Intestinal

Question 1

what 3 things can define constipation

Answer 1

<3 times a week // difficulty passing // incomplete emptying

Question 2

what are common complications of constipation (3)

Answer 2

overflow diarrhoea // AUR // haemorrhoids

Question 3

what defines diarrhoea

Answer 3

> 3 loose stools in a day

Question 4

what is acute vs chronic diarrhoea

Answer 4

acute <14 // chronic > 14 days

Question 5

what are common causes of acute diarrhoea (4)

Answer 5

infection // diverticulitis // abx // overflow constipation

Question 6

what can cause chronic diarrhoea (5)

Answer 6

IBS // UC // chrohns // colorectal cancer // coeliac

Question 7

what symptoms must be present for IBS and how long (3)

Answer 7

6 months: abdo pain +/- bloating +/- change in bowels

Question 8

what red flags need to be ruled out in IBS

Answer 8

rectal bleeding // weight loss // FH ovarian cancer // 60+

Question 9

what invx should be done in IBS

Answer 9

FBC // CRP // coeliac TTG antibodes

Question 10

1st line mx IBS (3)

Answer 10

pain = antispaspodic eg hyoscine (buscopan) // consitpation = laxitive // diarrhoea = loperamide

Question 11

what laxative should be avoided in IBS

Answer 11

lactulose

Question 12

what laxitve can be given in special cases of IBS

Answer 12

linaclotide

Question 13

2nd line mx IBS

Answer 13

TCAs low dose eg amitrip 5-10mg

Question 14

when is CBT offered in IBS

Answer 14

after 12 months

Question 15

what is diverticular disease

Answer 15

herniation of colonic mucosa through muscilar wall

Question 16

where does diverticular disease usually occur in colon + what area is usually spared

Answer 16

between teania coli // rectum spared

Question 17

difference between diverticular disease and diverticulosis

Answer 17

diverticulosis is no symptoms

Question 18

symptoms diverticular disease (3)

Answer 18

change bowel habits // PR bleed // abdo pain

Question 19

complications diverticular disease (6)

Answer 19

diverticulitis // bleed // fistula // perforation // peritonitis // abscess

Question 20

invx diverticular diseae

Answer 20

CT 1st –> colonscopy // barium enema

Question 21

how is severity determined in diverticular disease (4)

Answer 21

Hinchey: paracolonic abscess –> pelvic –> purulent peritnotis –> faecal peritonitis

Question 22

what are risk factors for diverticuloss

Answer 22

age and low fibre diet, obese

Question 23

what is diverticulitis

Answer 23

infected diverticulas

Question 24

symptoms of diverticulitis

Answer 24

LLQ pain // N+V // consipation or diarrhoea // urinary symptoms // PR bleed // signs of infection

Question 25

what is a serious complication of diverticulitis (5)

Answer 25

abcess // peritonitis // obstruction // perforation // colovesical or colovaginal fistula

Question 26

what X rays should be done in diverticulitis and what do they show

Answer 26

erect CXR - pneumoperitoneum // AXR - dilation

Question 27

what invx should be avoided in diverticulitis

Answer 27

colonscopy --> perforation

Question 28

how is mild --> severe diverticulitis managed

Answer 28

oral abx -- > IV ceftriaxone + IV metro

Question 29

how is severe diverticulitis with faecal peritonitis managed

Answer 29

resection + stoma // less severe = washout

Question 30

what are the 3 main ischaemias to the lower GI tract

Answer 30

acute mesenteric // chronic mesenteric // ischaemic colitis

Question 31

risk factors for bowel schaemia (5)

Answer 31

age // A fib // thromboemboli eg endocarditis, cancer // CVS eg smoking, HPT, DM // cocaine

Question 32

symptoms bowel ischaemia

Answer 32

abdo pain (sevre and sudden) // PR bleed // diarhhoea // fever // raised WCC and lactate

Question 33

invx bowel ischaemia

Answer 33

CT

Question 34

what causes mesenteric ischamia

Answer 34

embolus usually AF

Question 35

artery block in acute mesenteric ischaemia

Answer 35

mesenteric artery

Question 36

mx acute mesenteric ischaemia

Answer 36

urgent surgery

Question 37

what is ischaemic colitis

Answer 37

acute and transient block in blood flow --> inflam, ulcer, haemorrhage

Question 38

where does ischamic colitis usually occur + initial invx

Answer 38

splenic flexure // AXR shows thumbprinting

Question 39

what are the 2 most common causes of SBO

Answer 39

adehsions then hernias

Question 40

most common causes large BO

Answer 40

tumour // volvulus // diverticular

Question 41

key features SBO (5)

Answer 41

abdo pain // bilious vomiting // constipation // distension // tinkling bowel sounds

Question 42

1st line invx for small and large BO

Answer 42

AXR

Question 43

diagnostic invx small and large BO

Answer 43

CT

Question 44

mx for small and large BO (4)

Answer 44

NBM + IV fluid + NG tube // maybe surgery

Question 45

when would bowel obstruction commonly require surgery

Answer 45

perforation

Question 46

what is the most common type f volvulus

Answer 46

sigmoid (80%)

Question 47

what associations are there with sigmoid volvulus (5)

Answer 47

older // chronic constipation // Chagas disease // neruological conditions // psychiatric eg schizo

Question 48

what associations are there with caecal volvulus (3)

Answer 48

all ages // adhesions // pregnancy

Question 49

how is voluvulus diagnosed

Answer 49

AXR: sigmoid = LBO + coffeebean // caecal = SBO

Question 50

mx sigmoid volvulus

Answer 50

rigid sigmoidoscopy + rectal tube

Question 51

mx caecal

Answer 51

right hemicolectomy

Question 52

what is maximum normal diameter for small bowel when obstruction suspected

Answer 52

35mm

Question 53

what is maximum normal diameter for large bowel when obstruction suspected

Answer 53

55mm

Question 54

what type of tumour characterises Zollinger Ellison syndrome

Answer 54

gastrin secreting from dudodenum or pancreas

Question 55

what gene is Zollinger Ellison syndrome assoc with

Answer 55

MEN1

Question 56

symtoms zollinger ellison (3)

Answer 56

multiple gastroduodenal ulcers // diarrhoea // malabsorption