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Gastrointestinal > Diseases of Colon & Rectum > Flashcards

Diseases of Colon & Rectum Flashcards

1
Q

aetiology of colorectal cancer?

A

old age, low fibre intake, high fat & sugar intake, obesity, smoking, lack of exercise, long standing inflammatory disease e.g. Crohn’s

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2
Q

modes of cancer spread?

A

direct, lymphatic, blood (liver, lung)

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3
Q

presentation of colorectal cancer?

A

anaemia, tiredness, bowel changes, wt loss, rectal bleeding, pain or lump, tenesmus

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4
Q

what is tenesmus?

A

recurrent need to empty bowels

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5
Q

hx for colorectal cancer?

A

changes in bowel habits, bleeding from back passage, wt loss, abdominal pain, swelling in abdomen, previous operations?

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6
Q

ix for colorectal cancer?

A

FOBT (screening), barium enema, rigid sigmoidoscopy/ colonoscopy, CT colonography

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7
Q

how to stage for colorectal cancer using radiology

A

CT abdo, MRI rectum

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8
Q

what must be done before colonoscopy?

A

bowel prep, CO2 insufflation, buscopan IV

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9
Q

tx for colorectal cancer?

A 
surgery- right hemicolectom, extended right hemicolectomy, transferase colectomy, sigmoid colectomy, anterior resection, APR
post-op staging
chemo 
imaging 
palliative
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10
Q

what surgical technique is recommended and why?

A

laproscopy- smaller wound site and faster recovery

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11
Q

what type of palliative care is carried out for colorectal cancer?

A

stenting, palliative chemo/radio

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12
Q

what are adenomas also known as?

A

polyps

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13
Q

what is an adenoma?

A

a protrusion above an epithelial surface

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14
Q

true/false…

polyps are benign

A

false…

they can be malignant or benign

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15
Q

what are the classes of polyp?

A

adenoma, serrated polyp, polypoid adenocarcinoma, other

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16
Q

what is an adenoma?

A

benign tumour but can cause local invasion hence should all be removed

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17
Q

pathophysiology of an adenoma?

A

normal mucosa > adenoma > large adenoma > adenocarcinoma

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18
Q

what is the tx for polypoid adenocarcinoma?

A

surgical removal of colon/rectum, radio & chemo

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19
Q

where does polypoid adenocarcinoma usually invade into?

A

muscularis propria

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20
Q

what is the staging of polypoid adenocarcinoma?

A

Dukes Criteria

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21
Q

go through Dukes Criteria…

A

Dukes A: confined by muscularis propria
Dukes B: spread into muscularis propria
Dukes C: metastasis to LNs

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22
Q

recap of TNM staging…?

A

T: T1 (submucosa), T2 (into muscle), T3 (through muscle), T4 (adjacent structures)
N: N0 (no LNs), N1 (<3LNs) N2 (>3 LNs)
M: M0 (no mets), M1 (mets)

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23
Q

where site is polypoid adenocarcinoma usually found at?

A

left sided- rectum, sigmoid, descending

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24
Q

what are the common mutations that cause polypoid adenocarcinoma?

A

APC & K-ras

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25
Q

what nodes are invaded with polypoid adenocarcinoma?

A

mesenteric

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26
Q

local invasion of polypoid adenocarcinoma?

A

mesorectum, peritoneum, etc

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27
Q

what is the hereditary cancer causing syndrome?

A

non polyposis coli (HNPCC)

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28
Q

true/false…

HNPCC presents with <100 polyps

A

True

29
Q

describe HNPCC…

A

right sided, crohn’s like inflammation, late onset

30
Q

what is the familial cancer causing symptom?

A

adenomatous polyposis (FAP)

31
Q

how many polyps does FAP have?

A

> 100

32
Q

describe FAP…

A

early onset, defect in APC tumour suppression gene, throughout colon

33
Q

what is diverticular disease?

A

small sacs form in wall of large intestine

34
Q

why do diverticula form?

A

high luminal pressure caused by low fibre

35
Q

what is the epidemiology of diverticular disease?

A

> 50yo

36
Q

what is difference between diverticulosis and diverticulitis

A

diverticulosis: having diverticula (sacs)
diverticulitis: when diverticula become inflamed

37
Q

aetiology of diverticulitis?

A

low fibre intake, fatty food, Marfan’s

38
Q

symptoms of diverticulitis?

A

LIF pain/tenderness, septic, altered bowel habits

39
Q

ix for diverticulitis?

A

exam, barium enema, sigmoidoscopy, CT

40
Q

what is the diverticulitis scoring system for acute disease?

A

Hinchey Classification

41
Q

describe the Hinchey Classification

A
  1. para colic abscess
  2. pelvic abscess
  3. purulent peritonitis
  4. faecal peritonitis
42
Q

tx for uncomplicated diverticulitis

A

IV antibiotics and inc fibre

43
Q

tx for complex diverticulitis

A

Hartmann’s procedure, 1y resection/ anastomosis, percutaneous drainage, laparoscopic lavage and drainage, antibis

44
Q

what is hartmann’s procedure?

A

remove sigmoid colon and attach colostomy bag to descending colon

45
Q

complications of diverticulitis?

A

pericoli abscess, perforation, haemorrhage, fistula, stricture

46
Q

what is meckel’s diverticulum?

A

a result of the incomplete regression of Vitelli-intestinal duct

47
Q

symptoms of Meckel’s?

A

asymptomatic

48
Q

tx for Meckel’s?

A

laparoscopic resection

49
Q

when does Meckel’s present?

A

before 2 years of age- usually incidental finding

50
Q

what does Meckel’s usually mimic?

A

appendicitis

51
Q

complications of Meckel’s?

A

bleed, perforation, ulceration, diverticulitis, malignant change

52
Q

what are the types of colitis?

A

acute or chronic

53
Q

aetiology of colitis?

A

infective colitis, ulcerative, crohn’s, ischaemic

54
Q

what organisms cause infective colitis?

A

c.dif, campylobacter, shigella, e.coli 0157

55
Q

what is colitis?

A

inflammation of colon

56
Q

symptoms of colitis?

A

diarrhoea +-blood, cramps, dehydration, sepsis, wt loss & anaemia

57
Q

ix for colitis?

A

barium enema*, sigmoidoscopy & biopsy, stool cultures, X-ray

58
Q

tx for colitis

A

fluids, IV steroids, GI rest, surgery

59
Q

who does ischaemic colitis usually affect

A

elderly and arteriopaths

60
Q

infection of which artery may result in ischaemic colitis?

A

infected mesenteric artery

61
Q

what is colonic angiodysplasia?

A

submucosal lakes of blood

62
Q

where does colonic angiodysplasia usually affect?

A

right side of colon

63
Q

tx for angiodysplasia?

A

embolisation, ablation, surgical resection

64
Q

what are 3 less common bowel diseases?

A

large bowel obstruction
sigmoid volvulus
pseudomembranous colitis

65
Q

causes and tx of large bowel obstruction?

A

colorectal cancer, benign stricture, volvulus.

tx- resuscitate, operate, stent

66
Q

causes, ix and tx of sigmoid volvulus?

A

bowel twist on mesentery.
ix- X-ray, rectal contrast
tx- flatus tube, surgical resection

67
Q

what is most common presentation for pseudomembranous colitis?

A

massive diarrhoea & vomit

68
Q

tx for pseudomembranous colitis?

A

metronidazole/ vancomycin

Gastrointestinal (24 decks)

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