • Large rectocele
  • Pelvic flood dyssynergia/anismus
  • megarectum
85
Q

what would be the investigation in recent change in bowel habit with other symptoms such as bleeding?

A

colonoscopy
CT pneumocolon
to exclude colorectal cancer and diverticular disease

86
Q

what are the 3 categories of constipation?

A
  • normal transit through colon (59%)
  • defecatory disorders (25%)
  • slow transit (13%)
87
Q

describe normal transit constipation?

A
  • Travels through colon at normal rate and stool frequency is normal yet patient feels constipated due to perceived difficulties of evacuation or passing hard stools
  • Abdominal pain or bloating
  • Marker studies of colonic transit can be used to distinguish it from slow transit
88
Q

describe slow transit constipation?

A
  • Predominantly in young women who have infrequent bowel movement.
  • Often starts at puberty
  • Infrequent urge to defecate, bloating, abdominal pain and discomfort.
89
Q

describe defecatory disorders?

A
  • Paradoxical contraction rather than normal relaxation of external anal sphincter.
  • Due to dysfunction of anal sphincter and pelvic floor
  • Characterised by performing proctography and tests of anorectal physiology
90
Q

what are the common causes of constipation?

A 
anal fissure 
medicine induced constipation
hypercalcaemia 
hypothyroidism
diabetes mellitus
spinal cord lesion
colonic stricture 
colon cancer
parkinson's disease
91
Q

what are the signs and symptoms of anal fissures?

A

Rectal pain, bleeding, excessive straining

92
Q

what are the signs and symptoms of medicine induced constipation

A

Temporal relationship of onset of symptoms with medicine use

93
Q

what are the signs and symptoms of hypercalcaemia

A

Tiredness, nausea, vomiting, loss of appetite

94
Q

what are the signs and symptoms of hypothyroidism

A

Weight gain, dry skin, depression, fatigue, changes in voice

95
Q

what are the signs and symptoms of diabetes mellitus

A

Polyuria, polydipsia, polyphagia

96
Q

what are the signs and symptoms of spinal cord lesion

A

Motor and/or sensory changes in affected areas of body

97
Q

what are the signs and symptoms of Parkinsons disease?

A

Rigidity, akinesia, tremor

98
Q

what investigations would be performed in a patient with anal fissures?

A

Digital rectal examination

99
Q

what investigations would be performed in a patient with medicine induced constipation?

A

Withdraw medicines and see if symptoms improve

100
Q

what investigations would be performed in a patient with hypercalcaemia?

A

Corrected serum calcium level >2.75

101
Q

what investigations would be performed in a patient with hypothyroidism?

A

Thyroid stimulating hormone level elevated in primary hypothyroidism, low in central hypothyroidism

102
Q

what investigations would be performed in a patient with diabetes mellitus?

A

Fasting blood sugar, random plasma glucose, abnormal oral glucose tolerance test

103
Q

what investigations would be performed in a patient with spinal cord lesion?

A

Imaging of spinal cord with CT of MRI

104
Q

what investigations would be performed in a patient with colonic stricture?

A

Endoscopic diagnosis by direct visualisation or by barium enema

105
Q

what investigations would be performed in a patient with colon cancer?

A

Endoscopy or barium enema/CT

106
Q

what investigations would be performed in a patient with Parkinson’s disease?

A

Clinical diagnosis

107
Q

what investigations would be performed in a patient with Parkinson’s disease?

A

Clinical diagnosis

108
Q

what is the treatment of acute constipation?

A

treat underlying cause
diet + lifestyle advice + laxatives or prunes

constipation with faecal impaction-evacuation measures

opioid induced constipation-methylnaltrexone

109
Q

what is the treatment of acute constipation?

A

treat underlying cause
diet + lifestyle advice + laxatives or prunes

constipation with faecal impaction-evacuation measures

opioid induced constipation-methylnaltrexone

110
Q

when would you consider IBS as a diagnosis?

A

Consider IBS if patient has had 6 month history of

  • abdominal pain, and/or
  • bloating, and/or
  • change in bowel habit
  • IBS is a diagnosis of omission, must rule out other conditions such as IBD before making diagnosis of IBS
111
Q

what are some other symptoms of IBS?

A

-abdominal bloating (more common in women than men), distension, tension or hardness
-symptoms made worse by eating
passage of mucus
-abdominal pain relieved by defecation or associated with altered bowel frequency stool form, in addition to 2 of the following 4 symptoms:altered stool passage (straining, urgency, incomplete evacuation)
-Features such as lethargy, nausea, backache and bladder symptoms may also support the diagnosis

112
Q

What are the red flags for IBS?

A

rectal bleeding
unexplained/unintentional weight loss
family history of bowel or ovarian cancer
onset after 60 years of age

113
Q

what primary care investigations can be performed on a patient with suspected IBS?

A

full blood count
ESR/CRP
coeliac disease screen (tissue transglutaminase antibodies

114
Q

what conditions cause loose stool habits?

A 
IBS
coeliac
colorectal cancer
IBD
diverticular
hyperthyroidism
115
Q

what conditions cause constipation?

A 
hypothyroidism
bowel obstruction (no movement)
116
Q

describe the joint aetiopathology of IBS, IBD, coeliac and colorectal cancer?

A

Virtually any GI condition that is inflammatory mediated damages the mucosa (including the brush border) and therefore impairs normal digestion, absorption, bowel movements etc. less things that should be absorbed will be absorbed so more passes straight through.

117
Q

describe the aetiopathology of thyroid disease and altered bowel habit?

A

The thyroid gland controls the activity of many organs. In hypothyroidism there is reduced everything including digestion, absorption and GI movement and in hyperthyroidism the opposite is the case

118
Q

what is the aetiopathology of diverticular disease?

A

Inflamed mucosa impairs normal digestion, absorption etc

119
Q

what is the aetiopathology of bowel obstruction?

A

Any form of blockage will completely stop bowel movement because the GI tract is a glorified tube. If things can only move in one direction and there’s a blockage, there’s nowhere else to go (until pressure builds up and you get a ruptured viscous)

120
Q

why is cancer staging important?

A

Curability of a tumour is usually inversely proportional to the tumour burden. Staging is the evaluation of the extent of disease via invasive and non-invasive diagnostic test.

121
Q

what is clinical staging?

A

based on examination, radiographs, isotopic scans, CT, and other imaging

122
Q

What is pathologic staging?

A

takes into account information from surgical procedures such as intraoperative palpation, resection of regional lymph nodes and/or tissue adjacent to tumour, biopsy

123
Q

what are the different aspects of the TMN staging system?

A

TNM=Tumour, Node, Metastasis
T1-4 = size of tumour (higher the number larger the tumour)
N0-N3 = nodal involvement
M0-M1 = absence or presence of metastases

With increased staging the tumour burden increases and curability decreases

124
Q

what does T1 indicate?

A

T1 = limited to mucosa and submucosa

125
Q

what does T2 indicate?

A

T2 = extension into but not through muscularis propria

126
Q

what does T3 indicate?

A

invasion of perirectal fat

127
Q

what does T4 indicate?

A

invasion of adjacent structures

128
Q

what does N0 indicate?

A

no involved lymph node

129
Q

what does N1 indicate?

A

fewer than 4 regional nodes involved

130
Q

what does N2 indicate?

A

more than four regional lymph nodes involved

131
Q

what does N3 indicate?

A

distant nodes involved

132
Q

what does M0 indicate?

A

no metastasis

133
Q

what does M1 indicate?

A

Distant metastasis

134
Q

what is the epidemiology of colonic cancer?

A

Third most common cancer in males (risk is 1 in 15), second in females (1 in 19) but incidence is higher in men.

More common with age (peaks in over 80s), incidence has increased since the 1970s

30% present with advanced disease (defined as mets/ locally invasive so resection can’t happen)

135
Q

what are the usual characteristics of colonic cancer?

A
  • Majority found in sigmoid colon & at rectosigmoid junction
  • Usually small, annular and ulcerated
  • Polyps:
136
Q

what are the types of polyps seen in colonic cancer?

A

villous adenoma
hamartomatous polyps
hyperplastic

137
Q

what type of polyp has the greatest chance of malignant transformation?

A

villous adenoma

138
Q

what is the risk with hamartomatous polyps?

A

syndromes are high risk for malignancy, but the polyps aren’t that serious

139
Q

what type of polyps have low risk of becoming malignant?

A

hyperplastic

140
Q

what investigations would be perfomed in a patient with suspected colonic cancer?

A

Bloods – FBC, WCC, CEA, CRP + ESR

Foecal occult (as part of screening programme/ in suspected bowel cancer)

Colonoscopy (with biopsy) – has been viewed as the reference standard for years; patients shouldn’t have major co-morbidities

Barium enema/ flexible sigmoidoscopy – offered to patients with major co-morbidities

CT colonography – doesn’t require sedation and is still somewhat sensitive but if a lesion is found, they’ll need colonoscopy anyway

PET CT? – looking for metastasis

141
Q

what are the clinical features of colonic cancer?

A
  • Significant, unintentional weight loss
  • Anorexia
  • Malaise
  • Blood in/ with stools
  • Mucous in stools (from tumour secretion)
  • Intestinal obstruction (can be acute, chronic or acute on chronic)
  • Bowel perforation
  • Evidence of mets: Jaundice/ abdominal distension from ascites/ hepatomegaly
142
Q

describe features of ascending colon cancer?

A
  • more likely to grow beyond mucosa
  • no bowel obstruction-> grows large, late diagnosis
  • can ulcerate and bleed->anaemia
  • unexplained weakness
143
Q

describe the features of descending colon cancer?

A
  • More likely to be ring-shaped infiltrating masses -> napkin-ring constriction
  • Napkin-ring constriction -> colicky pain
  • Constriction -> blood streaked stools = haematochezia
  • Change in bowel habit (can be diarrhoea, constipation or the two alternating)
144
Q

Who are the members of the MDT involved in cancer care?

A 
Surgeon
Medical oncologist 
Clinical oncologist
Haematologist
Pathologist
Clinical nurse specialist
Radiologist
Physiotherapist
Dietitian
occupational therapist (OT)
Radiographer
doctor or nurse who specialises in symptom control
Counsellor
psychologist.
145
Q

what is stage A in dukes classification of colon cancer?

A

tumour confined to mucosa

90-95% 5yr survival

146
Q

what is stage B1 in dukes classification of colon cancer?

A

tumour growth into muscularis propria

75-80% 5 yr survival

147
Q

what is stage B2 in dukes classification of colon cancer?

A

Tumour growth through muscularis propria and serosa (full thickness)
60% 5 year survival

148
Q

what is stage C1 in dukes classification of colon cancer?

A

tumour spread to 1-4 regional lymph nodes

25-30% 5 yr survival

149
Q

what is stage C2 in dukes classification of colon cancer?

A

Tumour spread to more than 4 regional lymph nodes

25-30% 5 yr survival

150
Q

what is stage D in dukes classification of colon cancer?

A

distant metastases to liver, lung, bones

<1% 5 yr survival

Block 32 GI and surgery (12 decks)

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