Gastrointestinal Conditions Flashcards
Give FOUR differentials for a mass in the anterior triangle of the neck.
- Goitre (hypo/hyperthyroidism)
- Thryoid Ca
- Lymph node
- Thryoglossal cyst
- Branchial cyst
Suggest FOUR symptoms a patient might report when experiencing a flare up of Ulcerative Colitis.
- Crampy abdominal pain
- Change in stool consistency - mucus/blood in the stool, watery stool due to poor absorption
- Change in frequency - opening bowels more
- Tenesmus - feeling of incomplete emptying
- Weight loss
- Tiredness/malaise
What scoring system assesses the severity of Ulcerative Colitis? What are the three domains?
Truelove-Witts Criteria:
- Mild
- Moderate
- Severe
Suggest FOUR things you might see on examination of a patient experiencing a flare up of Ulcerative Colitis.
- Apthous mouth ulcers
- Sore eyes - uveitis/episcleritis
- ## Red lumps on shins - inflamed fat cells (erythema nodosum)
- Clubbing
Describe the distribution of Ulcerative Colitis within the GI tract.
- Limited to the large intestine
- Never spreads past the ileocaecal valve
- Starts at rectum/sigmoid colon
- Continous
- Only partial thickness of the bowel wall - oedematous mucosa and submucosa
Give THREE indications for surgical intervention in Ulcerative Colitis.
- Failed medical therapy
- Haemorrhage
- Perforation
- Toxic megacolon
- Malignant change
Suggest THREE differences between gastric and duodenal ulcers.
- Gastric ulcers associated with malignancy, duodenal almost never are
- Weight loss common in gastric ulcers, less in duodenal
- Bleeding much frequent in duodenal ulceration - melena
Suggest TWO conditions associated with Coeliac disease.
- Dermatitis herpetiformis
- Diabetes
- Thyroid disease
Describe the histological presentation of Coeliac disease
- Villous atrophy and blunting
- Intraepithelial lymphocyte invasion
Suggest FOUR main differences between Crohns and Ulcerative colitis.
- Crohns affects anywhere along the GIT (most commonly terminal ileum), UC only the bowel
- Crohns has skip lesions, UC continuous (confluent)
- Crohns is full thickness of the bowel wall, with UC it is just mucosa/submucosa
- Crohns maintained with MTX/azathioprine/biologics, UC maintained with 5-ASAs
- UC is bimodal distributed 15-30 olds and 60 year olds, Crohns is a young persons disease (burns out when older)
- Worst case in UC is fulminant pan colitis,
- Cardinal symptom of UC is bloody diarrhoea, weight loss and abdominal pain in Crohn’s disease
Why might a patient with Crohns describe post-prandial abdominal pain?
Stricturing
How might the presentation of differ between left sided and right sided Colorectal cancer?
- Left sided - blood and mucus in the stool, tenesmus, urgency, pain, change in bowel habit
- Right sided - more insidious presentation with weight loss, abdominal pain AND MOST IMPORTANTLY IRON DEFICIENCY ANAEMIA
Describe the Colorectal Ca sequence.
- Changes to normal epithelia (gene/protein/mucosal damage)
- Early adenoma that steadily changes (gene/protein/mucosal damage)
- Further epithelial changes to the adenoma, which grows
- Serious changes to the adenoma forms a cancer (carcinoma) which can then become metastatic
