Gastrointestinal: Colorectal Flashcards
RIF pain that started at umbilicus with fever and some vomiting is indicative of what condition?
Acute appendicitis
What are two ‘classic’ exam signs for appendicitis?
Pressing LIF to induce RIF pain (Rovsing’s sign)
Hip extension induces RIF pain (Psoas sign)
What is diagnostic for appendicitis?
What two tests should you do to ensure no other differentials?
Clinical features + Raised WCC
Urine negative for B-HCG (pregnancy), nitrites (renal colic)
What is the treatment for acute appendicitis?
Prophylactic antibiotics
Laparoscopic appendectomy
What does ‘generalised abdominal pain associated with green, bilious vomiting. Also complete constipation, abdominal distention and tinkling bowel sounds.’ describe?
Bowel obstruction
Features
Green, bilious vomiting
General abdominal pain
Constipation incl. no farts
Abdominal distention
Tinkling bowel sounds
What is ‘third spacing’?
Backlog of fluid due to lack of colonic reuptake
What findings help distinguish an ileus from a volvulus?
Ileus: absent rather than ‘tinkling’ bowel sounds
Volvulus: ‘coffee bean’ sign on AXR
What is the gold standard investigation for suspected bowel obstruction?
CT: Confirm +/- identify perforation
What AXR signs suggest bowel obstruction?
Distended bowel loops (loss of haustra)
lines across small bowel (valvulae conniventes)
What blood gases are present in bowel obstruction management?
Metabolic alkalosis (vomiting)
Raised lactate (ischaemia)
What is the treatment for bowel obstruction?
Conservative if stable or volvulus
Surgical correction if not
Stent if palliative
How do Crohn’s and Ulcerative colitis differ in a) symptoms b) GI involvement and c) extra-intestinal involvement?
Crohn’s // UC
a) Weight loss prominent, perianal pain, RIF mass // PR bleeding prominent, LIF pain, tenesmus
b) Skip lesions in terminal ileum (but anywhere potentially) // continous Rectum –> ileocaecal valve
c) Gallstones // Primary sclerosing cholangitis
Crohn’s vs UC: submucosa inflammation, increased goblet cells and granulomas?
Crohn’s
UC: Mucosal inflammation, reduced gobelt cells and crypt abscesses
Crohn’s vs UC: enema shows haustral loss, pseudopolyps and superficial ulceration
UC
Crohn’s: strictures, proximal bowel dilation, rose thorn uclers, fistulae
UC: ‘thumbprinting’
Crohn’s: String sign
What are the 1st, 2nd and adjunctive treatments used to induce remission in Crohn’s
1st line: Glucocorticoids
2nd line: Mesalazine (5-ASA)
+ azathioprine/mercaptopurine
What is mild-moderate vs severe ulcerative colitis?
Mild-moderate: 4-6 stools, small blood, no systemic
Severe: >6 stools, blood, systemic
How do you induce remission in mild-moderate UC?
1st line: topical aminosalicylate
if proctitis: + oral aminosalicylate /corticosteroids
How do you induce remission in severe UC?
IV steroids
+ ciclosporin if no improvement
How is maintenance done in Crohn’s?
Stop smoking
1st line: Azathioprine/mercaptopurine
How is mild-moderate UC remission maintained?
Aminosalicylate: Topical/oral/both
How is severe UC remission maintained?
Azathioprine / mercaptopurine
What clinical findings help discern coeliac disease from irritable bowel?
Coeliac // irritable bowel
Crampy abdo pain // pain worse on eating, relieved by opening bowels
Diarrhoea // constipation +/- diarrhoea
Mouth ulcers // PR mucus
What conditions is coeliac associated with?
Dermatitis herpetiformis
T1DM
Autoimmune thyroid disease
What blood antibodies confirm coeliac?
Anti-tTG, Anti-EMA
What tests confirm irritable bowel syndrome?
NONE
Negative inflammation, coeliac serology and faecal calprotectin
How is coeliac disease managed?
Lifelong gluten free diet
What is the first, second and third line medical management for IBS?
1st: Loperamide for diarrhoea, laxatives for constipation (not lactulose)
2nd: Tricyclics
3rd: SSRIs
