Colonic Disease

Question 1

Predisposing factors for colorectal cancer

Answer 1

Neoplastic polyps
Smoking
IBD
Alcohol

Question 2

What drug is though to reduce the occurrence of colorectal cancer?

Answer 2

Aspirin

thought to inhibit polyp growth

Question 3

Clinical presentation of colorectal cancer

Answer 3

PR blood
Altered bowel habit or obstruction 
Tenesmus 
Weight loss 
Abdominal pain

Question 4

Investigations for colorectal cancer

Answer 4

FBC

Colono/sigmoidoscopy

Question 5

Where can colorectal cancer spread?

Answer 5

Lymphatic 
By blood (liver, lung, bone)

Question 6

What is dukes classification used to stage?

Answer 6

Colorectal cancer

Question 7

Describe dukes classification

Answer 7

A - limited to muscularis mucosa
B - extension through muscularis mucosa
C - involvement of regional lymph nodes
D - distant metastases

Question 8

What surgical procedure is most commonly used in emergency bowel obstruction?

Answer 8

Hartmann’s procedure

Question 9

Adjuvant chemotherapy reduces mortality in which dukes classification?

Answer 9

C

Question 10

What treatment is most commonly used in the palliation of colorectal cancer?

Answer 10

Radiotherapy

Question 11

What is the most common type of colorectal carcinoma?

Answer 11

Adenocarcinoma

Question 12

What are diverticulum?

Answer 12

Outpouching of the gut wall usually at sites of entry of perforating arteries

Question 13

What is diverticulosis?

Answer 13

Means that diverticula are present

Question 14

What is Diverticular disease?

Answer 14

Means that diverticula are symptomatic

Question 15

What is diverticulitis?

Answer 15

Inflammation of a diverticulum

Question 16

Why do diverticula form?

Answer 16

Lack of fibre in diet
Increased intraluminal pressure
Force mucosa to herniate through muscle layers of the gut at weak points

Question 17

Symptoms of diverticulitis

Answer 17

Abdominal pain (left sided colic relieved by defaecation) 
Altered bowed habit 
Pyrexia
Tender colon 
Generalise peritonism

Question 18

Investigations for diverticulitis

Answer 18

Blood test

CT scan

Question 19

Treatment of diverticulitis

Answer 19

IV fluids

Antibiotics (Cirpofloxacin, metronidazole)

Question 20

Complications of diverticular disease

Answer 20

Perforation (abscess formation -> surgery)
Fistula (into bladder)
Intestinal obstruction (usually after repeated acute episodes)
Haemorrhage

Question 21

What are haemorrhoids?

Answer 21

Disrupted and dilated anal cushions

Question 22

Causes of haemorrhoids

Answer 22

Constipation ip with prolonged straining
Congestion from a pelvic tumour
Pregnancy
Portal hypertension

Question 23

Symptoms of haemorrhoids

Answer 23

Bright red blood coating stools
Mucous discharge
Anaemia

Question 24

For all rectal bleeding what exam do you do?

Answer 24

Abdominal exam
PR exam
Proctoscopy
Sigmoidoscopy

Question 25

Classification of haemorrhoids

Answer 25

1st degree - remain in the rectum
2nd degree - prolapse through the anus on defaecation but spontaneously reduce
3rd degree - as for 2nd degree but require digital reduction
4th degree - remain persistently prolapsed

Question 26

Treatment of 1st degree haemorrhoids

Answer 26

Fluid and fibre
Topical analgesics and stool softener
Topical steroids for short periods only

Question 27

Treatment for 2nd/3rd degree haemorrhoids

Answer 27

Band liganding

Sclerosants

Question 28

Treatment for 4th degree haemorrhoids

Answer 28

Surgery