Colorectal Flashcards
what biologic can be used in IBD?
Infliximab is a popular choice in managing complex peri anal crohns. It is absolutely vital that all sepsis is drained prior to starting therapy.
what class of drug should be avoided in IBD?
NSAIDs - they can precipitate symptoms
in which IBD is smoking protective?
UC
what is seen radiologically as a “lead pipe colon”?
UC
what is seen radiologically as “apple core appearance”?
Crohn’s
what is seen radiologically as a “coffee bean sign”?
volvulus
what is the definition of IBD?
chronic relapsing-remitting diseases characterised by acute, non-infectious inflammation of the gut. idiopathic in origin. mainly consists of Crohn’s and Ulcerative Colitis.
what are the common symptoms between Crohn’s and UC?
increased risk of Cancer (UC - colonic, Crohn’s - large and small bowel)
weight loss
fatigue and malaise
risk of toxic megacolon
associated with arthritis (RA), ankylosing spondylitis and sacroiliitis, uveitis and iritis
define toxic megacolon
colon is >5.5cm
can be caused by IBD or C. diff.
accompanied by abdominal distension (bloating), and sometimes fever, abdominal pain, or shock
location of Crohn’s
discontinuous skip lesions anywhere in the GIT
can get perianal disease and mouth ulcers
transmural granulomatous inflammation
Crohn’s appearance
cobblestoning on colonoscopy
apple-core on X-Ray
features of Crohns’s
fistulas (abnormal connections)
strictures (narrowing leading to obstruction)
abscesses (perianal and intra-abdominal)
malabsorption
location of UC
continuous disease starting in the rectum and advancing proximally until the terminal ileum
can get rectal disease
mucosal inflammation +/- pan-colonic inflammation
UC appearance
crypt abscesses
lead pipe colon
features of UC
faecal urgency/ incontinence
tenesmus
bloody stool and PR mucus
adhesions
medical management of UC
mesalazine (2-4g/day) topical 5-ASA derivative prednisolone steroid azathioprine for recurrent attacks ciclosporin/infliximab (anti-TNF antibody) acutely for steroid-refractory disease if severe
medical management of Crohn’s
mesalazine (4g/day)
prednisolone/budesonide if unresponsive
metronidazole, azathioprine and anti-TNF factor antibodies under consultant supervision
steroids are not used for more than three months as there is an increased risk of sepsis and mortality in CD
surgical management of UC
panproctocolectomy is curative of UC
restorative proctocolectomy with ileal pouch to anus anastomosis is common
surgical management of Crohn’s
non-curative in Crohn’s but is used to repair strictures and fistulae
liver disease associated with IBD
autoimmune hepatitis (UC) gallstones (CD) sclerosing cholangitis (UC>CD)
DDx for IBD
IBS coeliacs disease anal fissure (very painful) diverticulitis colitis colonic tumour ovarian tumour endometriosis C. diff
ABC of IBS
IBS is a diagnosis of exclusion
Abdo pain
Bloating
Change in bowel habits
IBS symptoms
chronic (>6 months) recurrent abdominal pain/ discomfort plus 2 of:
relief by defecation, altered stool form, altered bowel frequency
can also get urgency, incomplete evacuation, abdominal bloating and PR mucus
IBS management
symptomatic control –> diet & lifestyle, CBT or pharmacotherapy
laxatives for constipation (must increase water intake)
bulking agent or codeine (for diarrhoea)
colic/ bloating –> oral antispasmotics (e.g. mebeverine)
visceral hypersensitivity –> amitriptyline
what symptoms would make you suspect coeliac disease?
diarrhoea plus weight loss or anaemia (especially iron or B12)
pathophysiology of coeliac disease
small bowel T-cell immune response to gluten leading to villous atrophy and malabsorption
what must be done before a gluten screening blood test ?
the pt must have had gluten in their diet for the 6 weeks prior
if positive then a biopsy must be done
treatment and complications of coeliac disease
life-long gluten avoidance
increased risk of malignancy (lymphoma) if pt continues to eat gluten
other complications include anaemia, osteoporosis, hyposplenism, neuropathies and dermatitis herpetiformis
appendicitis presentation
umbilicus pain (visceral peritoneum) initially that localises to the RIF (parietal peritoneum)
RIF tenderness, low-grade fever, tachycardia and anorexia
+ve Rovsing’s sign (pain in RIF when palpating the LIF)
acute diverticulitis
.inflammation of diverticular
left sided severe, cramping abdominal pain with nausea, constipation and diarrhoea
complications - strictures and obstruction, fistula, abscesses, haemorrhage
intestinal obstruction
.small bowel - early faecal vomiting, late constipation, valvulae conniventes
large bowel - early absolute constipation, late vomiting, presence of haustration
ileus
a painful non-mechanical form of obstruction
due to C. diff, IBD or gallstone ileus
ileostomy
usually RIF
sprouted
more liquidly (contains digestive enzymes and is alkaline)
high frequency of discharge, more likely to cause electrolyte problems
colonostomy
usually LIF
flush with the skin
faecal discharge
what makes a good anastomoses?
good blood supply
good seal -ends are of equal length
not under tension
