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Y4 Gastroenterology and Hepatology > Colorectal Disease > Flashcards

Colorectal Disease Flashcards

1
Q

What is an inflammatory cause of bowel urgency

A

Proctitis

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2
Q

Coffee brown vomit indicator of?

A

UGIB

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3
Q

Fresh red vs dark red blood in stools

A

Fresh red means more recent, severe

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4
Q

What can cause Tenesmus

A

IBS or IBD- Incomplete emptying
Can be IBS or IBD- due to inflm of rectum pushing up tgt.
May be tumor- DRE to feel for lump

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5
Q

Weight loss in colorectal disease likely due to

A

Inflmtn or neoplastic

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6
Q

What is Thomas’ sign

A

ampullary carcinoma- steatorrhea + melena - silver stool

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7
Q

Tx for IBS

A

FODMAP diet

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8
Q

What diseases suggest increase likelihood of IBD

A

Diabetes, thyroid, RA, Ank spond, psoriasis- (immune mediated inflammatory disorder)

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9
Q

How does smoking affect risk of CD and UC

A

Smoker more likely to get CD but decreases UC risk while smoking, doubles after quitting smokinng

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10
Q

What drugs may cause microscopic colitis, what is common Px and which pop is it more common in

A

antidepressants like SSRIS and PPIs like Lansaprazole, profuse water diarrheoa, more common in older women

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11
Q

Tx for microscopic colitis

A

budesonide

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12
Q

In what disease can dairrheoa be exacerbated by alcohol

A

IBS

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13
Q

What is one parasitic cause of diarrheoa in travellers

A

amoebiasis

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14
Q

What is a histological finding in coeliac disease and what other tests can be done

A
  • Lymphocytes in villi and epithelium
    -Anti-TTG (if gluten has been taken)
  • Gastroscopy @ duodenum
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15
Q

Red flag for colon cancer

A

Change in bowel habit over age of 50

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16
Q

Another AID common in IBD pts

A

Hyperthyroidism-
heat intolerant, losing weight, horrible diarrhoea

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17
Q

Dx and Tx for SIBO

A

Rifaximin course- see if it resolves. Lactulose can see if bacteria is metabolising but not very specific

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18
Q

Sx and Tx of Bile Acid Malabsorbtion

A
  • Secretory Diarrhoea, Steatorrhoea
  • Colestyramine
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19
Q

Where is B12 absorbed

A

TI

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20
Q

What tumours may cause diarrheoa

A

NETS - due to carcinoid syndrome, serotonin is produced. If meta to liver, may have diarrheoa, wheezing, hot flushes

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21
Q

General Ix for Diarrheoa

A
  • coeliac serology on almost all pts esp those young
  • FC to exclude CD or UC
  • Qfit - above 10 cant exclude cancer if hv symptoms , need to do colonscopy
  • CT colonoscopy
  • CT CAP esp if hv weight loss
    SB MRI for intestinal CD- hyper enhanced or narrowed
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22
Q

5 Yr intermmitent Sx, 3/day, mushy and hard rock stool alternating, FC <20 - likely Dx and possible other Sx

A
  • Mixed type IBS
  • Abd pain better when move bowels
  • Sx worse on bread, milk, tomatoes and diet drinks
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23
Q

6mo mushy stools, 4.day on bad say, BS=6, Normal 1 EOD, BS-4
No nocturnal urgency
Weight loss
Assoc abdominal pain
Pain better when bowels moved
Worse with bread
Likely Dx?
Other Sx?
PMHx?

A
  • Coeliac, Dematitis herpetiformis- rash on arms, knees, assoc with coeliac
  • FMhx thyroid
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24
Q

6mo prog fluffy stools
7/day BS=6
Urgency and 2 ep incont
Bleeding mixed in stool
Overnight x2 /2 weeks
Weight loss
Rash on shins
FC >2000
Anaemic
Likely Dx?
Ix and Obs?

A
  • Low ani-TTG
    Erythema nodosum - rash on shins, may be in IBD
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25
Q

80+ yo
4 wk explosive watery diarrheoa
Bad - 4 day , BS=7
2 ep incont
Ondanston 4mg TDS
Cocodamol
Likely Dx?
XR appearace?
FC, RBC and anti-TTG?

A
  • Drugs can lead to overflow diarrhoea- slow bowel movement- impacted stool
  • Speckled appearrance on X ray
  • Low FC
  • Slightly anaemic,
  • Low anti-TTG
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26
Q

2mo light grey porridge like stools
Diff to flush smelly
Oil droplets
Prev alc dep
Recurrent abd pain
Likely Dx?
Ix?
Tx?

A
  • Pancreatitis (calcified) , possibly due to alcohol
  • BM= 18
  • Vit ADEK all low
  • Faecal elastase low pancreatic exocrine insufficient BUT may give false +ve in very water diarrheoa
  • Usually give creon as tx
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27
Q

64 YO male
1 mo abd pain
Worse 1-2 h after eating
Eat small meals
Incr stool freq 2-3 day
Current smoker, prev MI and TIA
No weight loss

A

Mesenteric ischemia- stenosis in gut

28
Q

Factors that increase the risk of bowel cancer

A

Smoking, alcohol, increased BMI, red/processed meat, TIIDM

29
Q

Polyposis related colorectal cancer syndrome vs nonpolyposis

A

Serrated polyposis syndrome vs Lynch syndrome

30
Q

3 pathways to CRC

A

Adenoma-cancer (70-90%), chromosomal instability from APC mutation then RAS activation or loss of TP53
Serrated neoplasia (10-20%), primary RAS/ RAF mutations followed by CPG island mutation
Microsatellite instability (2 -7%), Germline mutations in MMR genes (MSH2,6, MLH1,3, PMS 2,6) - Lynch syndrome

31
Q

Sx of CRC

A

Occult or overt rectal bleeding
Change in bowel habit
Anaemia
Abd pain
MAY BE ASx

32
Q

Dx for CRC

A
  • Colonoscopy + pathology (staining for hist subtype, grading, invasion etc. , can confirm presence of high grade dysplasia +tumour based marked, MSI)
  • CT CAP for staging
  • MRI (if at rectum) , required for loco-regional rectal cancer staging
  • CT colonoscopy for incomplete/ inadequate colonoscopy, old patients etc.
33
Q

How to manage early polyp cancer

A

Via en-bloc endoscopy like EMR / SED during endoscopy

34
Q

General Mx for CRC

A
  • Surgery
  • Chemo/radiotherapy
35
Q

Chemoprophylaxis for lynch syndrome pts

A

Aspirin

36
Q

When should colonoscopy be oferred to the public fo bowel cancer screening

A

> 55yo, or occult blood in stool, or IBD

37
Q

Sx of LGIB

A

PR bleeding, haemochezia ( passage of altered blood and stool), breathlessness, headache, cheat pain and fatigue ( 4 Sx of anaemia), and dizziness, blackout, collapse ( 3 Sx of shock)

38
Q

PMHx for LGIB

A

Diverticular disease, chronic liver disease, recent surgery/endoscopy

39
Q

What drugs may increase risk of LGIIB

A

DOACs, warfarin

40
Q

Bloods for LGIB

A

FBC, U and E, LFT, clotting, lactate

41
Q

Causes of LGIB

A

Diverticular bleeding ( most common for acute), haemorrhoids, anal fissures, ( subacute/chronic)
angiodysplasia, IBD, rectal ulcers,
rectal polapse, rectal varices, colorectal cancer, post-polypectomy, radiation colitis/ proctitis

42
Q

Dx of LGIB

A

Colonoscopy
CT angiogram ( 1st line if pt shocked), catheter angiography with embolisation should be performed.
Colonoscopy if pt shocked but CT angiogram not clear

43
Q

What score to classify LGIB, and what is the benchmark, what are the factors

A

Oakland score, <= - minor bleed, discahrge w/ OP Ix, >8 - major bleed, hopsitalisation for assess., resusc and Ix

Factors include Age, gender, previous LGIB adm, DRE findings, HR, SBP, Hb

44
Q

Mx of LGIB

A

Endoscopic - clips as first line +/- Adr. injxn, heater prob, heamosprat as last resort, APC for coagulation therapy, Thrombin/glue injxn

Interventional radioolgy- embolisation of bleeding vessels with coils, liquid agents and particals, but ischaemia possible in up to 24%

Surgery

45
Q

Sx of IDA

A

May be aSx, or have breathlessness, fatigue, angina, angular stomatitis, koilonychia, restless leg syndrome, papophagia

46
Q

Pathological causes of IDA -

A

Neoplasia, IBD, peptic ulcer, vascular malformation eg. angiodyplasia, haematuria, gynaecological blood loss

Coeliac and Crohn’s, Hypochlorohydria -atrophic gastritis, H. pylori and gastrectomy/bypass

47
Q

Is IDA macro or micro cytic and hypo or hyper chromic

A

micro, hypo

48
Q

What should be first measured for IDA and what are the caveats

A

Ferritin most specific, true IDA if ferritin low, but may be elevated in inflmt states/ infxn

49
Q

Iron studies- what should be seen in IDA

A

Decreased serum iron, transferrin saturation, increased serum transferrin, soluble transferrin receptor and TIBC, ferritin decreased or normal

50
Q

What to do if Dx of IDA is in doubt

A

Trial oral iron for 2-4 weeks, if Hb rise >10g/L in 2 weeks, suggestive of IDA

51
Q

Ix in IDA

A

Bi-directional endoscopy in men and post meno women, CT colonoscopy if multiple co-morbidities

Urinalysis for microscopic haematuria, coeliac serology, Ix of small bowel if no other cause found

52
Q

Colour of rectal bleeding

A

Bright red

53
Q

How can SoBoE be present in pts with CRC- bloods??

A

Pts may have microcytic anaemia

54
Q

First line investigation in pt with microcytic anaemia and suspected ca

A

endoscopy first, then colonoscopy if nothing found

55
Q

Where is squamous cell cancer found in the GI tract

A

only anus

56
Q

What are the categories for staging CRC

A
  • T
    • T1 - mucosa/submucosa
    • T2 - muscle
    • T3- serosa
    • T4- outside
  • N
    • 1-3
    • 3-7
    • > 7
  • M
    • 0/1 if there’s metastasis
57
Q

Tx for rectal ca

A

Resection - may need to remove sigmoid colon

58
Q

When should adjuvant chemotherapy be given for caecal cancer

A

for those fit enough, or node positive, or bad Duke’s B (T4, poor diff., lymphovasc inv. etc.)

59
Q

Side effect of CAPOX

A

Peri neuropathy

60
Q

Ix for rectal cancer

A

Will need full colonoscopy for distal polyps
- Look for resection margin → TMA
- May need radiotherapy pre-operatively to down stage disease and chemo to stop widespread of ca
- Neoadjuvant (preop) radioT can result in 30% red. in local RR
- No overall mort. red. for any XRT ref.
- Long course given prior to pt w/ any high risk features
- Short course don’t get chemo

61
Q

Stage T3/4, N+ M1 is stage what cancer? how to treat?

A

Stage 4 ca, just palliative intent with Sx control ( pain, profuse diarrheoa, obstructive sx)
- Can resect obst, put stent to reat obst, and bring out defunctioning stomas laprascopically

62
Q

What to do for qFIT +ve pts who are older ( check benchmark)

A

Colonoscopy to rule out cancer

63
Q

Observation vs resection for adenocarcinoma

A
  • High risk factors
    • Poor diff,
    • Venous invasion
    • Lymphatic inv,
    • distance to deep margine <1mm,
    • If none of these than >99% cured by polypectomy alone ( can consider cured for polyp cancer once removed)
64
Q

What should be done if pedunculated polyps is found on colonoscopy

A

Usually excise it with snare polypectomy then do histology

65
Q

Dx of anal fissures or haemorrhoidal bleeding

A

Haemorrhoidal bleeding is bright red and occurs during or after defecation. Proctoscopy can be used to make the diagnosis, but individuals who have altered bowel habit and those who present over the age of 40 years should undergo colonoscopy to exclude coexisting colorectal cancer. Anal fissure should be suspected when fresh rectal bleeding and anal pain occur during defecation.

66
Q

Risk

A

Y4 Gastroenterology and Hepatology (4 decks)

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