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Key Points > Bowel > Flashcards

Bowel Flashcards

1
Q

STOMAS

A

resection, diversion/rest, decompression

early: infection, hge, isch, high output, retraction, adhesion, obstruction
late: prolapse, hernia, obstruction, intuss, stenosis, fistula, dermatitis, psych

ileo: spout, RHS, liquid, 1-2day, IBD Hx
colo: flush, LHS, semi/formed, daily bag change

*anastamoses: gastrograffin

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2
Q

Appendix Sx2

A

abdo pain: dull central => sharp RIF
constipation, anorexia, N&V

rebound/percussion
guarding, peritonitis, shallow/still/cough
Rovsing’s, PR tender, ?tender mass
psoas (hip extension) or cope/obturator (flexion)
tachyC, tachyP, fever, fetor, flush

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3
Q

Appendix Alvarado

A 
migrating pain: KEY
anorexia (appe unlikely if hungry)
N&V
tender RIF (2pt): KEY
rebound/percussion: KEY
elevated temp: usually low grade
leucocytosis (2 points)
shifted left

5-6 possible; 7-8 probably, 9-10 v. likely

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4
Q

Appe Mx (Ix + Tx)

A 
must do b-HCG and amylase
UA (?UTI), FBC, UE, CRP
PR, PV (?PID/gynae)
USS: ?fatal delay; good for ?O&G
CT: ?fatal delay; good for ?Dx
AXR/eCXR: rarely used
laparoscopy: early Dx + resection

ABx once op decided (Cef + met)
?delayed closure/drainage if perf
exclude CRC, Meckel’s, PID, IBD
drain abscesses

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5
Q

Appe perf complications

A 
mass, abscess
local or general peritonitis
adhesions, fistulae, obstruction
portal pyaemia
retained faecolith (chronic infection)
infertility (tubal)
overwhelming sepsis + death

post-op: haematoma, infection, dehiscence, abscess, obstruction, hernia

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6
Q

Meckel’s

A

aSx, intuss/volvulus, diverticulitis (‘appe’), perf, PUD, hge, cyst, fistula

2s: 2-4% prev, 2” long, 2’ from IC valve, 2yo, 2x M, 2 types (gastric or heterotopic panc)

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7
Q

obstruction 4s

A

Sx: vom (+/-N&V), colic, constipation, distention

signs: distension, tinkling, empty PR, dehydration

SBO: adhesions, herniae, IBD/stricture, intuss
LBO: CRC, volv, diverticular, stricture
other: gallstone, ileus (L/S)/pseudo (L),

Tx: resus (NBM + fluids), drip and suck (most resolve 4/7), enema/evac, surgery
*surgery: refractory, ischaemia, tumour/hernia, perf, competent IC valve

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8
Q

Obstruction complications

A

distension + oedema: electrolytes, toxins, dehyd
bacteria: infection, ulceration
perforation (closed loop)
incomplete obstruction: slow CRC, visible peristalsis
strangulation/ischaemia/necrosis (peritonism, sharp, more ill)

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9
Q

paralytic ileus/pseudo-obstruction

A

ileus: SB > LB; hypoK, leak, sepsis, opiates, surgery
pseudo: LB; AKI, trauma, metabolic, drugs

no pain, absent BS
contrast enema diagnostic

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10
Q

Coeliac

A

tTG and EMA IgA gluten enteropathy

steatorrhoea/dd, weight loss, lethargy, pain, derma herpi

anaemia (mixed/normo), hypoalbo/Ca/vit D

Ab + Bx (jej/duo): flat mucosa, atrophy, hyperplasia, wcc

small lymphoma/AC risk

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11
Q

malabsorption investigations

A

FBC: anaemia + deficiency (Fe, B12, Ca)
high INR, lipids, serology

stool: sudan (fat globules)
barium: diverticula, Crohn’s
breath hydrogen: bacteria overgrowth

endoscopy + biopsy
ERCP: biliary/chronic panc

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12
Q

malabsorption DDx

A 
coeliac
Crohn's disease
reduced bile: PBC, obstruction
pancreatic: CF, CA, chronic/pseudocyst
small bowel: Whipple (PAS), enzymes, infiltration, resection
infection/overgrowth:
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13
Q

Chronic Panc

A

calcified proteins => obstruction

epigastric pain, erythema ab igne, brittle DM

analgesia, Creon, Multivate, DM control, diet
pancreatectomy, pancreaticojejunostomy

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14
Q

DD mechanisms

A

osmotic: malsorp => substances; watery
secretory: secretion + reduced absorption of fluid/electro

inflamm/mucosal: damage => fluid loss +/- blood

motility: altered peristalsis; anxiety, ANS/DM, IBS

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15
Q

DD history

A

Red Flags: nocturnal, blood/mucus, responds to fasting, weight loss

duration, previous, ‘FUN’, tenesmus/incomplete
volume, colour, smell, blood/mucus
assoc: pain, vom, systemic, food

PMH/DH: RDT, panc, systemic, lactase, ABx
SH: travel, drugs
FH: IBD, coeliac, neoplasm

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16
Q

Acute DD

A

watery: cholera, E. coli, rota/adenovirus, AAD, giardia
blood: campylo, shigella, EHEC, salmo, Yersinia, C. diff, schisto, IBD, diverticula, amoeba

17
Q

Chronic DD

A

colon: CA, IBD, IBS, colitis
SB: coeliac, IBD, bile acid, lactase, bacteria, ischaemia, RDT, lymphoma, infection

panc: chronic panc, CF, cancer
endo: hyperthy, DM, addison’s, carcinoid
other: IBS, surgery, drugs, overflow

18
Q

IBS

A

3d/month for 3/12
discomfort/pain, defaecate, frequency, form
abn freq/form/passage (strain, urgency, tenesmus)
bloating/distension, gynae and urinary Sx
sleep, back, headache, fatigue, hallitosis

  • > 40yo, acute (<6/12), anorexia/weight, nocturnal
  • exclude ovarian/CRC
  • Ix if other symptoms (e.g. dysphagia, reflux)

Tx: fibre, fluid, antispasm, antacid, ?TCA, CBT

19
Q

IBD - presentation/patho

A

Crohn’s: pain + weight loss + dd; perianal + systemic common
*skip, mouth-anus, transmural, cobblestone + fissure

UC: bloody dd; systemic = severe; tenesmus; non-smoker
*continuous, colonic, mucosal, pseudopolyps

20
Q

IBD - investigations and RF

A

RF: smoking (CD), FHx, GE, appendicitis, diet

Ix: bloods (incl. CRP/ESR, Fe, B12, folate, albumin) and cultures
scope + Bx, Ba (enema/follow-through), AXR, MRI (pelvic)

21
Q

IBD - treatment

A

Crohn’s: steroids (IV if severe); CST/immosupp; cipro/inflixi for fistulae

UC: ASA + CST (PR + IV CST if severe); ASA +/- immosupp;

surgery: complications/refractory; cure in UC, recurs in CD

22
Q

IBD (UC) severity

A

Mild: <4 stools/day, no systemic, CRP/ESR normal

Mod: 4-6 stools/day

Severe: systemic (Fever, tachy, Hb, alb), 6+ stools

*severe = Admit!

23
Q

IBD complications

A

CD: fistulae, strictures, adhesions, fissures, abscess/mass, episcleritis

UC: PSC and uveitis more common, TMC, CRC

both: arthritis (Commonest), ulcers, NASH, VTE, renal stones

24
Q

Diverticular disease

PR, scope, CT/USS

A

symptomatic: colic, bowel habit, nausea, flatulance
Tx: diet, mebeverine (SM relax)

complications: 
perforation (common Hartmann's)
peritonitis, abscess
stricture, fistulae, obstruction
bleeding: usually painless and large
25
Q

diverticulitis

eCXR, USS, contrast CT

A

inflammation: severe colic, constipation, LHS ‘appe’, systemic, mass

may be peritonic: tender, gaurding, high temp (?septic)

*bleeding = not diverticulitis (mutually exclusive)

Tx: bowel rest, ABx, drain (abscess), op (perf)

26
Q

CRC presentation

A

bowel habit, bleeding (incl. FOB), constitutional, pain (rare), pruritus ani, mass

30% emergencies: obstruction, perf, hge

RHS: often aSx; IDA, weight, pain
LHS: PR bleed, obstruction, tenesmus, PR mass

Red flags: tenesmus, nocturnal, age, habit + PR bleed, IDA, mass

27
Q

CRC RF

A

age, male, PMH Ca, FHx
polyposis (FAP, HPNCC, Lynch)
IBD (UC pancolitis)
western diet (low fibre, fat, meat), ciggs, alc, obesity

*anal Sqcc: HPV (Warts), infection; RDT +CTX

28
Q

TMN staging

A

Stage I: T1 (submucosa) or T2 (MP)

Stage IIa: T3 (subserosa)
Stage IIb: T4 (local invasion)

Stage IIIa: T1/2 + N1 (1-3 nodes)
IIIb = T3/4; IIIc = N2 (>3 nodes)

Stage IV: any M1

29
Q

Modified Duke’s Staging

A

A: within MP; S1 (T1/2)
B: subserosa/invasion; S2 (T3/4)
C: lymph nodes (C1 = local, C2 = apical); stage 3 (N1/2)
D: mets; stage 4 (M1)

*5ys: 80-95%; 66-85%; 35-65%; 5-7%

30
Q

CRC Mx (Ix + Tx)

A

FBC (IDA), FOB (Screening), scope +Bx, enema/CT pneumocolon

staging: LFTs, CT/MRI, liver USS
CEA (monitoring), DNA (?familial)

surgery: hemi/sigmoid/AR/APR, liver mets
hge, infection, CVS/VTE, AKI, damage, ileus/adhesions
RDT: neo for rectal, post if high recurrence risk
CTX: adjuvant for Dukes’ C+
Pall: CTx, surgery, stent

31
Q

CRC Screening + f/u

A

screening: FOB 2-yearly (60-69yo), sigscope (LHS), colonoscopy (high risk)

f/u: CEA 3-monthly + scope 3-yearly

32
Q

Haemorrhoids

3/7/11

A

bright PR bleed, prolapse, incontinence
pruritis, mucus d/c, anaemia, pain (thrombosis)

RF: constipation, stress, trauma, pelvic pressure/portal HTN

1st: no prolapse; 2nd: spont reduction; 3rd: digital; 4th: persistent prolapse

Mx: scope (Dx); diet (fibre, fluids, no caff), lax, PK
IF-coag, sclerosant, ligation, cryo, ectomy (4th)

33
Q

perianal disease

A

Fistula: abscess/CD/diverticular/CA; MRI/EUS

  • goodsall: anterior straight, posterior/>3cm curve to midline
  • Tx: excision/open + drain; incont risk

fissure (6/9/antlat): extreme pain, lasts hours; PR bleed, pruritus, constipation; IBD/sinus/skin tag

  • Tx: scope (dx), diet/softener, LA cream, SM relax (GTN, CCB)
  • sphincterotomy if refractory

infection: red, swollen, tender, fever, d/c
* abscess: surgery emergency; severe pain; GA drain
* pilonidal: natal cleft; excise tract

Key Points (20 decks)

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