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Lower GI > CRC > Flashcards

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
Q

What is the TrueLove & Witt severity score(s) for UC?

A
26
Q

What does the coffee bean sign mean on AXR?

A

Sigmoid volvulus

27
Q

What is foecal calprotectin for?

A

Protein released by neutrophils
- raised in segmental colitis

28
Q

Name as many intraluminal causes of bowel obstruction as you can:

A

Intraluminal

  • foreign bodies
  • Ba inspissation (colon)
  • Bezoar
  • Inspissated faeces
  • Gallstone ileus
  • Meconium (CF)
  • Parasites (ascaris, diphyllobothrium)
  • Enterolith
  • Intussusception
  • Polypoid & exophytic lesions
29
Q

Name as many intramural causes of bowel obstruction as you can:

A

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
Q

Name as many extrinsic causes of bowel obstruction as you can:

A

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
Q

What is in the retroperitoneum?
SAD PUCKER

A

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
Q

Histology of the colon: layers

A
  • colonic crypts & intestinal glands
  • mucosa
  • submucosa
  • muscularis
  • serosa (intra) / adventitia (retro)
33
Q

What is APC?

A

Adenomatous Polyposis Coli gene
- codes for tumour suppressor (apoptosis)
= polyps
- can accumulate k-RAS, p53

34
Q

What are adenomatous polyps indicative of?

A

APC mutation (normal cells)

35
Q

What do serrated polyps indicate?

A

DNA repair gene mutations (saw tooth appearance)

36
Q

Where does colon cancer usually metastasise?

A

Liver

37
Q

Where does rectal cancer usually metastasise?

A

Lungs

38
Q

Duke’s staging of CRC (%survival)

A

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
Q

What are non-modifiable RFs of CRC?

A
  • elderly
  • M
  • IBD
  • genetics (FAP, HNP)
40
Q

What are modifiable RFs for CRC?

A
  • smoking
  • red meat
  • lack of fibre
  • obesity
41
Q

Symptoms of Asd CRA

A
  • pain & WL (beyond mucosa)
  • no bowel obstruction (late diagnosis)
  • anaemia (bleeding & ulceration)
42
Q

Symptoms of Dscd CRA

A
  • LBO (napkin-ring constriction, infiltrating)
  • pain
  • haematochezia (fresh rectal bleeding)
43
Q

What neonatal presentation indicates intussusception?

A

Red current jelly stool

44
Q

What investigations are diagnostic of CRC?

A
  • colonoscopy + biopsy
  • faecal occult blood test (FOBT) = GI bleeding
  • CEA tumourmarker
  • Ba enema (apple-core sign in dscd colon)
45
Q

How is CRC screened for in the community?

A
  • 50+ (FHx FAP, HNP)
  • routine colonoscopy
  • FOBT
46
Q

How is CRC treated?

A
  • early, surgical resection
  • chemo (LNs)
  • symptom management (mets)
47
Q

What is the typical presentation of CRC (R) ?

A
  • non-obstructive
  • occult bleeding
  • Fe deficiency
48
Q

What is the typical presentation of CRC (L) ?

A
  • ring-shaped
  • obstructive
  • constipation
  • pain
49
Q

What symptoms are characteristic of UC?

A
  • bloody diarrhoea/mucus in stool
  • tenesmus, urgency
  • LIF abdominal pain
50
Q

What signs indicate UC on colonoscopy?

A

Continuous erythematous mucosa proximal from rectum
- crypt abscesses
- loss of goblet cells

Lower GI (7 decks)

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