Congenital and Cancer of Lower GI

Question 1

What is Meckel’s diverticulum?

Answer 1

The persistence of the vitelline duct which forms an outpouching

Question 2

Who tends to get Meckel’s diverticulum?

Answer 2

Symptomatic cases are usually young children

x2 indicence in males

Question 3

What are the signs/symptoms of symptomatic Meckel’s diverticulum?

Answer 3

Fresh painless rectal bleeding

Symptoms mimicking appendicitis

Question 4

What investigations can help diagnose Meckel’s diverticulum?

Answer 4

FBC
Radioisotope scan
AXR
CT

Question 5

What complications can Meckel’s diverticulum cause?

Answer 5

Ulceration, perforation and haemorrhage if it contains gastric mucosa
Diverticulitis and acute inflammation
Obstruction
Malignant changes (rare)

Question 6

What is the management of symptomatic Meckel’s diverticulum?

Answer 6

Surgical removal

Question 7

The rule of _ is helpful in Meckel’s diverticulum?

Answer 7

2s

Question 8

What is atresia?

Answer 8

The congenital absence or abnormal closure of a body cavity

Question 9

Who presents with atresia?

Answer 9

Newborn babies - present from birth

Question 10

What are the signs of oesophageal atresia?

Answer 10

US shows increase in amniotic fluid

Swallowing or breathing difficulties

Question 11

What are the signs of intestinal atresia?

Answer 11

Signs of obstruction
Green bile vomit
Swollen abdomen

Question 12

What are the signs of biliary atresia?

Answer 12

Jaundice

Question 13

What is the treatment for atresia?

Answer 13

Surgery

Question 14

What is meconium?

Answer 14

A newborn’s first stool

Question 15

What is meconium ileus?

Answer 15

Intestinal obstruction caused by meconium that is difficult to pass because it is too sticky

Question 16

Who tends to get meconium ileus?

Answer 16

90% of patients have cystic fibrosis

Question 17

What are the signs/symptoms of meconium ileum?

Answer 17

Meconium is slow to pass
Green bile vomit
Swollen abdomen

Question 18

What is omphalocele?

Answer 18

The intestinal loop does not return to the abdomen during development and instead herniates out into the umbilical cord and is covered in peritoneum

Question 19

What is the treatment for omphalocele?

Answer 19

Surgery

Question 20

What is gastrochisis?

Answer 20

Protrusion of abdominal contents through a hole in the anterior abdominal wall lateral to the umbilical cord, not covered in peritoneum

Question 21

What is the treatment for gastroschisis?

Answer 21

Surgery

Question 22

What causes intestinal malrotation?

Answer 22

The intestines aren’t anchored to the back wall correctly and can move and twist

Question 23

What are Ladd’s bands?

Answer 23

Abnormal tissue that can wrap around and cause obstructions of the small intestines

Question 24

What is a volvulus?

Answer 24

Where a loop of the intestine is wrapped around its own mesentery

Question 25

Who presents with intestinal malrotation?

Answer 25

Kids, 90% before age of 1 | Most have other deformities of the GI tract

Question 26

What are the symptoms of intestinal malrotation?

Answer 26

Vomiting of green bile Abdominal pain and the drawing of legs to the chest Abdominal distension Failure to thrive

Question 27

How is intestinal malrotation diagnosed?

Answer 27

Vomiting of green bile is assumed malrotation until proven otherwise Contrast AXR is diagnostic

Question 28

What is the management for intestinal malrotation?

Answer 28

Ladd's procedure

Question 29

What is the process of Ladd's procedure

Answer 29

1. Reduction of midgut volvulus 2. Complete dissection of Ladd's bands 3. Base of mesentery is widened 4. Prophylactic appendectomy because basically all these patients get appendicitis

Question 30

What is intussusception?

Answer 30

One segment of the intestine is pushed inside another, blocking the intestine

Question 31

Where does intussusception commonly happen?

Answer 31

Ileocaecal junction

Question 32

Who is intussusception most common in?

Answer 32

Children, particularly under three Most have other anatomical abnormalities Adults with perevious abdominal surgery

Question 33

What symptom of intussusception is an exam buzzword?

Answer 33

Blood and mucous stool, described as 'red-current jelly stool' or resembling cranberry sauce

Question 34

What are the symptoms of intussusception?

Answer 34

Blood and mucous stool Vomiting and diarrhoea Lethargy Abdominal mass

Question 35

What investigations are used in intussusception?

Answer 35

USS AXR/CT Air or barium enema

Question 36

What is the treatment for intussusception?

Answer 36

Enema fixes 90% by increasing pressure which pops the intussusception out Surgical release

Question 37

What is an anal fissure?

Answer 37

Small tear in the mucosa that lines the anus

Question 38

Who are anal fissures more common in?

Answer 38

The very young or old

Question 39

What are the causes for anal fissures?

Answer 39

``` Passage of large/hard stools Chronic diarrhoea Anal intercourse Childbirth IBD Anal cancer HIV TB Syphillis ```

Question 40

What are the symptoms/signs of anal fissures?

Answer 40

Pain during or after bowel movements Bright red blood on paper after wiping Visible crack in skin or small lump

Question 41

What is the conservative treatment for anal fissures?

Answer 41

Topical nitroglycerin Topical anaesthetic Botox injection

Question 42

What is the surgical treatment for anal fissures?

Answer 42

Lateral internal sphincterotomy - small incision made into the sphincter muscles

Question 43

What is the major type of colerectal carcinoma?

Answer 43

Adenocarcinoma

Question 44

What are the risk factors for colorectal carcinomas?

Answer 44

``` Smoking Red meat Low fibre diet IBD Familiar adenoma polyposis Lynch syndrome ```

Question 45

What are the symptoms of colorectal cancer?

Answer 45

``` Anaemia Pain Change in bowel habits Tenesmus Abdominal mass ```

Question 46

What are the investigations used for colorectal carcinoma?

Answer 46

Colonoscopy Flexible sigmoidoscopy Capsule endoscopy CT colonography