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1b. GASTROINTESTINAL > Large Colon and Rectum > Flashcards

Large Colon and Rectum Flashcards

1
Q

Describe the anatomical difference between Crohn’s and Ulcerative Colitis.

A

Crohn’s is mouth to anus.

UC is colon and rectum only.

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2
Q

Describe the pathological difference between Crohn’s and UC.

A

Crohn’s -> granulomas and skip lesions (+ deep ulceration, cobblestoning, cryptitis, pseudopolyps)
UC -> Superficial irregular crypts. Basal lymphoplasmocytic infiltrate

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3
Q

Name the genetic causes of Crohn’s and UC.

A

Crohn’s -> chromosome 16 -> HLA-DR1, HLA-DQw5

UC -> NOD-2, HLA-DR2

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4
Q

What are the presenting complaints of Crohn’s and UC?

A

Crohn’s -> abdo pain, perianal disease, diarrhoea

UC -> abdo pain, diarrhoea/blood, pus/mucus

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5
Q

Describe the lymphocytes involved in Crohn’s and UC.

A

Crohn’s -> TH1

UC -> TH1/TH2/NKTC

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6
Q

Describe the role of smoking and NSAIDs in Crohn’s and UC/

A

Crohn’s -> both bad

UC -> smoking is good, NSAIDs bad

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7
Q

Which investigations should be used in Crohn’s?

A

Ba follow through, MRI, technectium WBC scan

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8
Q

Which investigations should be used in UC?

A

CRP/albumin, AXR, endoscopy, histology

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9
Q

Describe the Truelove/Witt criteria for UC.

A

> 6 bloody stools in 24 hours, + fever, tachycardia, anaemia, increased ESR

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10
Q

Name and describe the drug treatments for Crohn’s and UC.

A 
Steroids (short course 6-8 wks)
Immunosuppressants (maintenance C/steroid-saving UC)
Anti-TNF therapy
5ASA therapy (UC)
Biosimilars
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11
Q

Describe IBS.

A

Irritable bowel syndrome - a functional GI disorder.

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12
Q

What are the Rome III criteria used to diagnose IBS?

A 
Recurrent abdo pain/discomfort + 2 of
- improvement with defecation
- change of frequency of stool
- change of appearance of stool
For 3 days/month for 3 months
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13
Q

What are the six Manning criteria for IBS?

A
  • pain relief on defecation
  • more frequent stools
  • visible abdo distension
  • passage of mucus
  • looser stools
  • sense of incomplete evacuation
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14
Q

What are the red flag symptoms for IBS?

A

Weight loss, blood in stool, anaemia, fever, history of progressive pain

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15
Q

Which are the risks for IBS?

A

<45, female, family history, mental health problems

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16
Q

What are the three types of IBS?

A

IBS-C (constipation), IBS-D (diarrhoea), IBS-M (mixed)

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17
Q

What should be used to treat IBS-C?

A 
Diet (more fruit and veg)
Short term antispasmodics
Fibre
Osmotic laxatives
5-HT4 antagonists
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18
Q

What should be used to treat IBS-D?

A 
Diet (avoid fruit/veg - FODMAP diet)
Short term antispasmodics
Loperamide (reducing frequency)
Codeine phosphate (pain)
5-HT3 antagonists
Antidepressants/anticonvulsants
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19
Q

What is intestinal failure?

A

Inability to maintain nutrition/fluid status from obstruction, dysmotility, resection, congenital defect, or disease

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20
Q

Describe the three types of intestinal failure.

A

Type 1 - acute, self-limiting, 2 weeks
Type 2 - acute, post surgery, 4 weeks
Type 3 - chronic, short bowel syndrome

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21
Q

How should the three types of intestinal failure be treated?

A

1 - fluid, electrolytes, PPIs
2 - parenteral +/- enteral
3 - home parenteral nutrition

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22
Q

Define short bowel syndrome.

A

A short bowel < 200 cm (normally 250-1050)

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23
Q

What are the last resorts for short bowel syndrome?

A

Transplant, bowel lengthening.

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24
Q

Name the three types of home parenteral nutrition (HPN).

A

Peripherally inserted central catheter (PICC), central venous, and portacath

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25
Q

What are the complications of home parenteral nutrition?

A

Pneumothorax, arterial puncture, sepsis, thrombosis

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26
Q

Name the four types of malignant tumours in the large colon.

A

Polypoid adenocarcinoma, carcinoid, sarcoma, lymphatomous

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27
Q

What is the macroscopic view of polyps and tumours?

A

Pedunculated, sessile, flat, irregular surface/stalk

28
Q

What are the majority of benign polyps in the colon?

A

Adenomas

29
Q

Which genetic factors convert adenomas to carcinomas, then to metastasis?

A

17p/18q and p53

nm23 (mets)

30
Q

Name the three main types of adenoma.

A

Tubular, villous, tubulovillous

31
Q

Name the three Duke’s polyp categories.

A

A -> confined -> 90% prognosis
B -> through propria -> 70%
C -> lymph nodes -> 35%

32
Q

Where are the majority (75%) of colon tumours located? Describe the presentation of both locations.

A

75% - descending and sigmoid -> blood PR, altered bowel habit, obstruction
25% - ascending -> anaemia, weight loss

33
Q

Describe the two types of multiple polyp conditions in the large bowel.

A

Hereditary non-polyposis coli (HNPC, <100 polyps)
Familial adenomatous polyposis (FAP, >100 polyps)
HNPC is late; DNA mismatch repair
FAP is early; tumour suppression

34
Q

What is diverticular disease?

A

Mucosal herniation through muscle coating

35
Q

What is diverticulitis?

A

Inflammation of diverticulosis (which is diverticula). May also bleed.

36
Q

How is diverticular disease found?

A

Usually incidental. Ba enema or sigmoidoscopy

37
Q

What is the main presentation of diverticulitis? What are the complications?

A

LIF pain, sepsis, altered bowel habit

Abscess, perforation, haemorrhage, fistula, stricture

38
Q

How should 1. uncomplicated, 2. complex, and 3. abscess diverticulitis be treated?

A
  1. oral abx, 2. Hertmann’s, 3. Drain/lavage
39
Q

What is angiodysplasia?

A

A small vascular malformation of the gut, forming submucosal lakes of blood

40
Q

What are the six main causes of bowel obstruction?

A

Cancer, stricture, volvulus, pseudo-obstruction, constipation, infarcation

41
Q

How should bowel obstruction be treated?

A

Resus, operation, stenting

42
Q

Give some ways STIs can be transferred to the GI tract.

A

Passive transfer of vaginal secretion, rimming, sex toys/fingers, systemic/local spread

43
Q

Give some risk factors that make STI more likely.

A

< 25, change in partners, no condom, MSM, past history, deprivation, black ethnicity

44
Q

How does Shigela spread as an STI? Who is at risk?

A

Faecal -> oral route. Bisexual/gay men

45
Q

How do gonorrhoea and chlamydia spread? How do they both present?

A

Infected fluids in contact with mucous membranes
G: abdo pain, diarrhoea, rectal bleeding/discharge, tenesmus. Purulent exudate
C: similar, less severe. Anal discomfort/itch/discharge

46
Q

What are the risk factors for LGV? How does it present?

A

Group sex, MSM, drug use, syphilis, hep C

Ulcers, inguinal/ano-rectal syndromes, fistulae

47
Q

What is the differential diagnosis of ‘piles’?

A

Haemorrhoids, herpes, syphilis, LGV, anal cancer

48
Q

How does syphilis present?

A

Primary: as a single solitary painless ulcer
Secondary: patches, ulcers, inflammation, hepatitis, procto-colitis

49
Q

How can HPV lead to anal cancer?

A

Anal intraepithelial neoplasia: AIN

50
Q

What are the general and dietary factors that may predispose to colorectal cancer?

A

Older age, obesity, smoking

High fat/sugar/alcohol/meat intake, low fibre

51
Q

Describe the genetic aetiology of colorectal cancer.

A

75-95% have no genetic factors.

Genetic factors: APC (100% will get cancer), p53, UC and Crohn’s (but UC > Crohn’s).

52
Q

Describe the four ways in which colorectal cancer can spread.

A

Direct, lymphatic, blood borne (liver/lung), or transcoelomic (rare)

53
Q

Describe the three main ways in which colorectal cancer is picked up on.

A 
Bowel screening (age 50-72)
Urgent referral (red flag symptoms)
- gastroenterologist decides whether SOPD/endoscopy
Emergency (obstruction, perforation, bleeding etc)
54
Q

Where do most colorectal cancers present - the left or right colon?

A

75% left, 25% right

55
Q

Describe the difference between colorectal cancer that presents in the left vs right colon.

A

Left - rectal bleeds, incomplete evacuation, constipation

Right - Anaemia, tiredness, change in bowel habit, weight loss, colicky abdo pain, mass in abdomen

56
Q

Which investigations are (primarily) used for colorectal cancer?

A

Sigmoidoscopy/colonoscopy (depending on tumour location) and CT colonography
(Barium enemas are now widely disregarded)

57
Q

Describe the three main mass findings on endoscope.

A

Sessile (flat) or pedunculated (mushroom) polyp, or cancer

58
Q

What is required to prepare a patient for a CT colonography?

A

Bowel perforation, faecal tagging, CO2 insuppuration, buscopan IV

59
Q

Describe what a CT scan would show in the presence of colorectal cancer.

A

An irregular, narrow lumen, speculated outer border, sharp demarcation

60
Q

Which tools are used to stage 1. colonic cancer and 2. rectal cancer?

A
  1. CT, 2. MRI
61
Q

What are the three main types of surgery for colorectal cancer?

A

Open, laparascopic, robotic

62
Q

Why is laparascopic surgery generally preferred to open surgery?

A

Leaves fewer scars/wounds, same results

63
Q

Which things are done in colorectal paliation?

A

Stenting, radio/chemo therapy, defunctioning, bypass

64
Q

What is rectal prolapse?

A

Prolapse of the anterior mucosa (partial) or full

65
Q

How may patients describe an anal fissure?

A

Like passing glass

1b. GASTROINTESTINAL (10 decks)

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