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AMEDEX MIX > AMC 2 > Flashcards

AMC 2 Flashcards

1
Q

Commonest GIT malignancy: mainly adenocarcinoma

A

Colorectal cancer

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2
Q

Second most common cause of death from cancer in Western society

A

Colorectal cancer

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3
Q

Generally men over 50 years (90% of all cases)

A

Colorectal cancer

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4
Q

Two-thirds in descending colon and rectum

A

Colorectal cancer

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5
Q

Colorectal cancer Predisposing factors

A

Ulcerative colitis (longstanding)
Familial: familial adenomatous polyposis (FAP), hereditary non-polyposis colorectal cancer
Colonic adenomata
Decreased dietary fibre
Age >50 years

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6
Q

Alternating constipation with spurious diarrhoea

A

Colorectal cancer

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7
Q

Unsatisfactory defecation

A

Colorectal cancer

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8
Q

Rectal examination—this is appropriate because many cancers are found in the lowest 12 cm
and most can be reached by the examining finger

A

Colorectal cancer

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9
Q

If obstructing, there is a risk of rupture of the caecum.

A

Colorectal cancer

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10
Q

Spread
Lymphatics → epigastric and para-aortic nodes
Direct → peritoneum
Blood → portal circulation

A

Colorectal cancer

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11
Q

FOBT: immunochemical tests (e.g. Inform and InSure) do not require dietary or medication
restriction

A

Colorectal cancer

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12
Q

Colonoscopy ± biopsy
CT colonography (investigation of choice)
Serum CEA level

A

Colorectal cancer

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13
Q

Ultrasonography and CT scanning not useful in primary diagnosis; valuable in detecting
spread, especially hepatic metastases

A

Colorectal cancer

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14
Q

PET-CT scanning (if available) is useful for follow-up

A

Colorectal cancer

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15
Q

If FOBT is positive—investigate by colonoscopy or by flexible sigmoidoscopy.

A

Colorectal cancer

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16
Q

An FOBT every 2 years is now recommended for all people from 50–74 years

A

Colorectal cancer

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17
Q

FOBT is safer, cheaper and more convenient than colonoscopy.

A

Colorectal cancer

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18
Q

Do not use the
CEA blood test as a screening tool.

A

Colorectal cancer

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19
Q

Colonoscopy as screening is only recommended in 2% of the population

A

Colorectal cancer

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20
Q

Moderate risk (family history category 2): 2 yearly FOBT from 40–49, then colonoscopy
every five years from 50–74 years.

A

Colorectal cancer

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21
Q

High risk (family history category 3): 2 yearly FOBT from 35–44, then colonoscopy every 5
years from 45–74 years

A

Colorectal cancer

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22
Q

flexible sigmoidoscopy and rectal biopsy for those with ulcerative colitis

A

Colorectal cancer

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23
Q

Refer to a bowel cancer specialist to plan appropriate surveillance

A

Colorectal cancer

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24
Q

Early surgical excision is the treatment, with the method depending on the site and extent of the
cancer

A

Colorectal cancer

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25
Q

Dukes classification gives a guide to prognosis

A

Colorectal cancer

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26
Q

The survival rates for
Dukes C cancer have improved with more effective chemotherapy.

A

Colorectal cancer

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27
Q

Follow-up includes:
CEA antigen
colonoscopy
abdominal imaging: ultrasound or CT scan of liver

A

Colorectal cancer

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28
Q

Patients with constipation or change in bowel habit of recent onset without obvious cause need
further investigation.

A

Colorectal cancer

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29
Q

intestinal disorder characterised by abnormal frequency and liquidity
of faecal evacuations.

A

Diarrhoea

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30
Q

In Australia most infective
cases are viral.

A

Diarrhoea

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31
Q

vomiting and diarrhoea =

A

gastroenteritis

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32
Q

diarrhoea (only) =

A

enteritis

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33
Q

The characteristics of the stool provide a useful guide to the site of the bowel
disorder.

A

Diarrhoea

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34
Q

Disorders of the upper GIT tend to produce diarrhoea stools that are copious,
watery or fatty, pale yellow or green.

A

Diarrhoea

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35
Q

Colonic disorder tends to produce stools that are small, of variable consistency,
brown and may contain blood or mucus

A

Diarrhoea

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36
Q

Acute gastroenteritis should be regarded as a diagnosis of exclusion.

A

Diarrhoea

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37
Q

is more likely to be due to protozoal infection (e.g. amoebiasis,
giardiasis or Cryptosporidium) than bacillary dysentery.

A

Chronic diarrhoea

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38
Q

Certain antibiotics can cause an overgrowth of Clostridium difficile, which produces
pseudomembranous colitis.

A

Diarrhoea

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39
Q

Coeliac disease, although a cause of failure to thrive in children, can present at any
age

A

Diarrhoea

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40
Q

In disorders of the colon, the patient experiences frequency and urgency but
passes only small amounts of faeces.

A

Diarrhoea

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41
Q

can be classified broadly into four types:
acute watery diarrhoea
bloody diarrhoea (acute or chronic)
chronic watery diarrhoea
steatorrhoea

A

Diarrhoea

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42
Q

Common causes are:
gastroenteritis/enteritis:
bacterial: Salmonella sp., Campylobacter jejuni, Shigella sp., enteropathic Escherichia coli,
Staphylococcus aureus (food poisoning)
viral: rotavirus (50% of child hospital admissions),1 norovirus, astrovirus, adenovirus

A

Acute diarrhoea

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43
Q

Unexpected weight loss
Persistent/unresolved
Blood in stool
Fever
Overseas travel
Severe abdominal pain
Family history: bowel cancer, Crohn disease

A

Red flag pointers for diarrhoea

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44
Q

Irritable bowel syndrome was the commonest cause of

A

Chronic diarrhoea

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45
Q

In children, coeliac disease and cystic fibrosis can present as

A

chronic diarrhoea

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46
Q

although not causing true diarrhoea, can present as loose, redcurrant jelly-like
stools and should not be misdiagnosed (as gastroenteritis).

A

intussusception

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47
Q

must also be considered
in the onset of acute diarrhoea and vomiting

A

Appendicitis

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48
Q

may lead to the
haemolytic uraemic syndrome or thrombotic thrombocytopenic purpura, particularly in children

A

Infection with enterohaemorrhagic strains of E. coli (e.g. O157:H7, O111:H8)

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49
Q

Clue: Think of it with atypical gastroenteritis and bloody diarrhoea

A

Avoid antibiotics

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50
Q

This potentially fatal colitis can be caused by the use of any antibiotic, especially clindamycin,Page 413
lincomycin, ampicillin and the cephalosporins (an exception is vancomycin).

A

Pseudomembranous colitis

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51
Q

It is usually due to
an overgrowth of C. difficile, which produces a toxin that causes specific inflammatory lesions,
sometimes with a pseudomembrane.

A

Pseudomembranous colitis

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52
Q

Clinical features
Profuse, watery diarrhoea
Abdominal cramping and tenesmus ± fever
Within 2 days of taking antibiotic (can start up to 4 to 6 weeks after usage)
Persists 2 weeks (up to 6) after ceasing antibiotic

A

Pseudomembranous colitis

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53
Q

Diagnosed by characteristic lesions on sigmoidoscopy and a tissue culture assay and/or PCR for
C. difficile toxin

A

Pseudomembranous colitis

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54
Q

Treatment2
Cease antibiotic
Hygiene measures to prevent spread

A

Pseudomembranous colitis

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55
Q

Mild to moderate: metronidazole 400 mg (o) tds for 10 days
Severe: vancomycin 125 mg (o) qid for 10 days
Consult with specialist. Beware of toxic megacolon.

A

Pseudomembranous colitis

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56
Q

Central colicky abdominal pain indicates involvement of the

A

small bowel

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57
Q

while lower
abdominal pain points to the

A

large bowel

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58
Q

profuse bright red bleeding, consider

A

diverticulitis or carcinoma of colon

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59
Q

small
amounts with mucus or mucopus, consider

A

inflammatory bowel disorder

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60
Q

Diarrhoea at night suggests

A

organic disease

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61
Q

the stools are distinctively pale, greasy, offensive, floating and difficult to flush.

A

steatorrhoea

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62
Q

‘Rice water’ stool is characteristic of

A

cholera

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63
Q

inflammatory bowel disease, colonic polyps, carcinoma, infective especially Shigella,
Salmonella, Campylobacter, E. coli, amoebiasis, colitis (pseudomembranous, ischaemic).

A

Bloody diarrhoea

64
Q

Antibody tests, total IgA (e.g. IgA transglutaminase for

A

coeliac disease

65
Q

Haemagglutination tests for

A

amoebiasis

66
Q

Fluid loss with dehydration, electrolyte loss (Na+, K+, Mg+, Cl-)
Vascular collapse
Hypokalaemia

A

Complications of diarrhoea

67
Q

DxT acute diarrhoea + colicky abdominal pain ± vomiting →

A

gastroenteritis

68
Q

DxT (young adult) diarrhoea ± blood and mucus + abdominal cramps
→

A

inflammatory bowel disease (UC/Crohn)

69
Q

DxT as above + constitutional symptoms ± eyes/joints →

A

Crohn disease

70
Q

DxT altered bowel habit: diarrhoea ± constipation ± rectal bleeding ±
abdominal discomfort →

A

colorectal carcinoma

71
Q

DxT profuse watery diarrhoea + abdominal cramps and increasing
distension (on antibiotics) →

A

pseudomembranous colitis (Girotra’s
triad)

72
Q

DxT variable diarrhoea/constipation + abdominal discomfort + mucus
PR + flatulence →

A

irritable bowel syndrome

73
Q

The common causes are coeliac disease, chronic pancreatitis and postgastrectomy.

A

malabsorption

74
Q

Bulky, pale, offensive, frothy, greasy stools
Stools difficult to flush down toilet
Weight loss
Prominent abdomen
Failure to thrive (in infants)
Increased faecal fat
Signs of multiple vitamin deficiencies (e.g. A, D, E, K)

A

malabsorption

75
Q

It is widely underdiagnosed because most patients present with non-GIT symptoms, such as
tiredness.

A

Coeliac disease

76
Q

Classic tetrad: diarrhoea, weight loss, iron/folate deficiency, abdominal bloating

A

Coeliac disease

77
Q

Characteristic duodenal biopsy: villous atrophy (key test)

A

Coeliac disease

78
Q

IgA transglutaminase antibodies (>90% sensitivity and specificity)

A

Coeliac disease

79
Q

Associations
Iron-deficiency anaemia
Malignancy, especially lymphoma, GIT
Type 1 diabetes

A

Coeliac disease

80
Q

Dermatitis herpetiformis

A

Coeliac disease

81
Q

Diet control: high complex carbohydrate and protein, low fat, lifelong gluten-free (no wheat,
barley, rye and oats)

A

Coeliac disease

82
Q

Give pneumococcal vaccination (increased risk of pneumococcus sepsis)

A

Coeliac disease

83
Q

This is due to atheromatous occlusion of mesenteric vessels (low blood flow)

A

Ischaemic colitis

84
Q

sharp abdominal pain in an elderly person with bloody diarrhoea (low blood flow)
or
periumbilical pain and diarrhoea about 15–30 minutes after eating

A

Ischaemic colitis

85
Q

associated with fever, diarrhoea
and/or vomiting,

A

Acute gastroenteritis

86
Q

Mainly rotavirus (developed countries) and adenovirus: viruses account for about 80%

A

Acute gastroenteritis

87
Q

Bacterial: C. jejuni and Salmonella sp. (two commonest), E. coli and Shigella sp.
Protozoal: G. lamblia, E. histolytica, Cryptosporidium
Food poisoning—staphylococcal toxin

A

Acute gastroenteritis

88
Q

correction of fluid and electrolyte loss.

A

Acute gastroenteritis

89
Q

The most accurate way to monitor dehydration is to weigh the child, preferably without
clothes, on the same scale each time.

A

Acute gastroenteritis

90
Q

If acute invasive or persistent Salmonella are present, give antibiotics (ciprofloxacin or
azithromycin)

A

Acute gastroenteritis

91
Q

Avoid
Drugs: antidiarrhoeals, anti-emetics and antibiotics

A

Acute gastroenteritis

92
Q

Fluid loss (mL) = % dehydration × body weight (kg) × 10

A

Acute gastroenteritis

93
Q

Aim to give more (replace fluid loss) in the first 6 hours.
Rule of thumb: give 100 mL/kg (infants) and 50 mL/kg (older children) in first 6 hours.

A

Acute gastroenteritis

94
Q

Diarrhoea often follows acute gastroenteritis when milk is reintroduced into the diet (some
recommend waiting for 2 weeks).

A

Sugar intolerance

95
Q

Stools may be watery, frothy, smell like vinegar and tend to
excoriate the buttocks. They contain sugar.

A

Sugar intolerance

96
Q

Remove the offending sugar from the diet.
Use milk preparations in which the lactose has been split to glucose and galactose by enzymes,
or use soy protein.

A

Sugar intolerance

97
Q

A clinical syndrome of loose, bulky, non-offensive stools with fragments of undigested food in a
well, thriving child.

A

Toddler’s diarrhoea (‘cradle crap’)

98
Q

Diagnosis: duodenal biopsy (definitive).
Treatment: remove gluten from diet.

A

Coeliac disease

99
Q

severe diarrhoea, especially if associated with
blood or mucus, may be a feature of a more serious bowel infection such as amoebiasis.

A

Traveller’s diarrhoea

100
Q

is caused
by E. coli, which produces a watery diarrhoea within 14 days of arrival in a foreign country.

A

Most traveller’s diarrhoea

101
Q

If moderate to severe, azithromycin is
recommended for 2–3 days.

A

traveller’s diarrhoea

102
Q

Any traveller with persistent diarrhoea after visiting less developed countries, especially India
and China, may have a

A

protozoal infection such as amoebiasis or giardiasis

103
Q

If there is a fever and blood or mucus in the stools, suspect

A

amoebiasis

104
Q

is
characterised by abdominal cramps, flatulence and bubbly, foul-smelling diarrhoea

A

Giardiasis

105
Q

anti-emetic injection (for severe vomiting) prochlorperazine IM, statim
or
metoclopramide IV, statim
Antidiarrhoeal preparations:
(avoid if possible, but loperamide preferred) loperamide (Imodium) 2 caps statim then 1 after
each unformed stool (max. 8 caps/day)

A

treatment of diarrhoea

106
Q

diarrhoea in adults and older children is usually self-limiting and does not require
antibiotic treatment

A

Bacterial

107
Q

Campylobacter, Salmonella, Shigella and E. coli are the most common causes.

A

Bacterial diarrhoea

108
Q

use oral
rehydration solution 2–3 L orally over 24 hours if mild to moderate dehydration.

A

Bacterial diarrhoea

109
Q

If severe,
intravenous rehydration with N saline is recommended.

A

Bacterial diarrhoea

110
Q

Only treat if symptoms have persisted for more than 48
hours.

A

Bacterial diarrhoea

111
Q

Recommended empirical therapy is ciprofloxacin or norfloxacin.

A

Bacterial diarrhoea

112
Q

cotrimoxazole (double strength) 1 tab (o) 12 hourly for 5 days: use in children (children’s
doses)
or
norfloxacin 400 mg (o) 12 hourly for 5 days (preferred for adults)
or
ciprofloxacin 500 mg (o) bd for 5 days

A

Shigella dysentery (moderate to severe)

113
Q

tinidazole 2 g (o), single dose (may need repeat)
or
metronidazole 400 mg (o) tds for 7 days

A

Giardiasis

114
Q

Antibiotics are not generally advisable, but if severe or prolonged, use:
ciprofloxacin 500 mg (o) bd for 5–7 days
or
azithromycin 1 g (o) day, then 500 mg for 6 days
or
ceftriaxone IV or ciprofloxacin IV if oral therapy not tolerated

A

Salmonella enteritis

115
Q

Salmonella is a notifiable disease; infants under 15 months are at risk of

A

invasive
Salmonella infection.

116
Q

metronidazole 600–800 mg (o) tds for 6–10 days
plus
diloxanide furoate 500 mg (o) tds for 10 days

A

Amoebiasis (intestinal)

117
Q

bloody diarrhoea and mucus
colonic pain and fever
urgency to visit toilet and feeling of incomplete defecation
constitutional symptoms including weight loss and malaise

A

Inflammatory bowel disease3

118
Q

extra-abdominal manifestations such as arthralgia, low back pain (spondyloarthropathy), eye
problems (iridocyclitis), liver disease and skin lesions (pyoderma gangrenosum, erythema
nodosum)

A

Inflammatory bowel disease3

119
Q

Investigations include FBE, vitamin B12 and folate, LFTs (abnormal enzymes), HLA-B27, faecal
calprotectin (if normal, no intestinal inflammation; if abnormal, needs colonoscopy) and
lactoferrin

A

Inflammatory bowel disease

120
Q

Mainly a disease of Western societies
Mainly in young adults (15–40 years)
High-risk factors—family history, previous attacks, low-fibre diet
Recurrent attacks of loose stools

A

Ulcerative colitis

121
Q

Begins in rectum (continues proximally)—affects only the colon: it usually does not spread
beyond the ileocaecal valve
An increased risk of carcinoma after 7–10 years

A

Ulcerative colitis

122
Q

Diagnosis
Faecal calprotectin: a sensitive test
Proctosigmoidoscopy: a granular red proctitis with contact bleeding
Barium enema: characteristic changes

A

Ulcerative colitis

123
Q

regional enteritis, granulomatous colitis

A

Crohn disease

124
Q

Recurrent diarrhoea in a young person (15–40 years)
Blood and mucus in stools (less than UC)
Colicky abdominal pain (small bowel colic)

A

Crohn disease

125
Q

Right iliac fossa pain (confused with appendicitis)
Constitutional symptoms (e.g. fever, weight loss, malaise, anorexia, nausea)

A

Crohn disease

126
Q

Signs include perianal disorders (e.g. anal fissure, fistula, ischiorectal abscess), mouth ulcers

A

Crohn disease

127
Q

Skip areas in bowel: ½ ileocolic, ¼ confined to small bowel, ¼ confined to colon, 4% in upper
GIT

A

Crohn disease

128
Q

Sigmoidoscopy: ‘cobblestone’ appearance (patchy mucosal oedema)

A

Crohn disease

129
Q

Colonoscopy: useful to differentiate from UC
Biopsy with endoscopy

A

Crohn disease

130
Q

5-aminosalicylic acid derivatives (mainly UC): sulfasalazine (mainstay), olsalazine,
mesalazine. Usually start with these agents

A

Ulcerative colitis

131
Q

corticosteroids (mainly for acute flares): oral, parenteral, topical (rectal foam, suppositories
or enemas)
for severe disease, immunomodifying drugs (e.g. azathioprine, cyclosporin, methotrexate)
and anti-TNF and biological agents (e.g. adalimumab, vedolizumab, infliximab)

A

Ulcerative colitis

132
Q

Surgical treatment: reserve for complications; avoid surgery if possible

A

Ulcerative colitis

133
Q

Typically in younger women (21–40 years)
Any age or sex can be affected
May follow attack of gastroenteritis/traveller’s diarrhoea
Cramping abdominal pain (central or iliac fossa)

A

Irritable bowel syndrome (IBS)

134
Q

Pain usually relieved by passing flatus or by defecation
Variable bowel habit (constipation more common)
Diarrhoea usually worse in morning—several loose, explosive bowel actions with urgency

A

Irritable bowel syndrome (IBS)

135
Q

Often precipitated by eating
Faeces sometimes like small hard pellets or ribbon-like

A

Irritable bowel syndrome (IBS)

136
Q

relieved by defecation
onset associated with a change in stool frequency
onset associated with a change in form (appearance) of stool (loose, watery or
pellet-like)

A

Rome III diagnostic criteria for irritable bowel syndrome

137
Q

Age of onset >50 years
Fever
Unexplained weight loss
Rectal bleeding
Pain waking at night
Persistent daily diarrhoea/steatorrhoea
Recurrent vomiting

A

Red flag pointers for non-IBS disease

138
Q

Major change in symptoms
Mouth ulcers
↑ CRP, ESR
Anaemia
Family history of bowel cancer or IBD

A

Red flag pointers for non-IBS disease

139
Q

is a problem of the colon (90% in descending colon) and is related to lack
of fibre in the diet. It is usually symptomless.

A

Diverticular disorder

140
Q

Present in one in three people over 60 years (Western world)

A

Diverticular disorder

141
Q

infected diverticula and symptomatic

A

Diverticulitis

142
Q

Intermittent cramping lower abdominal pain in LIF
Tenderness in LIF
Rectal bleeding—may be profuse (± faeces)

A

Diverticular disorder

143
Q

Bleeding—may cause massive lower GIT bleeding
Abscess
Perforation

A

Diverticular disorder

144
Q

Peritonitis
Obstruction (refer CHAPTER 24 )
Fistula—bladder, vagina

A

Diverticular disorder

145
Q

WBC and ESR—to determine inflammation
Sigmoidoscopy
Barium enema

A

Investigations Diverticular disorder

146
Q

Management
It usually responds to a high-fibre diet.
Avoidance of constipation.

A

Diverticular disorder

147
Q

Oral antidiarrhoeal drugs are contraindicated in

A

children

148
Q

can readily provoke dystonic reactions in children, especially if young
and dehydrated

A

Anti-emetics

149
Q

is invariably self-limiting (lasts 2–5 days). If it lasts longer than 7
days, investigate with culture and microscopy of the stools.

A

Acute diarrhoea

150
Q

If diarrhoea is associated with episodes of facial flushing or wheezing, consider

A

carcinoid syndrome

151
Q

Recurrent pain in the right hypochondrium is usually a feature of

A

IBS (not gall
bladder disease).

152
Q

Recurrent pain in the right iliac fossa is more likely to be

A

IBS than appendicitis.

153
Q

if a patient’s diarrhoea resolves spontaneously on hospital
admission.

A

Consider alcohol abuse

154
Q

diarrhoea 30 minutes after meal →

A

mesenteric ischaemia

155
Q

It is enterically
transmitted and arises from the ingestion of contaminated food, such as shellfish, or water.

A

Hepatitis A

156
Q
A

AMEDEX MIX (7 decks)

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