Large bowel disease Flashcards
what exactly is a diverticulum
mucosal herniation through muscle coat
where is diverticular disease usually
sigmoid colon
how is diverticular disease classified
hinchey classification
what is colonic angiodysplasia
submucosal lakes of blood, usually on right side of colon
causes of large bowel obstruction
colorectal cancer
benign stricture
volvulus
what is a sigmoid volvulus and the complication
bowel twists on the mesentery
gangrene
what is a pseudo-obstruction and who is it more common in
no real large bowel obstruction
elderly and debilitated
what genes predispose to IBD
NOD2/CARD15
what T cell mediated response is chrons disease
TH1
what T cell mediated response is UC
TH1/TH2
when are antibiotics effective in chrons
peri-anal chrons disease
True/false - smoking aggravates UC and protects against chrons
false - it aggravates chrons and protects against UC
what is proctitis
UC only affecting rectum
what is left sided colitis
UC affecting descending and sigmoid colon and rectum
what is pancolitis
UC affecting entire colon
what is severe colitis classed as
> 6 bloody stools/24hrs and one of Fever, tachycardia, elevated ESR, anaemia
what does endoscopy look like with UC
inflammation extending from anal margin to transition zone
lost vessel pattern
contact bleeding
grainy mucosa
true/false - UC has increased risk of colorectal cancer
true
what is primary sclerosing cholangitis and who is it more common in
inflammatory disease of biliary tree
more common in IBD (80%)
what type of lesions and inflammation does chrons cause
skip lesions and transmural inflammation
complications of chrons
peri-anal disease, abscess, fistula
stricture
treatment options available for UC
5ASA Steroids Immunosuppression Anti-TNF therapy Surgery
Treatment options for chrons
Steriods
immunosuppression
anti-TNF
surgery
what types of 5ASA therapy are there
oral- pH or delayed release (asacol/pentasa)
suppository/enema (salazopyrin/balsalazide/mesalazine)
side effects of 5-ASA therapy
diarrhoea and idiosyncratic nephritis
side effects of steroid therapy
osteoporosis acne skin thinning weight gain diabetes hypertension growth failure
what drugs may be used for immunosuppression and what are the side effects
methotrexate/azathroprine/mercaptopurine
pancreatitis/hepatitis/lymphoma
name the 2 anti TNF drugs and their administration
infliximab - IV
adalimumab - S/C
for what IBD is surgery curative
UC
too much surgery in chrons can cause…
SBS/SGS
risk factors of IBS
usually <45
2 times more likely women
FHx
Anxiety, depression
name 3 antispasmodics and effectiveness and indication
IBS-C and D
peppermint oil
mebeverine, alverine citrate
mild short term relief of discomfort
indication of soluble fibre for IBS and name
mild diarrhoea
ispaghula
Polyethylene glycol use and downside
osmotic laxative to prevent H2O absorption
doesnt improve discomfort
name a guanate cyclase agonist, mechanism and effect
linaclotide
increases GMP so increases motility and intestinal secretion
reduces abdominal pain/constipation
name a C-2 chloride channel activator, mechanism and effect
lubiprostone
increases chloride rich secretion so increased water secretion into bowel
soften stool and improve motility
downside to loperamide
does not improve pain/bloating
what anti-diarrhoeal does improve bowel pain/bloating but what is the downside
codeine phosphate
dependence
when is surgery in UC indicated
medically unresponsive disease
malignancy
growth retardation in children
in a proctocolectomy what are the options
end ileostomy
ileorectal anastomosis
pouch
true/false - pouch is just like a rectum
false
complications of proctocolostomy with pouch
haemorrhage abscess infection anastomotic leak impotence pouchitis
when is a subtotal colectomy usually indicated in UC
severe colitis
true/false - surgery cures chrons
false- but it is the best chrons management
surgery for multisite chrons
stricturoplasty
causes of fistulas
Sepsis
Nutrition
Anatomy
Prolonged stay
management of fistulas?
resect and close secondary organ
stoma if severe
mortality of colorectal cancer
50% in 5 years
what do most colorectal cancers originate from and in what timeframe
adenomatous polyps
3-5 years
causes of colorectal cancer
genes - rare age smoking high sugar, fat, alcohol, red meat, processed foods IBD -UC low fibre lack of physical exercise
most colorectal cancers are not genetic, but for the ones that are name 2 common mutations
p53
APC - 100% chance getting it
in what ways do bowel cancer patients present with bowel cancer
bowel screening
urgent referral
emergency
following initial diagnosis how would you investigate further
biopsy and confirm by histopathology
stage with CT chest/abdo/pelvis OR MRI if rectal
what is a right hemicolectomy
removal of caecum and ascending colon
what is a transverse colectomy
removal of transverse colon
what is an extended right hemicolectomy
removal of caecum, ascending colon and transverse colon
what is a sigmoid colectomy
removal of sigmoid colon
what is an anterior resection
resection of diseased part of colon and rectum
what is an APR
removal of anus and diseased rectum and colon to form colostomy
besides cancer what aggressive options may be used to treat colorectal cancer
chemotherapy/radiotherapy
how would you treat advanced colorectal cancer
cancer resection and chemo - colon, lung, liver
HIPEC
what palliative support may be offered to patients whos cancer cannot be treated
stenting
palliative radiotherapy/chemo
bypass
