GI Tumours and torsions Flashcards
1
Q
What is a volvulus
A
Complete twisting of a loop of intestines around its mesenteric attachment
2
Q
When can a volvulus occur
A
Stomach Small Intestines Caecum Transverse Colon Sigmoid Colon
3
Q
What is the most common part of the body in which a volvulus forms
A
Sigmoid
4
Q
What age group do sigmoid volvulus effect
A
Elderly
5
Q
When do volvulus tend to present
A
Children + babies
6
Q
Clinical presentation of a volvulus
A
- Bilious vomiting
- Failure to thrive
- Anorexia
- Constipation
- Bloody stools
- Abdo pain
- malnutrition
- Immunodeficiency
- Regurgitation of saliva
- Dysphagia and noisy gastric peristalsis may occur in chronic volvulus
7
Q
How common is volvulus of the stomach
A
- Quite rare
8
Q
What is the classical triad of GI obstruction features
A
- Vomiting
- Pain
- Failed attempts to pass an nasogastric tube
9
Q
What is differential diagnosis of volvulus
A
- Acute obstruction
- Appendicitis, cholecystitis, constipatoin
- Gastroenteritis
- GORD
- Hepatitis
- Peptic Ulcers
- Pancreatitis
10
Q
What would an abdominal x-ray show for volvulus diagnosis
A
- Sigmoid shows inverted U shape loop of bowel that looks a bit like a coffee bean
11
Q
Other than AXR, what is used to diagnose for volvulus
A
- ULTRASOUND
- MRI
- CT
12
Q
How is volvulus treated
A
Surgical correction
13
Q
Name the surgical correction for Volvulus
A
Ladd’s procedure
14
Q
What is Ladd’s procedure
A
Anti-clockwise rotation to correct error
15
Q
What is non-surgical treatment of volvulus
A
GI compression with naso-gastric tube
16
Q
Complications of volvulus treatment
A
- Intestinal ischaemia, mucosal necrosis + sepsis
- Perforation, peritonitis + death
- Malabsorption
- Growth retardation
17
Q
In what part of the oesophagus is squamous cell carcinoma common
A
Middle third and upper third
18
Q
Where do adenocarcinomas of the oesophagus take place
A
Lower third and cardia
19
Q
What age of people does oesophageal carcinoma tend to effect
A
60-70yrs old
20
Q
How is the incidence of SCC changing
A
Decreasing
21
Q
What gender do SCCs effect
A
Males
22
Q
Causes of SCC
A
- High levels of consumption
- Achalasia
- Tobacco use
- Obesity
- Smoking
- Low fruit + veg consumption
23
Q
Why does obesity contribute to SCC
A
Increased reflux
24
Q
What is Achalasia
A
Disorder where oesophagus has reduced ability to do peristalsis and transport food down
25
What decreases the risk of SCC
```
Diets rich in:
fibre
carotenoids
folate
Vit C
```
26
What epithelium do adenocarcinomas of the oesophagus occur in
Columnar-lined epithelium
27
Causes of adenocarcinomas
1. Smoking
2. Tobacco
3. GORD
4. Obesity (increased reflect)
28
Risk factors for adenocarcinomas
Same as SCC
29
Why are SCCs dangerous
People with SCCs are asymptomatic so when it is found it is EXTREMELY ADVANCED
30
Describe progressive dysphagia (SCC)
1. Initially there is difficulty swallowing solids but dysphagia for liquids follows within weeks
2. Dysphagia to solids AND liquids from the start this indicates banging disease
31
Clinical presentation of SCC/Adenocarcinoma
1. Weight Loss
2. Lymphadenopathy 3. Anorexia
4. Pain due to impaction of food or infiltration of cancer into adjacent structures
5. Oesophageal obstruction eventually causes difficulty in swallowing saliva, coughing and aspiration into lungs
6. Signs from upper thirds of oesophagus (hoarseness and coughs)
32
How is oesophageal cancer diagnosed
1. Oeosphagoscopy with biopsy
2. Barium swallow
3. CT scan/MRI/PET for tumour staging
33
Why is barium swallow for oesophagus cancer needed
Allows us to see strictures
34
How is oesophageal cancer surgically improved
1. Combined with chemotherapy BEFORE SURGERY (improves outcome) + radiotherapy
35
When is there a best chance of oesophageal cancer cure
If tumour has NOT infiltrated outside the oesophageal wall (stage I)
36
If locally incurable or metastatic, how is oesophageal cancer treated
Systemic chemotherapy (stage II and III)
37
How is dysphagia treated
1. Endoscopic insertion of expansing metal stent across tumour to ensure oesophageal potency
2. Laser and alcoholic injections to cause TUMOUR NECROSIS and increase lumen size
3. Palliative care
38
Survival rates of dysphagia
Low
39
What benign oesophageal tumour is most common
Leiomyomas
40
What other benign tumours can appear in the oesophagus
1. Papillomas
2. Fibrovascular types
3. Haemangiomas
4. Lipomas
41
What is a hemangioma
benign tumour of the blood vessels
42
What are leiomyomas
Smooth muscle tumours arising from the oesophageal wall
43
Characteristics of leiomyomas in the oesophagus
1. Intact
2. Well-encapsulated
3. Within the overlying mucosa
4. Slow-growing
44
Clinical features of leiomyomas
1. Asymptomatic
2. Dysphagia
3. Retrosternal pain
4. Food regurgitation
5. Recurrent chest infections
45
How are benign oesophageal tumours diagnosed
1. Endoscopy
2. Barium Swallow
3. Biopsy to rule of malignancy
46
How are benign oesophageal tumours treated
1. Endoscopic removal
| 2. Surgical removal
47
In what gender do gastric tumours effect
Males
48
How does age effect incidence of gastric tumours
Increases with age
49
How is the incidence of adenocarcinomas in the body and distal stomach changing
Falling
50
Main causes of gastric tumours
1. Smoking
2. Helicobacter pylori
3. Dietary factors
4. Loss of p53 and APC genes
5. First degree relative with gastric cancer
6. Pernicious anaemia
51
How do helicobacter pylori cause gastric cancer
Infection causes chronic gastritis which leads to atrophic gastritis and pre-malignant intestinal metaplasia -> dysplasia
52
What things in the diet can cause gastric tumours
1. High salt and nitrate increases risk
| 2. Non-starchy veg, fruit, garlic + low salt DECREASES risk
53
What are all gastric cancers
ADENOCARCINOMAS
54
Appearance of intestinal gastric cancers
1. Well-formed + differentiated glandular structures
55
Appearance of tumours in intestinal gastric cancers
Polypoid or ulcerating lesions with heaped-up, rolled edges
56
What is seen in the mucosa of people with intestinal gastric cancers
Intestinal metaplasia with H. pylori
57
In what part of the stomach does intestinal gastric cancer take place
Distal stomach in patients with atrophic gastritis
58
Appearance of cells in diffuse intestinal gastric cancer
1. Poorly cohesive undifferentiated cells that tend to infiltrate gastric wall
59
What part of the stomach do diffuse gastric cancer effect
Cardia
60
What has the worse prognosis, intestinal or diffuse
Diffuse
61
Clinical presentation of gastric cancer
1. Epigastric pain indistinguishable from peptic ulcer disease (CONSTANT + SEVERE)
2. Nausea, anorexia
3. Weight loss
4. Vomiting is frequent
5. Anaemia
6. Liver metastasis resulting in jaundice
62
How is epigastric piani relived
Food and antacids
63
When is vomiting most severe
If tumour encroaches on pylorus
64
What symptom is seen if gastric cancer is in the fundus
Dysphagia
65
Where can gastric cancer metastasise
Liver, bone, brain and lung
66
What lumps node is palpable in gastric cancers
In supraclavicular fossa on left side
67
How i s gastric cancer diagnosed
gastroscopy and biopsy to confirm adenocarcinoma
68
How many biopsies of the stomach are taken
8-10
69
Why is an endoscopic ultrasound used to diagnose gastric cancers
Evaluate depth of invasion
70
Why are CT/MRI used for gastric cancer diagnosis
Staging
71
Why are PET scans used for gastric diagnosis
Identifies metastases
72
How are gastric cancers treated
1, NUTRITIONAL SUPPORT
| 2. Surgery and combination chemotherapy followd by radiotherapy
73
What combination chemotherapy is used for gastric cancers
1. EPIRUBICIN
2. CISPLATIN
3. 5-FLUOROURACIL
ECF chemo
74
When is chemo given
Around same time as surgery
75
How common are small intestine tumours
RARE
76
What kind of tumour is most prevalent in the small intestines
ADENOCARCINOMAS
77
Where in the small intestines can non-hodgkin's lymphoma be found
ILEUM (not as common as adenocarcinomas)
78
Risk factors for small intestinal cancers
1. Coeliac
| 2. Crohn's
79
Clinical presentation of small intestinal cancers
```
Pain
Diarrhoea
Anorexia
Weight loss
Anaemia
Palpable mass
```
80
How are small intestinal cancers diagnosed
1. ULTRASOUND
2. ENDOSCOPIC BIOPSY
3. CT SCAM
81
What would a CT scan show
Small bowel wall and lymph node involvement
82
What are clonal polyps
Abnormal growth of tissue projecting from colonimucosa
83
What are adenomas
Benign, dysplastic tumour of columnar cells or glandular tissues
Precursor lesions to colon cancer
84
Are adenomas common before age of 30
No
85
When are polyps removed
At colonoscopy
86
Clinical presentation of polyps in rectum and sigmoid colon
Bleeding
87
How do FAPs form
Mutation in APC gene
88
At what age do FAPs form
16 and cancer at 39
89
How are FAPs characterised
Autosomal dominant
Colorectal and duodenal adenomas
90
How are FAPs treated
Prophylactic colectomy and ileorectal anastomosis
91
What is HNPCC (Lynch syndrome)
1. Mutation in one of the DNA mismatch repairs genes (hMSH2 or hMSH1)
92
Role of hMSH1 and 2
Maintain stability of DNA during replication causing highly repeated short DNA sequences known as micro satellites that are shorter or longer than normal (increases risk of DNA damage)
93
What kind of cancer are colorectal carcinomas
ADENOCARCINOMAS
94
Where do CRCs occur
Distal colon
95
Risk factors for CRCs
1. Increasing age
2. Low fibre diet
3. Saturated animal fat + red meat consumption
4. Sugar consumption
5. Colorectal polyps
6. Alcohol + smoking
7. Obesity
8. Adenomas
9. Ulcerative colitis
10. Family History
96
How to reduce risk of CRCs
1. Veg
2. Garlic
3. Milk
4. Excersise
5. Low-dose aspirin
97
What is the appearance of CRCs
Polyploid mass with ulceration
98
How do CRCs metastasise
Direct infiltration through bowel wall and spread down lymphatics and blood vessels to liver and lungs
99
When do right-sided adenocarcinomas stop being asymptomatic
Until they present with iron deficiency anaemia due to bleeding
100
Clinical presentation of right-sided adenocarcinomas (CRCs)
Mass
Weight loss
Low Haemoglobin
Abdo pain
101
Clinical presentation of left-sided adenocarcinomas (CRCs)
1. Changes in bowel habit with blood and mucus in stools
2. Diarrhoea
3. Alteration constipation and diarrhoea
4. Thin/altered stools
5. Blood in stools
102
What do patients with rectal carcinomas present with
Rect bleeding and mucus
When cancer grows will have thinner stool and tenesmus
103
What is tenesmus
Cramping rectal pain
104
In emergencies what are 4 signs of gastro obstruction
1. ABSOLUTE constipation
2. Colicky abdo pain
3. Abdo distension
4. VOMITING
105
What can CRCs be mistaken for
1. Haemorrhoids
2. Fissures
3. Anal Prolapse
4. Diverticular disease
5. IBD
6. Ischaemic colitis
7. Massive upper GI bleed
8. Meckel's diverticulum
106
How are CRCs diagnosed
1. Faecal occult blood
2. Tumour markers (not specific)
3. COLONOSCOPY
4. Double contrast barium enema
5. CT colonoscopy
107
How is the uncomfortableness of a colonoscopy treated
Sedation
108
Risk of colonoscopy
Perforation (needs a stoma)
DEATH
109
What is a double-contrast barium enema a replacement for
Colonoscopy
Doesn't require sedation and avoids perforation
110
Con of double-contrast barium enemas
Limited in detecting small lesions
111
Why are CT colonoscopies used in the elderly
No sedation and avoids perforation risk (limited in detecting small lesions)
112
Why is an MRI used in CRC diagnosis
Determines spread
