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CRC Flashcards

1
Q

A 60M presents with anaemia. What is your immediate referral?

A

Colonoscopy (rule out malignancy)

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2
Q

What are the key signs of SBO?

A

Bilious vomiting (green)
Tinkling bowel sounds
Valvula conniventes (central, coiled)

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3
Q

Indications for hemicolectomy

A

Tumour (respective side)

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4
Q

What is a total proctolectomy? When might it be indicated?

A

Removal of all colon, rectum & anus
- UC

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5
Q

What is a Sigmoid Hartmann’s surgery? When is it indicated?

A

Sigmoidectomy (loop/end colectomy & ileostomy, ends not anastomosed as allowed to let heal before as will crumble, leak, inflammation)
- emergency obstruction
- bowel perf

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6
Q

What is a subtotal colectomy?

A

Remove colon (preserve sigmoid & rectum for function)

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7
Q

What is a total abdominal colectomy?

A

Removal of large bowel, anastomose small bowel & rectum

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8
Q

What would be the indication for an extended R. Hemicolectomy?

A

Transverse colon tumour (as isolated to midgut not hindgut embryologically)

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9
Q

What is the indication for an APR (abdominal-perineal resection)?

A

Tumour within 8cm of anal verge.

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10
Q

When is an anterior resection indicated?

A

Tumour > 8cm from anal verge.
(Anterior resection of upper 2/3 rectum)

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11
Q

What is the characteristic presentation of appendicitis?

A
  • young pt
  • severe, localised central umbilical pain
  • moves to RIF
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12
Q

What incisions are typically used for appendectomies?

A
  • Lanz (best cosmetic outcomes)
  • McBurney’s
  • Grid-iron
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13
Q

What condition mimics the pain profile of appendicitis?

A

Mesenteric adonitis

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14
Q

Hinchey classification of colon perforations

A

CXR: pneumonitis & UTI

  • colovesical fistulas (wee out poo)
  • colovaginal fistulas (vagina poo)
    = peritonitis
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15
Q

What is Meckle’s diverticulum?

A

Most common congenital anomaly of GI tract (2%) involves incomplete obliteration of vitelline duct
- 2ft. prox to ICV
- 2”

Painless rectal bleeding

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16
Q

How does ischaemic bowel present?

A
  • sudden onset post-prandial pain
    Necrotic: out of proportion to exam
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17
Q

What is a volvulus?

A

Bowel twists around mesentry (sigmoid/coecal)
- obstruction
- ileus

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18
Q

How do haemorrhoids typically present?

A

Painless rectal bleed (pain = ischaemia)
- 3, 7, 11o’clock
- elderly, straining

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19
Q

How are haemorrhoids managed?

A
  • Laxative (lactulose etc)
  • Steroids
  • Surgical removal
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20
Q

What is Goodsall’s rule of fistulae?

A

Defines where fistula can track to via the transverse line (can leave open & heals if below puborectalis; if above requires SETON to avoid affecting anal sphinchter & causing incontinence)

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21
Q

What causes anal worts?

A

HPV 6 & 11
- must contact trace

22
Q

What is proctalgia fugal?

A

Presents as pruritic anus (typically at night)
- M

23
Q

Histopathology of Crohn’s disease

A
  • transmural
  • non-caseating granulomas
  • rosethorn ulcers
  • crypt abscesses
  • mouth — anus skip lesions
24
Q

Causes of Crohn’s disease

A
  • MMA
  • B12 & folate deficiency
25
What is the TrueLove & Witt severity score(s) for UC?
26
What does the coffee bean sign mean on AXR?
Sigmoid volvulus
27
What is foecal calprotectin for?
Protein released by neutrophils - raised in segmental colitis
28
Name as many intraluminal causes of bowel obstruction as you can:
**Intraluminal** - foreign bodies - Ba inspissation (colon) - Bezoar - Inspissated faeces - Gallstone ileus - Meconium (CF) - Parasites (ascaris, diphyllobothrium) - Enterolith - Intussusception - Polypoid & exophytic lesions
29
Name as many intramural causes of bowel obstruction as you can:
**Intramural** Congenital - atresia, stricture/stenosis, web, intestinal duplication, Meckle diverticulum Inflammatory - Crohn’s, diverticulitis, ischaemic stricture, radiation enteritis/stricture Meds - NSAIDs, KCl tablets Neoplasms - 1ry intestinal/colon; 2ry mets/carcinomatosis Trauma - intramural haematoma
30
Name as many extrinsic causes of bowel obstruction as you can:
**Extrinsic** Adhesions - congenital (Ladds/Meckel bands), post-op, post-inflammatory (PID) Hernias - abdo wall, internal, strangulation Volvulus Mass effect - abscess, annular pancreas, pancreatic pseudocyst, carcinomatosis, endometriosis, pregnancy
31
What is in the retroperitoneum? SAD PUCKER
S - suprarenal glands A - aorta & SVC D - D2 &D3 P - pancreas (-tail) U - ureters C - colon (asd & dsc) K - kidneys E - eosophagus R - rectum
32
Histology of the colon: layers
- colonic crypts & intestinal glands - mucosa - submucosa - muscularis - serosa (intra) / adventitia (retro)
33
What is APC?
Adenomatous Polyposis Coli gene - codes for tumour suppressor (apoptosis) = polyps - can accumulate k-RAS, p53
34
What are adenomatous polyps indicative of?
APC mutation (normal cells)
35
What do serrated polyps indicate?
DNA repair gene mutations (saw tooth appearance)
36
Where does colon cancer usually metastasise?
Liver
37
Where does rectal cancer usually metastasise?
Lungs
38
Duke’s staging of CRC (%survival)
A - mucosal (90-95%) B1 - muscularis propria (75-80%) B2 - MP + serosa (60%) C1 - 1-4 LNs (25-30%) C2 - 4+ LNs D - mets (liver, lungs, bones) (<1%)
39
What are non-modifiable RFs of CRC?
- elderly - M - IBD - genetics (FAP, HNP)
40
What are modifiable RFs for CRC?
- smoking - red meat - lack of fibre - obesity
41
Symptoms of Asd CRA
- pain & WL (beyond mucosa) - no bowel obstruction (late diagnosis) - anaemia (bleeding & ulceration)
42
Symptoms of Dscd CRA
- LBO (napkin-ring constriction, infiltrating) - pain - haematochezia (fresh rectal bleeding)
43
What neonatal presentation indicates intussusception?
Red current jelly stool
44
What investigations are diagnostic of CRC?
- colonoscopy + biopsy - faecal occult blood test (FOBT) = GI bleeding - CEA tumourmarker - Ba enema (apple-core sign in dscd colon)
45
How is CRC screened for in the community?
- 50+ (FHx FAP, HNP) - routine colonoscopy - FOBT
46
How is CRC treated?
- early, surgical resection - chemo (LNs) - symptom management (mets)
47
What is the typical presentation of CRC (R) ?
- non-obstructive - occult bleeding - Fe deficiency
48
What is the typical presentation of CRC (L) ?
- ring-shaped - obstructive - constipation - pain
49
What symptoms are characteristic of UC?
- bloody diarrhoea/mucus in stool - tenesmus, urgency - LIF abdominal pain
50
What signs indicate UC on colonoscopy?
Continuous erythematous mucosa proximal from rectum - crypt abscesses - loss of goblet cells

Lower GI (7 decks)

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