Colorectal Flashcards

1
Q

RIF pain differential

A
Appendicitis 
Pelvic inflammatory disease (PID) or tubo-ovarian abscess or ectopic
Endometriosis
Ovarian cyst or torsion
Ureterolithiasis and renal colic
Degenerating uterine leiomyomata
Diverticulitis
Crohn disease
Colonic carcinoma
Renal colic 
UTI
Constipation
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2
Q

'’Classic signs’’ of appendicitis

A
· Right lower quadrant (right iliac
fossa) abdominal pain
· Anorexia
· Nausea and vomiting
(Leukocytosis)
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3
Q

U/S features of appendicitis

A

a thickened wall >2 mm, increased
appendiceal diameter >6 mm, and free
fluid.

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4
Q

Common causes of LGIB

A
· Diverticulosis
· Angiodysplasia
· Colitis
· Neoplasia
· Haemorrhoids and other anorectal
disorders
· Drug related
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5
Q

Investigations for LGIB

A

Endoscopy > Colonoscopy > CT mesenteric angiography > Radiolabelled cell scanning

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6
Q

Hernia types comparison

A

Look at picture on phone

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7
Q

Dysentery differential

A
UC
Crohn's 
Amebiasis
Acute divericulosis
Bacterial/viral AGE
Psuedomembranous colitis
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8
Q

Smoking is bad in which, UC or Crohn’s?

A

Crohn’s

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9
Q

Severe acute attack of UC is:

A
more than six stools a day associated with 2 or more
of the following:
· Pyrexia
· Anaemia
· Tachycardia
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10
Q

Med management of UC

A
· Resuscitation
· Confirm the diagnosis usually with
gentle rigid or flexible
sigmoidoscopy Colonoscopy is not
indicated because of the risk of
perforation.
· Exclude infective diarrhoea even in
a patient known to suffer from
ulcerative colitis, with stool cultures
· Daily erect chest and abdominal
xrays.
· At least twice daily accessment by
both a medical and surgical
gastroenterologist.
· High dose intravenous steroids
· Within 3 to 5 days. If the patient
has not settled, consider surgery or
rescue therapy with cyclosporine
or anti TNF agents
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11
Q

Surgical indications for IBD

A

Emergency:
Toxic megacolon (colectomy)
Colonic perf
Massive haemorrhage

Urgent:
Failed medical therapy

Elective:
Chronic ill health
Risk of malignancy

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12
Q

SBO causes

A

Adhesions and hernias

Lumen: FB, bezoar, gallstone, enterolith
Wall: Crohn’s, neoplastic, intussiception
Outside: Intraabdominal sepsis

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13
Q

Rx of SBO

A
Immediate aggressive early fluid resuscitation
Replace electrolytes
Antibiotics if perforation is suspected. 
Keep nil per mouth with a
nasogastric tube (prevent pressure and voms) and urinary catheter
placed. 
Nonmechanical bowel obstruction must be
excluded as a differential diagnosis.
Majority will require surgery.
Adhesive bowel obstruction is
managed conservatively by ‘drip and
suck’ (intravenous line and nasogastric
tube) as long as there is no suspected
perforation. If a patient shows no signs
of improvement or deteriorates then
surgery for adhesiolysis may be
required.At surgery adhesions are
released, any non-viable bowel is
resected and anastomoses or stomas
made as required.
Hernias are usually reduced by the
standard hernia incision depending on
the site (i.e. inguinal, umbilical). The
bowel must be adequately assessed
for viability before being reduced.
Foreign bodies require a laparotomy
and an enterotomy (incision through
the bowel wall) to remove.
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14
Q

Rx of appendix abcess

A

CT or ultrasound guided percutaneous

drainage is the treatment of choice

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15
Q

Grading of haemorrhoids

A

1 - non-prolapsing internal
2- protrude when straining, reduce spontaneously
3- protrude spontaneously but require manual reduction
4- Chronic irreducible prolapse

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16
Q

Rx of haemorrhoids

A

Only if bother pt.
Medical - warm baths, high fibre, fluid intake, softners, , toilet habit change, analgesia
Non-surgical - rubber band ligation
Surgical - haemorrhoidectomy

17
Q

Rx anal fissures

A

Treat consipation/hard stools
Nitroglycerin, botox
Lateral sphincterotomy