Colorectal Flashcards
RIF pain differential
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
'’Classic signs’’ of appendicitis
· Right lower quadrant (right iliac fossa) abdominal pain · Anorexia · Nausea and vomiting (Leukocytosis)
U/S features of appendicitis
a thickened wall >2 mm, increased
appendiceal diameter >6 mm, and free
fluid.
Common causes of LGIB
· Diverticulosis · Angiodysplasia · Colitis · Neoplasia · Haemorrhoids and other anorectal disorders · Drug related
Investigations for LGIB
Endoscopy > Colonoscopy > CT mesenteric angiography > Radiolabelled cell scanning
Hernia types comparison
Look at picture on phone
Dysentery differential
UC Crohn's Amebiasis Acute divericulosis Bacterial/viral AGE Psuedomembranous colitis
Smoking is bad in which, UC or Crohn’s?
Crohn’s
Severe acute attack of UC is:
more than six stools a day associated with 2 or more of the following: · Pyrexia · Anaemia · Tachycardia
Med management of UC
· 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
Surgical indications for IBD
Emergency:
Toxic megacolon (colectomy)
Colonic perf
Massive haemorrhage
Urgent:
Failed medical therapy
Elective:
Chronic ill health
Risk of malignancy
SBO causes
Adhesions and hernias
Lumen: FB, bezoar, gallstone, enterolith
Wall: Crohn’s, neoplastic, intussiception
Outside: Intraabdominal sepsis
Rx of SBO
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.
Rx of appendix abcess
CT or ultrasound guided percutaneous
drainage is the treatment of choice
Grading of haemorrhoids
1 - non-prolapsing internal
2- protrude when straining, reduce spontaneously
3- protrude spontaneously but require manual reduction
4- Chronic irreducible prolapse