colorectal - benign

Question 1

how does lower GI bleeding present

Answer 1

bright or dark blood (right side) per rectum

Question 2

indications for surgery in lower GI bleed (4)

Answer 2

60+ // continued bleeding after endoscopy // recureent bleed // CVD + hypotension

Question 3

what should all lower GI bleeding patients have

Answer 3

history, exam, PR, proctoscopy

Question 4

features of haemorrhoidss

Answer 4

painless pr bleeding // itch // (pain or incontinence if thombosed)

Question 5

what differentiates internal vs external haemorrhoids

Answer 5

external = below dentate line (+sore) // internal = above dentate line

Question 6

grade I–>IV haemorrhoids

Answer 6

I = no prolapse // II = prolapse on defecation + reduce // III manually reduced // 4 = no reduced

Question 7

lifestyle and topic haemorrhoid treatment

Answer 7

increase fibre + fluid // topical anaesthetics + steroids

Question 8

1st line non surgical haemorrhoid mx

Answer 8

band ligation (> slcerotherapy)

Question 9

mx of persistent haemorrhoids

Answer 9

surgery

Question 10

how do thrombosed haemorrhoids present

Answer 10

v painful + tender lump // purple, oedema, tender

Question 11

mx thrombosed haemorrhoids

Answer 11

within 72 hours –> excise // otherwise stool softner, ice pack, analgesia

Question 12

RF for anal fissure (3)

Answer 12

consiption // IBD // STI

Question 13

features anal fissure + location

Answer 13

painful, bright red PR bleeding // posterior midline

Question 14

if fissures are found outwith normal location what should be considered

Answer 14

other causes eg crohns

Question 15

1st + 2nd line mx of acute anal fissure (<1 week)

Answer 15

bulk forming laxatives –> lactulose + lubricant –> top lidocaine

Question 16

mx of chronic anal fissure >1 week (3)

Answer 16

topical GTN –> sphincterotomy –> butulinum toxin

Question 17

who normally gets perianal abscess

Answer 17

40 yr old men

Question 18

presentation perianal abscess

Answer 18

pain worse sitting // hardended tissue // pus

Question 19

bacteria of perianal abscess

Answer 19

e coli (if staph A think skin infection)

Question 20

invx perianal abscess

Answer 20

inspection PR // transperineal USS

Question 21

RF perianal abscess (3)

Answer 21

IBD // DM // malignancy

Question 22

1st line mx perianal abscess

Answer 22

incision + drainage

Question 23

how does fissure in ano present

Answer 23

bright red blood // painful after defication

Question 24

what causes fissure in ano

Answer 24

constipation

Question 25

how do anal fistulas usually form

Answer 25

from previous ano-rectal disease

Question 26

what is angiodysplasia

Answer 26

vascular deficiency in GI tract –> bleeding

Question 27

symptoms angiodysplasia

Answer 27

GI bleed // iron anaemia // aortic stenosis // old

Question 28

invx angiodysplasia

Answer 28

colonoscopy +/- mesenteric angio

Question 29

mx angiodysplasia (3)

Answer 29

endoscopic cautery // tranexamic acid // oestrogen

Question 30

what are villous adenomas

Answer 30

colonic polyps that can be malignant –> secrete lots of mucous

Question 31

what is pilonideal disease

Answer 31

sinuses + cysts form near upper cleft of buttocks

Question 32

cause Pilonidal disease

Answer 32

hair debris collecting in pores

Question 33

features Pilonidal disease

Answer 33

acute inflammation –> abscess (pain, discharge)

Question 34

mx Pilonidal disease

Answer 34

asymptomatic = hygiene // symptomatic = incision + drain, close secondary intention