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Y5 colorectal > bowel pathology > Flashcards

bowel pathology Flashcards

1
Q

what is a closed loop bowel obstruction and give an example of one

A

where there is a second obstructing point proximally eg a LBO with a competent ileocaecal valve

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2
Q

3 main causes of SBO in order

A

1) adhesions
2) hernias
3) tumours

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3
Q

O/E of a bowel obstruction

A

tympanic to percuss and guarding

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4
Q

why would you do a lactate blood for a bowel obstruction

A

to see if it was ischaemic

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5
Q

what lines are seen on a SBO xray

A

valvulae conniventes (which are complete lines across the bowel)

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6
Q

Main Mx points for a bowel obstruction

A

NGT for decompression, NBM, fluids, referral to surgery

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7
Q

pattern of vomiting in SBO vs LBO

A

SBO has early bilious vomit where as LBO has early constipation and then late faeculant vomit

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8
Q

LBO causes

A

1) cancer
2) diverticular disease
3) volvulus

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9
Q

what can the categories of obstruction be split into

A

intraluminal (foreign body, faecal compaction), mural (cancer) or extramural (hernias or volvulus)

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10
Q

how can you spot bowel necrosis on CT

A

pneumatosis intestinalis, oedematous and thickened walls, less contrast infiltration

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11
Q

complications of bowel obstruction

A

perforation, peritonitis, dehydration, hypovolaemic shock

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12
Q

gold standard investigation for a bowel obstruction

A

CT AP with contrast

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13
Q

what is angiodysplasia

A

vascular abnormality of GI tract - cause AVMs which can be congenital or acquired. May present with malaena or haematchezia.

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14
Q

Mx of angiodysplasia

A

can be conservative but may need interventional radiology

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15
Q

what can cause a pseudo obstruction of the bowel

A

adynamic bowel due to interruption of the ANS which can be caused by recent surgery, electrolyte imbalance, neurological disease

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16
Q

how does the anatomy of the intestine change as we move down

A

it becomes smaller in diameter and there are more folds

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17
Q

what is a true diverticular

A

an outpouching of the bowel wall which contains all three layers (the mucosa, submucosa and the serosa)

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18
Q

why is the rectum normally spared in diverticulosis

A

the out pouching normally forms where the blood vessels penetrate at the tenaei coli. The rectum does not have these.

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19
Q

RF for diverticulosis

A

obesity, age and low fibre diet (due to constipation which then increases the luminal pressure)

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20
Q

what is diverticular disease

A

the presence of diverticular and symptoms (pain, change in bowel habit, PR bleed)

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21
Q

what is the pain usually like in diverticular disease

A

colicky and relieved by defecation

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22
Q

how should diverticular disease by treated

A

increased fibre in diet and can use bulk forming laxatives

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23
Q

what is diverticulitis

A

when the diverticular become inflamed, normally due to bacterial growth

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24
Q

how does diverticulitis present

A

acute abdo pain, normal LIF and systemic signs

25
Q

when would you suspect a diverticular abscess

A

signs of diverticulitis and a mass in LIF

26
Q

Mx of diverticular abscess

A

<5cm - can use Abx but if bigger need surgical drainage

27
Q

imagine for acute diverticulitis vs non acute diverticular disease

A

acute - CT AP with contrast
non acute - flexible sigmoidoscopy

28
Q

how is acute diverticulitis managed

A

IV abx and supportive.

29
Q

complications of diverticulitis

A

recurrence, stricture, fistula (colovesicular and colovaginal) and perforation

30
Q

how may a colovesciular fistula present

A

pneumaturia / UTI

31
Q

what kind of bowel obstruction does a volvulus cause

A

closed loop

32
Q

why is volvulus most likely to occur in sigmoid (in older adults)

A

longest mesenteric attachment

33
Q

RF of volvulus

A

age, chronic constipation or chronic laxative use, high fibre diet

34
Q

IX for volvulus

A

bloods (as for any obstruction to rule out a pseudobstruction –> U+E, Ca, TFT
-G+S for surgery
-CT AP with contrast

35
Q

Mx of volvulus

A

fluid resus, decompression by sigmoidoscope

36
Q

what is acute mesenteric ischaemia

A

sudden interruption in blood supply to the mesentery. Normally used by embolus (RF - Afib). Can also be caused by thrombosis. Bowel becomes ischaemic –> necrotic

37
Q

how does acute mesenteric ischameia present

A

acute onset pain, pain disproportionate to clinical findings, high lactate, GI symptoms, may be in shock

38
Q

IX for mesenteric ischaemia

A

ABG, bloods, mesenteric angiography or if patient is deteriorating do a laparotomy, CT angiography

39
Q

Mx for mesenteric ischaemia

A

laparotomy - can do embolectomy or may need to remove necrotic part of the bowel

40
Q

pathway that a bowel cancer develops along

A

normal epithelium –> abnormal epithelial –> small adenoma –> large adenoma —> carcinoma

41
Q

screening test fr bowel cancer

A

FIT test very 2 years from 60 -74

42
Q

HNPCC gene (lynch)

A

MSH2 (autosomal dom) - associated with 2) endometrial and then ovarian and gastric

43
Q

FAP gene

A

APC (autosomal dominant)

44
Q

how is Right sided cancer most likely to present

A

anaemia + mass

45
Q

colonoscopy with biopsy is gold standard for bowel cancer diagnosis, if this cannot be used (patient is too frail), what can be used instead

A

CT colonography

46
Q

what imaging is done for cancer in rectum and why

A

MRI to see if it has invaded the mesorectal fascia which is very important for staging

47
Q

what does anyone having a bowel op get

A

Abx (gentamicin / metronidazole due to gram negative bacteria) and DVT prophylaxis

48
Q

when a defunctioning loop ileostomy is used, when is the distal anastomosis checked

A

after 6 weeks using a dye

49
Q

when is a high anterior resection appropriate

A

when the cancer is 5cm clear of the anus, this is a good option because it leaves the anal sphincter in tact

50
Q

what op is done to remove cancer in the transverse colon

A

extended right hemicolectomy

51
Q

when is a APR done

A

for low rectal tumours when they are <5cm from anus (removes anal sphincters too so has to have end colostomy)

52
Q

how and when would an anastomotic leak present

A

5-7 days post surgery and patient present with fever/pain/delirium

53
Q

Mx for anastomotic leak

A

IVabx and exploratory laparotomy

54
Q

how can be wound infection be treated after bowel surgery

A

VAC (helps wounds heal faster generally)

55
Q

RF of a post op ileus

A

opioids, age, pelvic surgery, electrolyte imbalance and intraoperative intestinal handling

56
Q

Presentation of a post op ileus

A

high NGT output, distension, failure to pass stool or flatulance, vomiting
O/E - ABSENT bowel sounds

57
Q

Ix for post op ileus

A

FBC, U+E, CTAP with contrast

58
Q

MX of post op ileus one a anastomotic leak is ruled out

A

NBM, daily bloods, encourage mobilisation, reduce opiate analgesia

(preventative measures - limited handing of intestine and limit opioid analgesia)

59
Q
A

Y5 colorectal (8 decks)

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