Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Yr3 - General Surgery > Large Bowel > Flashcards

Large Bowel Flashcards

1
Q

Risk factors of appendicitis

A

Family history
Ethnicity - more common in Caucasians
Environmental - seasonal presentation over summer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms of acute appendicitis

A 
Abdominal pain - peri-umbilical dull pain -> RIF well-localised and sharp pain
Vomiting
Anorexia
Nausea
Diarrhoea
Constipation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Clinical features of acute appendicitis

A

Tachycardia
Tachypnoeic
Pyrexia
Rebound tenderness
Percussion pain over McBurney’s point
Rovsing’s sign - RIF pain on palpation of LIF
Psoas sign - RIF pain on extension of right hip

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Differential diagnosis of acute appendicitis

A 
Renal
- ureteric stones
- UTI
- pyelonephritis
GI
- mesenteric adneitis
- diverticulitis
- IBD
- Meckel's diverticulum
Urological
- testicular torsion
- epididymo-orchitis
Gynaecological
- PID
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Investigations of acute appendicitis

A 
Urinalysis - exclude UTI
Pregnancy test or serum β-hCG
Routine bloods
Trans-abdominal US
CT scan
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment for acute appendicitis

A

Laparoscopic appendectomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Complications of acute appendicitis

A

Perforation
Surgical site infection
Appendix mass - omentum and small bowel adhere to appendix
Pelvic abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Development of colorectal cancers

A

Most commonly adenocarcinoma

Progression of normal muscosa to colonic adenoma to invasive adenocarcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Genetic mutations predisposing to colorectal cancers

A

Adenomatous polyposis coli (APC)
- tumour suppressor gene
- growth of adenomatous tissue
- assoicated with Familial Adenomatous Polyposis (FAP)
Hereditary NonPolyposis Colorectal Cancer (HNPCC)
- DNA mismatch repair gene
- associated with Lynch syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Risk factors of colorectal cancer

A 
Increasing age
Family history
IBD
Low fibre diet
High processed meat intake
Smoking 
High alcohol intake
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Common clinical features of bowel cancer

A 
Change in bowel habit
Rectal bleeding
Weight loss
Abdominal pain
Iron-deficiency anaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Clinical features of right-sided colon cancers

A 
Abdominal pain
Occult bleeding
Anaemia
Mass in RIF
Often present late
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Clinical features of left-sided colon cancers

A

Rectal bleeding
Change in bowel habit
Tenesmus
Mass in LIF or on PR exam

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

2 week referral for suspected bowel cancer if

A

≥ 40 with unexplained weight loss and abdo pain
≥ 50 with unexplained rectal bleeding
≥ 60 with iron-deficiency anaemia or change in bowel habit
Positive occult blood screening test

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Investigations for colorectal cancer

A

FBC - microcytic anaemia
Colonoscopy with biopsy
CT scan - look for distant metastases and local invasion
MRI rectum - asses depth of invasion
Endo-anal ultrasound - assess suitability for trans-anal resection

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Duke’s staging for colorectal cancer

A

A - confined beneath the muscularis propria
B - extension through the muscularis propria
C - involvement of regional lymph nodes
D - distant metastasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Treatment for colorectal cancer

A

Definitive option is surgery

Chemotherapy and radiotherapy for neoadjuvant and adjuvant treatment and palliation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Surgical treatment of colorectal cancer

A

Right hemicolectomy - caecal or ascending colon tumours
Left hemicoectomy - descending colon tumours
Sigmoidcolectomy
Anterior resection - high rectal tumours
Abdominoperineal resection - low rectal tumours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Describe Hartmann’s procedure

A

Used in emergency bowel surgery
Complete resection of recto-sigmoid colon
Formation of end colostomy and closure of rectal stump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Palliative treatment for colorectal cancer

A

Endoluminal stenting - relieve acute bowel obstruction in LS tumours
Stoma formation
Resection of secondaries

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Define diverticulum

A

Outpouching of bowel wall

Commonly found in sigmoid colon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Describe 4 different manifestations of diverticular disease

A

Diverticulosis - presence of diverticula
Diverticular disease - symptomatic diverticula
Diverticulitis - inflammation of diverticula
Diverticular bleed - diverticulum erodes into a vessel causing large volume painless bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pathophysiology of diverticular disease

A

Aging bowel becomes weakened
Movement of stool leads to increase in luminal pressure
Outpouching of mucose through weaker areas of bowel wall
Bacterial overgrow in outpouchings - diverticulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Risk factors of diverticular disease

A 
Low dietary fibre intake
Obesity
Smoking
Family history
NSAIDs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Features of diverticulitis
``` Acute abdominal pain - localised in LIF, worsened by movement Localised tenderness Systemic upset - decreased appetite - pyrexia ```
26
Complications of diverticular disease
Pericolic abscess Fistula formation Bowel obstruction
27
Diverticular disease investigations
``` Routine bloods Faecal calprotecin Venous blood gas Flexible sigmoidoscopy CT abdomen-pelvis scan ```
28
Conservative management of diverticulitis
IV antibiotics IV fluids Bed rest
29
Surgical management of diverticular disease
Perforation with faecal peritonitis or overwhelming sepsis | Hartmann's procedure
30
Crohn's disease
Entire GI tract Transmural inflammation Granulomatous microscopic changes Skip lesions, cobblestone appearance and fistula formation
31
Ulcerative colitis
Large bowel Inflammation of mucosa only Crypt abscess formation, reduced goblet microscopic changes Continuous inflammation, pseudopolyps and ulcers
32
Crohn's risk factors
Family history Smoking White European descent Appendicectomy
33
Clinical features of Crohn's disease
``` Episodic abdominal pain and diarrhoea Systemic symptoms and malnourishment Oral aphthous ulcers Perianal disease Abdominal tenderness ```
34
Extra-luminal features of Crohn's disease
``` Musculoskeletal - enteropathic arthrits or nail clubbing - metabolic bone disease Skin - erythema nodosum - pyoderm gangrenosum Eyes - episcleritis - anterior uvetitis HPB - PSC - cholangiocarcinoma - gallstones Renal - renal stones ```
35
Investigations for Crohn's disease
``` Routine bloods - anaemia, low albumin, raised CRP and WCC Faecal calprotectin Stool sample - infective cause Colonoscopy with biopsy CT scan MRI scan ```
36
Inducing remision of Crohn's disease
Fluid resuscitation Nutritional support Prophylactic heparin + anti-embolic stockings Corticosteriod therapy Immunosuppresive agents - mesalazine or azathioprine Biological agents - infliximab
37
Maintaining remission in Crohn's disease
Azathioprine or mercaptopurine monotherapy Smoking cessation Colonoscopic surviellance - increased risk of colorectal malignancy
38
Surgical management of Crohn's disease
Ileocaecal resection Surgery for peri-anal disease - abscess drainage Stricutroplasty - division of stricture Small or large bowel resection
39
Surgical intervention indicated in Crohn's disease
Failed medical management Severe complications Growth impairment in younger patients
40
Complications of Crohn's disease
``` Gastrointestinal - fistula - stricture formation - recurrent perianal abscesses/fistula - GI malignancy Extraluminal - malabsorption - osteoporosis - increased risk of gallstones - increased risk of renal stones ```
41
Clinical features of UC
``` Insidious in onset Bloody diarrhoea Proctitis PR bleeding and mucus discharge Systemic features ```
42
Extra-luminal manifestations of UC
``` Musculoskeletal - enteropathic arthirits - nail clubbing Skin - erythema nodosum Eyes - episclertitis - anterior uveitis HPB - PSC ```
43
UC Investigations
Routine bloods - anaemia, low ablumin and raised CRP and WCC Faecal calprotectin Stool sample Colonoscopy with biopsy/flexible sigmoidoscopy
44
Inducing remission in UC
``` Fluid resuscitation Nutitional support Prophylactic heparin Corticosteriod therapy Immunosuppressive agents - mesalazine or azathioprine Biological agents - infliximab ```
45
NICE UC treatment guidlines
Mild to Moderate - topical mesalazine or sulfasalazine - add oral prednisolone - add oral tacrolimus Mild to Moderate - extensive inflammation - high oral dose mesalazine or sulfasalazine - add oral prednisolone - add oral tacrolimus Severe - intravenous corticosteriods and assess the need for surgey - add infliximab if no short-term response
46
Maintaining remission of UC
Immunomodulators - mesalazine or sulfasalazine Infliximab Colonoscopic surveilllance - increased risk of colorectal malignancy
47
Surgical management of UC
Total proctocolectomy is curative | Initally sub-total colectomy with preservation of rectum
48
Indications for surgical management of UC
Disease refractory to mediacal management Toxic megacolon Bowel perforation Reduce risk of colonic carcinoma
49
Complications of UC
Toxic megacolon Colorectal megacolon Osteoporosis Pouchitis
50
Define pseudo-obstruction
Dilation of the colon due to an adynamic bowel in the absence of mechanical obstruction
51
Mechanism of pseudo-obstruction
Interruption of the autonomic nervous supply to the colon resulting in the absence of smooth muscle action in the bowel wall
52
Causes of pseudo-obstruction
Electrolyte imbalance or endocrine disorders Medication - opoids, calcium-channel blockers, anti-depressants Recent surgery, severe illness or trauma Recent cardiac event Parkinson's disease Hirschsprung's disease
53
Clinical features of pseudo-obstruction
Abdo pain Abdo distention Constipation Vomiting
54
Investigations for pseudo-obstruction
FBC, CRP, U&Es, Ca2+, Mg2+ and TFTs AXR - shows bowel distention Abdominal-pelvis CT with IV contrast
55
Management of pseudo-obstruction
Most cases managed conservatively NBM and IV fluids - NG tube if vomiting Endoscopic decompression Nutritional support
56
Define volvulus
Twisting of loop of intesting around its mesenteric attachment -> closed loop bowel obstruction Affected bowel becomes ischaemic due to compromised blood supply -> bowel necrosis and perforation
57
Risk factors of volvulus
``` Increasing age Neuropsychiatric disorders Resident in a nursing home Chronic constipation or laxative use Male gender Previous abdominal operations ```
58
Clinical features of volvulus
Colicky pain Adbominal distention Absolute constipation Rapid onset and degree of abdo distention
59
Investigations for volvulus
Routine bloods - exclude psuedo-obstruction CT scan abdomen-pelvis with contrast AXR - coffee bean sign
60
Conservative management of volvulus
Decompression by sigmoidoscope | Insertion of flatus tube
61
Surgical management of volvulus
Sigmoidectomy with primary anastomosis
62
Indications of surgery of volvulus
Colonic ischaemia or perforation Repeated failed attempts at decompression Necrotic bowel
63
Complications of volvulus
Bowel ischaemia and perforation Risk of recurrence Stoma complications

Yr3 - General Surgery (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions