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Phase 2a > GI conditions > Flashcards

GI conditions Flashcards

1
Q

Crohn’s Disease: Pathology

A
  • Affects any part of GI tract mouth → anus (mostly terminal ileum and proximal colon)
  • Inflammation in all bowel wall layers
  • Patches of inflammation (non-continuous, skip lesions)
  • Granulomas inflammation
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2
Q

Crohn’s Disease: Risk Factors (5)

A
  • Family history
  • More genetic than UC
  • Smoking increases risk
  • NSAIDs exacerbate
  • Stress and depression trigger flares
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3
Q

Crohn’s Disease: Epidemiology

A
  • More common in western world
  • Affects females more than males
  • Presents 20-40 years
  • Lower incidence than UC
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4
Q

Crohn’s Disease: Symptoms (3)

A
  • Small bowel - right lower quadrant abdo pain, weight loss, malabsorption, severe can mimick appendicitis
  • Colon - bloody diarrhoea, pain on defecation
  • Oral aphthous ulcers
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5
Q

Crohn’s Disease: Complications (7)

A
  • Malabsorption
  • Small bowel obstruction
  • Bowel perforation
  • Abscesses
  • Colorectal cancer
  • Anaemia
  • Sclerosing cholangitis
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6
Q

Crohn’s Disease: Investigations (5)

A
  • Bloods - raised WCC, raised platelets, raised CRP & ESR
  • Anaemia - normocytic, iron, folate or B12 deficiency
  • pANCA negative
  • Hypoalbuminemia when severe
  • Colonoscopy - gold standard, granulomatous transmural inflammation
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7
Q

Crohn’s Disease: Treatment (7)

A
  • Oral prednisolone - glucocorticoid steroid, first line
  • IV hydrocortisone - stronger steroid, in severe cases
  • Smoking cessation
  • Treat deficiencies
  • Anti-TNF antiBodies - if not responsive to steroids (infliximab, adalimumab)
  • Azathioprine - maintains remission
  • Surgery - 80% need it
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8
Q

Ulcerative Colitis: Description

A

Inappropriate immune response against (possibly abnormal) colonic flora in genetically susceptible individuals

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9
Q

Ulcerative Colitis: Pathology

A
  • Only affects colon (rectum → ileocaecal valve)
  • Total continuous inflammation with ulcers and pseudo-polyps when severe
  • Only mucosa inflamed
  • Crypt abscesses
  • Depleted goblet cells
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10
Q

Ulcerative Colitis: Risk Factors (3)

A
  • Family history
  • NSAIDs
  • Stress and depression (triggers flares)
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11
Q

Ulcerative Colitis: Epidemiology

A
  • More common in western world
  • Presentation 20-40 years
  • More common than Crohn’s
  • Smoking is a protective factor!
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12
Q

Ulcerative Colitis: Symptoms (7)

A
  • Abdo pain/cramps - lower left quadrant
  • Episodic or chronic diarrhoea (blood and mucus)
  • Fever
  • Anorexia
  • Malaise
  • Weight loss
  • Clubbing
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13
Q

Ulcerative Colitis: Complications (5)

A
  • Colon - bleeding, perforation, colorectal cancer
  • Skin - erythema nodosum (symmetrical shin bumps), pyoderma gangrenosum (painful ulcers on skin)
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14
Q

Ulcerative Colitis: Investigations (5)

A
  • Blood tests - raised WCC, raised platelets, raised CRP (c-reactive protein) and ESR (erythrocyte sedimentation rate)
  • Colonoscopy - gold standard, sigmoidoscopy is diagnostic
  • Anaemia - normocytic
  • Hypoalbuminemia - when severe
  • pANCA - antibody often positive in UC and never in Crohn’s
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15
Q

Ulcerative Colitis: Treatment (3)

A
  • 5-aminosalicyclic acid (5-ASA) - oral is first line, also can be suppository. Sulfasalazine! (mesalazine, olsalazine)
  • Prednisolone - glucocorticoid steroid, second line not responding to 5-ASA or severe cases
  • Colectomy - severe cases with no response to treatment. Ileoanal anastomosis (remove colon and attach ileum and anus) or ileostomy (stoma)
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16
Q

IBS: Definition

A

Mixed group of abdominal symptoms with no organic cause

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17
Q

IBS: Epidemiology

A
  • Onset <40 years
  • More females
  • 20% of western world
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18
Q

IBS: Risk Factors (3)

A
  • GI infections
  • Stress
  • Eating disorders
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19
Q

IBS: Types

A
  • IBS-C - with constipation
  • IBS-D - with diarrhoea
  • IBS-M - mixed
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20
Q

IBS: Symptoms (3)

A
  • Abdominal pain
  • Bloating
  • Change in bowel habit
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21
Q

IBS: Diagnostic criteria

A
  • Abdominal pain with at least 2 of:
  • Relieved by defecation
  • Altered stool form
  • Altered bowel frequency
  • For at least 6 months
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22
Q

IBS: Investigations (2)

A
  • Rule out differentials
  • Bloods - anaemia, inflammation, coeliac
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23
Q

IBS: Treatment (6)

A
  • Dietary modification (determine trigger foods)
  • Soluble fibre not insoluble fibre
  • Antispasmodics - for pain/bloating in moderate
  • Loperamide (Imodium) - for diarrhoea
  • Laxatives - for constipation
  • Can use antidepressants when severe - dampen gut sensitivity
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24
Q

Coeliac: Description

A
  • Inflammation of the mucosa of the upper small bowel in response to gluten
  • Autoimmune - T cell mediated
  • Intolerance to Prolamin causes villous atrophy (villi erode away) → malabsorption
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25
Q

Coeliac: Epidemiology

A
  • 1% of UK population (only 25% diagnosed)
  • HLA-DQ2 and HLA-DQ8 gene associations
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26
Q

Coeliac: Risk Factors (2)

A
  • Other autoimmune diseases (T1DM, autoimmune thyroid disease, Sjogren’s syndrome, Addison’s disease)
  • IgA deficiency
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27
Q

Coeliac: Pathology

A

a-Gliadin resistant to digestion → passes through damaged epithelial wall into cells → deaminated by tissue transglutaminase → antigen-presenting cells activate gluten sensitive CD4 T cells → inflammatory cascade → villous atrophy and crypt hyperplasia (elongated intestinal grooves)

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28
Q

Coeliac: Symptoms (8)

A
  • Weight loss (malabsorption)
  • Fatigue (malabsorption)
  • Staetorrhoea (floating stool due to unabsorbed fat)
  • Anaemia
  • D&V
  • Abdo pain
  • Mouth ulcers
  • Dermatitis herpetiformis (deposition of IgA in skin causing raised red pathces)
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29
Q

Coeliac: Investigations (4)

A
  • Serum antibody testing - first line, IgA tissue transglutaminase (tTG)
  • Duodenal biopsy - gold standard, endoscopically will show villous atrophy, crypt hyperplasia and increased epithelial WBCs
  • FBC - anaemias
  • Genetic testing - HLA-DQ2 & HLA-DQ8
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30
Q

Coeliac: Treatment (2)

A
  • Gluten free diet
  • Treat vitamin deficiencies
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31
Q

Coeliac: Complication

A

Hyposplenism - give vaccination against pneumococcal infection

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32
Q

GORD: Pathology

A

Reduced tone of lower oesophageal sphincter → increase in transient relaxations → reflux of gastric acid, pepsin, bile and duodenal contents to oesophagus

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33
Q

GORD: Causes (6)

A
  • Obesity
  • Hiatus hernia
  • LOS hypotension
  • Loss of oesophageal peristaltic function
  • Over eating
  • Systemic sclerosis
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34
Q

GORD: Risk Factors (4)

A
  • Obesity
  • Male
  • Pregnancy
  • Smoking
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35
Q

GORD: Symptoms (6)

A
  • Heart burn - burning chest pain, made worse by lying down
  • Odynophagia - painful swallowing
  • Hoarse throat
  • Wheezing
  • Nocturnal asthma
  • Acidic taste in mouth
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36
Q

GORD: Differential Diagnosis (4)

A
  • Coronary artery disease
  • Biliary colic
  • Peptic ulcer
  • Malignancy
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37
Q

GORD: Investigations (2)

A
  • Symptoms usually diagnostic (red flags: weight loss, haematemesis, dysphagia)
  • Oesophago-gastro-duodenoscopy - shows if there is oesophagitis or hiatus hernia
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38
Q

GORD: Treatment (5)

A
  • Lifestyle changes - weight loss, smoking cessation, small meals
  • Antacids (gaviscon)
  • Proton Pump Inhibitors - inhibit gastric hydrogen release, preventing the production of gastric acid (lansoprazole, omeprazole)
  • H2 receptor antagonists - block histamine receptors on parietal cells, reducing acid release (cimetidine)
  • Surgery
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39
Q

GORD: Complications (2)

A
  • Barret’s Oesophagus - oesophageal epithelial metaplasia from squamous to columnar. Can progress to oesophageal cancer
  • Peptic stricture - inflammation of oesophagus → narrowing and stricture
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40
Q

Oesophageal Cancer: Epidemiology

A
  • 6th most common
  • Squamous cell carcinomas are in the middle third (40%) and upper third (15%)
  • Adenocarcinomas are in lower third and stomach cardia (45%)
  • More males, presents age 60-70
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41
Q

Oesophageal Cancer: Causes (8)

A
  • Squamous:
    • Alcohol abuse
    • Smoking
    • Obesity
    • Low fruit and veg consumption
  • Adenocarcinoma
    • GORD
    • Smoking
    • Obesity
    • Barrett’s oesophagus is the biggest risk factor
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42
Q

Oesophageal Cancer: Risk Factors (5)

A
  • Smoking
  • Alcohol
  • Obesity
  • Barrett’s oesophagus
  • Achalasia (disorder of reduced peristalsis)
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43
Q

Oesophageal Cancer: Pathology

A

Oesophageal epithelium undergoes metaplasia from squamous to columnar glandular (like stomach)

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44
Q

Oesophageal Cancer: Symptoms (4)

A
  • Pain
  • Dysphagia - starts just with solids then liquids become painful, liquid pain at first indicates benign
  • Anorexia
  • Weight loss
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45
Q

Oesophageal Cancer: Investigations (3)

A
  • Oesophagoscopy with biopsy
  • Barium swallow - to see strictures
  • CT/MRI/PET for tumour staging
46
Q

Oesophageal Cancer: Treatments (3)

A
  • Surgery
  • Chemo/radiotherapy
  • Palliative care
47
Q

Oesophageal Cancer: Leiomyomas description

A

Benign smooth muscle tumours arising from oesophageal wall. Intact, well encapsulated and within overlying mucosa, slow growing

48
Q

Gastric Cancer: Epidemiology

A
  • Eastern Europe and Asia
  • Unknown cause
  • More males
  • Falling incidence
49
Q

Gastric Cancer: Symptoms (6)

A
  • Epigastric pain - constant and severe
  • N&V
  • Weight loss
  • Dysphagia
  • Anaemia - from blood loss
  • Jaundice - liver metastasis
50
Q

Gastric Cancer: Investigations (3)

A
  • Gastroscopy with biopsy
  • Endoscopic ultrasound
  • CT/MRI/PET
51
Q

Gastric Cancer: Treatment (2)

A
  • Nutritional support
  • Surgery with chemo
52
Q

Colorectal Cancer: Epidemiology

A
  • 3rd most common cancer worldwide
  • Mostly in distal colon
  • More males
  • Usually >60 years
53
Q

Colorectal Cancer: Risk Factors (3)

A
  • Increasing age
  • Family history
  • Genetic predisposition
54
Q

Colorectal Cancer: Pathology

A
  • Normal epithelium → adenoma → colorectal adenocarcinoma → metastatic colorectal adenocarcinoma (almost always adenocarcinoma)
  • Spreads by direct infiltration through the bowel wall then spread to lymphatic and blood vessels and metastasise to liver and lung
55
Q

Colorectal Cancer: Staging

A

Duke stage:

  • A - just in mucosa, 95% 5 year survival
  • B - into submucosa, 75% 5 year survival
  • C - invaded nearby lymph nodes, 35% 5 year survival
  • D - metastasised, 25% 5 year survival
56
Q

Colorectal Cancer: Symptoms (4)

A
  • Right-sided carcinoma - asymptomatic, iron deficiency, mass, weight loss, abdominal pain
  • Left-sided and sigmoid carcinoma - change in bowel habit, blood and mucus in stools, alternated constipation and diarrhoea
  • Rectal carcinoma - rectal bleeding and mucus, cramping rectal pain and thinner stools as it grows
  • Emergency (obstruction) - absolute constipation, colicky abdominal pain, abdominal distension, vomiting stool
57
Q

Colorectal Cancer: Differential Diagnosis (6)

A
  • Haemorrhoids
  • Anal fissure
  • Anal prolapse
  • IBD
  • Ischaemic colitis
  • Meckel’s diverticulum
58
Q

Colorectal Cancer: Investigations (3)

A
  • Colonoscopy - gold standard
  • Digital Rectal exam - detects less than half
  • Double contrast barium enema
59
Q

Colorectal Cancer: Management (4)

A
  • Surgery
  • Endoscopic stenting
  • Radiotherapy
  • Chemo
60
Q

Small Intestinal Cancer: Epidemiology

A
  • 1% of all malignancies
  • Adenocarcinomas mostly
61
Q

Small Intestinal Cancer: Risk Factors (3)

A
  • Family history
  • Coeliac
  • Crohn’s
62
Q

Small Intestinal Cancer: Symptoms (6)

A
  • Abdo pain
  • Diarrhoea
  • Weight loss
  • Anorexia
  • Anaemia
  • Palpable mass
63
Q

Small Intestinal Cancer: Investigations (3)

A
  • Ultrasound
  • Endoscopic biopsy
  • CT/MRI
64
Q

Small Intestinal Cancer: Treatment (2)

A
  • Surgery
  • Radiotherapy
65
Q

Peptic Ulcer: Epidemiology

A
  • More elderly
  • More in developing countries (due to h. Pylori)
  • Duodenal ulcers are more common than gastric ulcers
66
Q

Peptic Ulcer: Causes (6)

A
  • H. Pylori - most common. Lives in gastric mucus and secretes urease → urea in stomach splits to CO2 and ammonia → ammonia + H+ = ammonium → damage gastric epithelium → inflammation reducing mucosal defence
  • NSAIDs - COX-1 inhibited → reduced prostaglandin synthesis → reduced mucus secretion → reduced mucosal defence
  • Mucosal Ischaemia - stomach cells have insufficient blood supply → necrosis → reduced mucin production → gastric acid attacks cells → ulcer. Treat with H2 blocker
  • Increased acid - overwhelms mucosal defence → acid attacks mucosal cells → cell death → ulcers. Increased by stress. Treat with PPI and H2 blocker
  • Bile reflux - duodeno-gastric reflux → regurgitated bile strips away mucus layer → reduced mucosal defence
  • Alcohol
67
Q

Peptic Ulcer: Symptoms (9)

A
  • Burning epigastric pain
  • Bloating
  • Vomiting
  • Haematemesis
  • Dyspepsia (indigestion)
  • Nausea
  • Gastric ulcers are painful when hungry, eating, at night
  • Duodenal ulcers are painful after meals, relieved by eating
  • Cancer red flags: unexplained weight loss, anaemia, GI bleeding, dysphagia, mass
68
Q

Peptic Ulcer: Investigations (4)

A
  • Endoscopy with biopsy - urease test and histology
  • Stool antigen test - for H. Pylori
  • Urea breath test
  • Blood test for IgG antibodies
69
Q

Peptic Ulcer: Treatment (6)

A
  • Lifestyle - smoking cessation, reduce stress, drink less
  • Stop NSAIDs
  • Antibiotics for H. Pylori - CAP (clarithromycin, amoxicillin, PPI)
  • PPIs - lansoprazole, omeprazole
  • H2 antagonists - reduces acid release (cimetidine)
  • Surgery
70
Q

Peptic Ulcer: Complications (5)

A
  • Haemorrhage (ulcers hiting artery)
  • Perforation
  • Obstruction
  • Peritonitis
  • Acute pancreatitis
71
Q

Appendicitis: Pathology

A
  • Appendix at McBurney’s point - 2/3rds from umbilicus to anterior superior iliac spine
  • Appendix obstruction → invasion of gut organisms → inflammation → necrosis → perforation
72
Q

Appendicitis: Epidemiology

A

Incidence between 10-20 yrs

73
Q

Appendicitis: Causes (5)

A
  • Faecoliths (stool forming solid stones) - most common
  • Bezoars/metastases - least common
  • Trauma
  • Intestinal worms
  • Lymphoid hyperplasia
74
Q

Appendicitis: Symptoms (5)

A
  • Early pain around umbilicus that migrates to right iliac fossa
  • Guarding - involuntary muscle contraction when pressing abdomen
  • Fever
  • N&V
  • Anorexia
75
Q

Appendicitis: Investigations (3)

A
  • CT - gold standard, sensitive and specific
  • Bloods - raised WCC, raised CRP & ESR
  • Pregnancy test to exclude ectopic pregnancy
76
Q

Appendicitis: Treatment (2)

A
  • Appendicectomy - gold standard, laparoscopic
  • IV antibiotics and fluids - pre and post operative
77
Q

Appendicitis: Complications (3)

A
  • Perforation
  • Adhesions
  • Appendiceal abscess
78
Q

Bowel Obstruction: Description

A

Arrest of the onward propulsion of intestinal contents

79
Q

Small Bowel Obstruction: Epidemiology, Causes, Pathology

A
  • Most common - 60-75%
  • Causes - adhesions (60%, previous abdo surgery or infetions), hernias, malignancy, Crohn’s
  • Pathology - obstruction → distension above the blockage → increased pressure on blood vessels in bowel wall → ischaemia and necrosis → perforation
80
Q

Small Bowel Obstruction: Symptoms, Investigations, Treatment

A
  • Symptoms - pain (on and off, higher than LBO), vomiting (begins earlier than in LBO), increased bowel sounds (tinkling)
  • Investigations - Abdominal x-ray (first line, shows gas shadows), Non-contrast CT (gold standard, localises obstruction)
  • Treatment - aggressive fluid resuscitation and decompression (drip and suck), analgesia, anti-emetics, antibiotics, surgery (laparotomy)
81
Q

Large Bowel Obstruction: Causes, Symptoms, Investigations, Treatment

A
  • Causes - malignancy (90%), volvulus (rotation of bowel on mesenteric axis → ischaemia and necrosis), Crohn’s
  • Symptoms - abdo pain (less localised than SBO and lower), more abdominal distension (swollen), vomiting later than SBO, constipation earlier than SBO
  • Investigations - abdo x-ray (1st line, gas shadows and distension), CT (gold standard)
  • Treatment - drip and suck
82
Q

Pseudo-Obstruction: Presentation, Causes, Treatment

A
  • Presents identically to LBO or SBO
  • Causes - Trauma, post-operative (paralytic ileus), drugs (opiates)
  • Treat underlying problem
83
Q

Acute Mesenteric Ischaemia: Location, Causes, Symptoms

A
  • Affects small bowel
  • Causes: Superior mesenteric artery (SMA) thrombosis or SMA embolism due to AF. Mesenteric vein thrombosis (less common, in young patients in hypercoaguble states)
  • Symptoms: acute severe abdo pain, no tenderness/ guarding/ distension, rapid hypovolaemic shock
84
Q

Acute Mesenteric Ischaemia: Investigations, Treatment, Complications

A
  • Investigations: bloods, abdo x-ray (rule out bowel obstruction), laparoscopy, CT angiography (non-invasive, detects blockages)
  • Treatment: fluid resuscitation, antibiotics, IV Heparin (reduce clotting), surgery
  • Complications: sepsis, peritonitis
85
Q

Chronic mesenteric Ischaemia: Description

A
  • Affects small bowel
  • Same as AMI but symptoms are less severe and last longer
86
Q

Ischaemic Colitis: Location, Causes, Symptoms

A
  • Affects large bowel
  • Causes: thrombosis, emboli, low flow states
  • Symptoms: sudden onset left iliac fossa pain, bright red blood in stools, hypovolaemic shock
87
Q

Ischaemic Colitis: Investigations, Treatment

A
  • Investigations: urgent CT (rule out perforation), sigmoidoscopy (shows epithelial cell apoptosis), colonoscopy (gold standard, only after recovery, excludes strictures and confirm mucosal healing)
  • Treatment: symptomatic treatment, fluids, antibiotics
88
Q

Diverticular Disease: Diverticulosis defintion

A

Presence of diverticula - pouches of mucosa extrude through the colonic muscular wall

89
Q

Diverticular Disease: Diverticulitis definition

A

Inflammation from faeces blocking the neck of the diverticulum

90
Q

Diverticular Disease: Meckel’s Diverticulum definition

A

A congenital condition that is present in around 2% of the population. Typically children present with symptoms around the age of 2. A small number of these will go on to develop diverticulitis, which in children presents very similar to appendicitis.

Test show ectopic ileal, gastric or pancreatic mucosa

91
Q

Diverticular Disease: Epidemiology

A
  • Affects 50% of population over 50
  • Unknown cause
92
Q

Diverticular Disease: Symptoms (4)

A
  • Mostly asymptomatic
  • Pain
  • Constipation
  • Bleeding
93
Q

Diverticular Disease: Investigation

A

CT

94
Q

Diverticular Disease: Treatment (2)

A
  • Antibiotics
  • Surgery in rare cases of frequent attacks or complications
95
Q

Gastritis: Description

A

Inflammation of the stomach lining that is associated with mucosal injury

96
Q

Gastritis: Pathology

A
  • H. Pylori - lives in gastric mucus and secretes ureas → splits stomach urea into CO2 and ammonia → ammonia + H+ = ammonium → damages gastric epithelium → inflammation
  • Autoimmune gastritis - affects fundus and body of stomach → atrophic gastritis and loss of parietal cells → IF deficiency → pernicious anaemia
  • Aspirin and NSAIDs - inhibits prostaglandins by inhibiting COX-1 → reduces mucus production
97
Q

Gastritis: Causes (9)

A
  • H. Pylori - most common
  • Autoimmune
  • Viruses (CMV and HSV)
  • Duodenogastric reflux
  • Crohn’s
  • Mucosal Ischaemia
  • Increased acid
  • Aspirin and NSAIDs
  • Alcohol
98
Q

Gastritis: Symptoms (6)

A
  • Epigastric pain
  • N&V
  • Indigestion
  • Loss of appetite
  • Abdominal bloating
  • Haematemesis
99
Q

Gastritis: Differential Diagnosis (5)

A
  • Peptic ulcers
  • GORD
  • Non-ulcer dyspepsia
  • Gastric lymphoma
  • Gastric carcinoma
100
Q

Gastritis: Investigations (4)

A
  • Endoscopy
  • Biopsy and histology
  • H. Pylori urea breath test
  • H. Pylori stool antigen test
101
Q

Gastritis: Treatment (3)

A
  • CAP - clarithromycin, amoxicillin, PPI
  • H2 antagonists - ranitidine, cimetidine
  • Prevention - PPIs with NSAIDS
102
Q

Mallory-Weiss Tear: Epidemiology

A
  • More males
  • Aged 20-50
103
Q

Mallory-Weiss Tear: Risk Factors (4)

A
  • Alcoholism
  • Bulimia
  • Male
  • NSAID abuse
104
Q

Mallory-Weiss Tear: Pathology

A

Vomiting/ coughing/ retching increases intra-abdominal pressure → forces stomach contents into oesophagus → dilation and tearing

105
Q

Mallory-Weiss Tear: Symptoms (6)

A
  • Vomiting
  • Abdominal pain
  • Haematemesis (vomiting blood)
  • Postural hypotension (low BP after standing up)
  • Dizziness
  • Melena (black stools)
106
Q

Mallory-Weiss Tear: Differential Diagnosis (4)

A
  • Gastroenteritis
  • Peptic Ulcer
  • Cancer
  • Oesophageal Varices
107
Q

Mallory-Weiss Tear: Investigation

A

Endoscopy

108
Q

Mallory-Weiss Tear: Treatment

A
  • Mostly heal in 24 hrs
  • Surgery if not healing
109
Q

Haemorrhoids: Description, types, investigation, treatment

A
  • Vascular mucosal cushions function to maintain anal continence. When they enlarge, the vessels are brought closer to abrasion and can bleed into the anus.
  • Can be internal (above dentate line) or external (below)
  • Internal: Painless. 1st degree: Do not prolapse. 2nd degree: Prolapse on straining, spontaneous reduction 3rd degree: Prolapse on straining, manual reduction 4th degree: Permanently prolapse, no reduction.
  • External: Painful and itchy. Visible on external examination. Can also have internal
  • Investigation: Digital Rectal Exam (DRE)
  • Treatment: increase fluid and fibre, analgesia, rubber band ligation, haemorrhoidectomy
110
Q

Anorectal Abscess: Risk Factors, Pathology, Symptoms, Investigation, Treatment

A
  • Risk Factors: male, DM, STI, IBD, immunocompromised
  • Infection of anal sinus → inflammation → abscess
  • Symptoms: hard, tender perianal lump, fever, constipation, pus discharge
  • Investigation: DRE
  • Treatment: Surgical drainage, analgesia
111
Q

Fissure-in-ano: Description, Symptoms, Treatment

A
  • Tear in the mucosa of the anal canal under pressure of defecation
  • Symptoms: pain on defecation, bright red blood in stool
  • Treatment: simple pain relief, warm bath
112
Q

Pilonidal Sinus: Description, Epidemiology, Treatment

A
  • Ingrowth of hair excites a foreign body reaction and causes abscess with foul smelling discharge, pain, redness, swelling
  • Most common in obese caucasian males
  • Treatment: excision of sinus tract and cover with skin flap if infected. Leave if asymptomatic

Phase 2a (15 decks)

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