Investigations + treatment Flashcards
FBC?
colonic mass can bleed causing anaemia.
Electrolytes and calcium?
hypokalaemia and hypercalcaemia can cause constipation
Faecal occult blood test?
for colon cancer
Proctoscopy?
transparent dilator used to visualise the anus and rectum.
Rigid sigmoidoscopy?
visualises far sigmoid colon
Flexible sigmoidoscopy?
with sedation can visualise as far as the splenic flexure, can take biopsie and remove small polyps.
Colonoscopy?
involves whole bowel to iliocaecal valve
OGD?
inserted via mouth, can see to duodenum, should be performed in context of iron deficiency anaemia to rule out upper GI blood loss
Constipation primary management?
Lifestyle changes; increase fluid intake, exercise.
Bulk producers; fibre supplements
Osmotic laxitives; act by retaining fluid in the bowels, only use short term though.
Hypothyroidism diagnosis and management?
confirmed by high blood TSH, management is daily oral levothyroxine
Hypercalcaemia symptoms?
“moans, groans, bones and stones”, polydipsia and and polyuria are also common. Is confirmed by checking serum calcium.
Underlying causes of hypercalcaemia (4)?
Bone metastases; increased bone turnover, so high ALP.
Myeloma; similar picture to bone metastases but normal ALP.
Primary and tertiary hyperparathyroidism; PTh causes increased bone turnover, so high ALP.
Vit D overdose; increases gut absorption of calcium
Features of bowel obstruction?
Absolute constipation, colicky abdo pain, distended abdomen, nausea and vomiting. Plain abdo xray can confirm this
Bowel obstruction on x ray?
Small bowel loops >3cm or large >6cm indicate obstruction. Coffee bean sign on xray means sigmoid volvulus
Causes for constipation after surgery?
common as paralysis called ileus occurs due to anaesthesia, opiate analgesia. Postoperative ileus is usually self limiting.
Colon cancer TNM classification?
tumour size (1-4),
nodes 0-1 depending on lymph nodes affected,
metastasis 0-1 depending on whether it has spread to other organs.
Colon cancer Dukes classification?
Dukes A; no spread to muscularis propria taken out surgically, Dukes B; tumour invading beyond muscularis propia offered surgical removal and chemotherapy, Dukes C; spread to lymph nodes, Dukes D; tumour metastasized to other organs, largely palliative.
