Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI and General Surgery > Large Bowel > Flashcards

Large Bowel Flashcards

1
Q

Where is the appendix found?

A

base attachment to the caecum

where 3 taenia coli converge

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

What are the taenia coli?

A

3 longitudinal bands of muscle

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

What are the clinical features of appendicitis?

A 
vomiting 
anorexia 
nausea 
diarrhoea or constipation 
abdo pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Describe the abdo pain in appendicitis.

A

periumbilical to RIF because:

  1. appendix is a midgut organ
  2. dull and poorly localised pain from midgut felt in umbilical region (T8-T10) as visceral afferents enter spinal cord at these regions
  3. inflamed appendix starts to irritate parietal peritoneum in RIF - somatic nerve supply
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is found on examination in appendicitis?

A

pyrexia, tachypnoea, tachycardia
rebound tenderness
percussion pain - McBurneys point (2/3rds between umbilicus and ASIS)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

How is appendicitis diagnosed?

A

clinical diagnosis
increased WCC
acute abdo investigations
USS, CT abdo (only done if uncertain diagnosis)

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

How is appendicitis managed?

A

lap appendectomy

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

What is diverticular disease? Where does it commonly occur?

A

outpouching of bowel wall

commonly sigmoid colon

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

What are the 4 manifestations of diverticular disease?

A

diverticulosis
diverticular disease
diverticulitis
diverticular bleed

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

What is diverticulosis? How does it present?

A

presence of diverticula (asymptomatic)

incidental finding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is diverticular disease? How does it present?

A

symptomatic diverticula

intermittent lower abdo pain (usually left)
PR bleeding
altered bowel habit
flatulence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What is diverticulitis? How does it present?

A

inflammation of diverticula

acute abdo pain
localised tenderness
pyrexia
systemic upset

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a diverticular bleed?

A

erodes into large vessel

large volume painless bleed

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

What are complications of diverticular disease?

A

perforation
fistula formation e.g. colovesical, colovaginal
bowel obstruction (secondary to strictures)
pericolic abscess

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

What are the investigations for diverticular disease?

A 
routine bloods, group and save 
flexi sig (uncomplicated diverticular disease)
CT abdo pelvis (suspected diverticulitis) 
- can't sigmoidoscopy - risk of perforation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the management of diverticular disease?

A

uncomplicated:

  • analgesia
  • increase fibre intake

diverticulitis:

  • analgesia, IV fluids
  • IV amox, met and gent

diverticular bleed:

  • appropriate resus
  • usually self limiting, if not embolisation or surgical resection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is a perforated diverticulum managed?

A

surgical management if perforation + faecal peritonitis

- sigmoid colectomy and end colostomy

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

What is the most common form of colorectal cancer?

A

adenocarcinoma

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

How does colorectal adenocarcinoma usually progress?

A

normal mucosa to colonic adenoma (polyps)
to invasive adenocarcinoma
(10% adenomas become malignant)

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

What genetic mutations predispose to colorectal cancer?

A

HNPCC (assoc w Lynch syndrome)

APC

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

What are risk factors for colorectal cancer?

A 
adenomatous polyps 
increased age
family history 
IBD 
processed and red meat intake 
alcohol, smoking
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is used for colorectal cancer screening? When does it take place?

A

FIT - faecal immunochemistry test

50-75 every 2 years

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

What are the clinical features of colorectal cancer?

A
  • change in bowel habit
  • PR bleeding
  • weight loss
  • iron deficiency anaemia
  • abdo pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the NICE guidelines for urgent referral for colorectal cancer?

A 
>40 years, weight loss + abdo pain 
>50 years + PR bleeding 
>60 years  + anaemia 
>60 years + change in bowel habit 
positive screening test
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are the investigations for suspected colorectal cancer?

A 
FBC - microcytic anaemia 
imaging
- colonoscopy and biopsy 
- flexi sig or CT colongraphy if too frail 
staging
- CT CAP
- MRI rectum 
CEA 
- used to monitor disease progression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

When is radiotherapy used in treatment of colorectal cancer?

A

rectal cancers - chemoradiotherapy can be curative

post op decreased local recurrence

27
Q

How is colorectal cancer treated?

A

surgery - curative for localised malignancy

chemoradiotherapy (advanced disease or rectal cancers)

28
Q

What is the surgery for colorectal cancer management?

A

regional colectomy + primary anastomosis or stoma formation

29
Q

What are palliative options for colorectal cancer?

A

stenting - for obstruction
stoma formation
resection of secondaries

30
Q

When is an anterior resection used for rectal tumours?

A

high rectal tumours >5cm from anus

31
Q

When is an abdominoperineal resection used for rectal tumours?

A

low rectal tumours <5cm from anus

32
Q

When is Hartmaan’s procedure used?

A

obstruction or perforation (emergency bowel surgery)

33
Q

What is Hartmaan’s procedure?

A

complete resection of the recto-sigmoid colon and end colostomy

34
Q

What kind of inflammation do you get in Crohn’s disease?

A

non-caseating granulomatous inflammation
transmural
skip lesions

35
Q

Where can Crohn’s disease affect?

A

any part of the GI tract, mouth to anus

36
Q

Why do you get fistula formation in Crohn’s disease?

A

transmural inflammation (all layers)

37
Q

What does Crohn’s look like macroscopically?

A

skip lesions
fissures and deep ulcers (‘cobblestone’)
fistula formation

38
Q

What are the GI and intestinal features of Crohn’s?

A 
episodic abdo pain and diarrhoea 
mouth ulcers, stomatitis 
perianal disease (fistule, abcesses, skin tags)
39
Q

What are the systemic features of Crohn’s?

A

malaise
anorexia
low grade fever
malnutrition (terminal ileum effected - B12 deficiency and anaemia)

40
Q

What are the extra intestinal features of Crohn’s?

A 
anterior uveitis 
gallstones, cholangiocarcinoma 
renal stones 
erythema nodosum 
large joint arthritis 
pyoderma gangrenosum
41
Q

How is Crohn’s disease investigated?

A 
bloods: FBC, raised CRP and WCC, B12?
stool sample: infective cause?
faecal calprotectin 
imaging:
- colonoscopy w/ biopsy (gold standard)
- CT (acute, severe disease) 
- MRI (perianal disease)
42
Q

How is an acute attack of Crohn’s managed?

A

fluid resus
nutritional support
IV steroids

43
Q

How is remission induced and maintained in Crohn’s?

A

induced:

  • corticosteroids
  • 5 ASA drugs e.g. mesalazine (less effective)
    • immunosuppression e.g. aziothioprine, methotrexate
  • biologics used if other therapies fail e.g. infliximab

maintained:

  • smoking cessation
  • azathioprine or mercaptopurine
  • methotraxate 2nd line
44
Q

When is surgery indicated in Crohn’s?

A

failed medical treatment
severe complications e.g. strictures, fistulae
growth impairment (younger patients)

45
Q

What are some surgical options in Crohn’s?

A

bowel resection
peri-anal disease surgery (abscess drainage)
stricturoplasty (if obstructed)

46
Q

Why can renal stones happen in Crohn’s?

A

malabsorption of fats in small intestine

47
Q

Why do gallstones happen in Crohn’s?

A

decreased reabsorption of bile salts in terminal ileum

48
Q

What is the inflammation like in UC?

A

diffuse continual mucosal inflammation of large bowel

49
Q

What does UC look like macroscopically?

A

pseudopolyps and ulcers

starts in rectum and spreads proximally

50
Q

What is ‘backwash ileitis’?

A

incompetent ileocaecal valve + UC

effects distal ileum

51
Q

What are the GI symptoms of UC?

A

bloody diarrhoea
mucus
crampy abdo pain
frequency, urgency, tenesmus

52
Q

What are the extra intestinal symptoms of UC?

A

large joint arthritis
erythema nodosum
anterior uveitis
PSC

53
Q

In which do you tend to see more systemic symptoms - UC or Crohn’s?

A

Crohn’s

54
Q

What scoring system is used to grade UC? What are the headings?

A

Truelove and Witt

bowel movements per day
blood
pyrexia 
pulse >90 
anaemia 
ESR
55
Q

How is UC investigated?

A 
bloods 
stool sample 
faecal calprotectin 
imaging
- colonoscopy with biopsy 
- (flexi sig may be adequate)
- CT (toxic megacolon, bowel perforation) or AXR (mural thickening, thumbprinting)
56
Q

How is remission induced in UC?

A

mild to moderate:

  • step 1 - mesalazine or sulfasalazine
  • step 2 - prednisolone + tacrimolimus

severe:

  • IV corticosteroids
  • surgery?
    • infliximab
57
Q

How is remission maintained in UC?

A

mesalazine or sulfasalazine

next line - biologics (infliximab)

58
Q

What are indications for surgery in UC?

A

perforation
non response to medical therapy
masssive haemorrhage
toxic megacolon

59
Q

What are surgical options for UC?

A

subtotal colectomy - for disease control, preservation of rectum
total proctocolectomy + ileostomy (curative)

60
Q

Where would you normally find an ileostomy?

A

right hand side

61
Q

Where would you normally find a colostomy?

A

left hand side

62
Q

Which type of stoma is spouted?

A

ileostomy - protect skin from irritant contents

63
Q

What is the consistency of contents in an ileostomy vs colostomy?

A

watery greenish

colostomy - more fully formed faeces

GI and General Surgery (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions