Congenital and Cancer of Lower GI Flashcards
What is Meckel’s diverticulum?
The persistence of the vitelline duct which forms an outpouching
Who tends to get Meckel’s diverticulum?
Symptomatic cases are usually young children
x2 indicence in males
What are the signs/symptoms of symptomatic Meckel’s diverticulum?
Fresh painless rectal bleeding
Symptoms mimicking appendicitis
What investigations can help diagnose Meckel’s diverticulum?
FBC
Radioisotope scan
AXR
CT
What complications can Meckel’s diverticulum cause?
Ulceration, perforation and haemorrhage if it contains gastric mucosa
Diverticulitis and acute inflammation
Obstruction
Malignant changes (rare)
What is the management of symptomatic Meckel’s diverticulum?
Surgical removal
The rule of _ is helpful in Meckel’s diverticulum?
2s
What is atresia?
The congenital absence or abnormal closure of a body cavity
Who presents with atresia?
Newborn babies - present from birth
What are the signs of oesophageal atresia?
US shows increase in amniotic fluid
Swallowing or breathing difficulties
What are the signs of intestinal atresia?
Signs of obstruction
Green bile vomit
Swollen abdomen
What are the signs of biliary atresia?
Jaundice
What is the treatment for atresia?
Surgery
What is meconium?
A newborn’s first stool
What is meconium ileus?
Intestinal obstruction caused by meconium that is difficult to pass because it is too sticky
Who tends to get meconium ileus?
90% of patients have cystic fibrosis
What are the signs/symptoms of meconium ileum?
Meconium is slow to pass
Green bile vomit
Swollen abdomen
What is omphalocele?
The intestinal loop does not return to the abdomen during development and instead herniates out into the umbilical cord and is covered in peritoneum
What is the treatment for omphalocele?
Surgery
What is gastrochisis?
Protrusion of abdominal contents through a hole in the anterior abdominal wall lateral to the umbilical cord, not covered in peritoneum
What is the treatment for gastroschisis?
Surgery
What causes intestinal malrotation?
The intestines aren’t anchored to the back wall correctly and can move and twist
What are Ladd’s bands?
Abnormal tissue that can wrap around and cause obstructions of the small intestines
What is a volvulus?
Where a loop of the intestine is wrapped around its own mesentery
Who presents with intestinal malrotation?
Kids, 90% before age of 1
Most have other deformities of the GI tract
What are the symptoms of intestinal malrotation?
Vomiting of green bile
Abdominal pain and the drawing of legs to the chest
Abdominal distension
Failure to thrive
How is intestinal malrotation diagnosed?
Vomiting of green bile is assumed malrotation until proven otherwise
Contrast AXR is diagnostic
What is the management for intestinal malrotation?
Ladd’s procedure
What is the process of Ladd’s procedure
- Reduction of midgut volvulus
- Complete dissection of Ladd’s bands
- Base of mesentery is widened
- Prophylactic appendectomy because basically all these patients get appendicitis
What is intussusception?
One segment of the intestine is pushed inside another, blocking the intestine
Where does intussusception commonly happen?
Ileocaecal junction
Who is intussusception most common in?
Children, particularly under three
Most have other anatomical abnormalities
Adults with perevious abdominal surgery
What symptom of intussusception is an exam buzzword?
Blood and mucous stool, described as ‘red-current jelly stool’ or resembling cranberry sauce
What are the symptoms of intussusception?
Blood and mucous stool
Vomiting and diarrhoea
Lethargy
Abdominal mass
What investigations are used in intussusception?
USS
AXR/CT
Air or barium enema
What is the treatment for intussusception?
Enema fixes 90% by increasing pressure which pops the intussusception out
Surgical release
What is an anal fissure?
Small tear in the mucosa that lines the anus
Who are anal fissures more common in?
The very young or old
What are the causes for anal fissures?
Passage of large/hard stools Chronic diarrhoea Anal intercourse Childbirth IBD Anal cancer HIV TB Syphillis
What are the symptoms/signs of anal fissures?
Pain during or after bowel movements
Bright red blood on paper after wiping
Visible crack in skin or small lump
What is the conservative treatment for anal fissures?
Topical nitroglycerin
Topical anaesthetic
Botox injection
What is the surgical treatment for anal fissures?
Lateral internal sphincterotomy - small incision made into the sphincter muscles
What is the major type of colerectal carcinoma?
Adenocarcinoma
What are the risk factors for colorectal carcinomas?
Smoking Red meat Low fibre diet IBD Familiar adenoma polyposis Lynch syndrome
What are the symptoms of colorectal cancer?
Anaemia Pain Change in bowel habits Tenesmus Abdominal mass
What are the investigations used for colorectal carcinoma?
Colonoscopy
Flexible sigmoidoscopy
Capsule endoscopy
CT colonography
