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1. 4th year > Lower GI > Flashcards

Lower GI Flashcards

1
Q

abdo pain mimicking appendicitis in kids + rectal bleeding

A

meckels diverticulum

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2
Q

dx meckels diverticulum

A

radio nucleotide scan - t99

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3
Q

tx meckels diverticulum

A

surgical excision - wedge or small bowel resection with anastomosis

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4
Q

3 main causes of malabsorption

A

bowel disease
pancreatic - CF or cancer
infection - giardiasis

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5
Q

ix for malabsorption

A
  • Stool sample  microscopy.
  • Bloods: FBC, B12, folate, iron, calcium, anti TTG.
  • Hydrogen breath test. (bacterial overgrowth, intolerances)
  • OGD + biopsy.
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6
Q

skin condition associated with coeliac

A

dermatitis herpetiformis

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7
Q

1st line ix coeliac

A

serum anti TTG (IgA) after eating gluten for 6 weeks

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8
Q

gold standard ix for coeliac

A

OGD + duodenal/jujenal biopsy - villous atrophy, crypt hyperplasia, lymphocytes

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9
Q

deficiencies in coeliac

A

iron deficiency anaemia
B12 and folate
osteoporosis
osteomalacia

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10
Q

cancer linked to coeliac

A

T cell lymphoma

small bowel cancer

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11
Q

if patient with ? coeliac has low total IgA what can you measure

A

IgG TTG

assocaited with HLA DQ2 and 8

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12
Q

vaccines in coealic

A

pneumococcal with 5 yearly booster

due to hyposplenism

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13
Q

ix for lactose intolerance

A

hydrogen breath test

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14
Q

ix for bacterial overgrowth

A

hydrogen breath test

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15
Q

who is at risk of bacterial overgrowth

A

elderly

post gastric surgery

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16
Q

tx bacterial overgrowth

A

abx e.g. trimethoprim

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17
Q

tx tropical sprue

A

tetracycline + folic acid

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18
Q

ix tropical sprue

A

OGD + biopsy

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19
Q

what is whipples disease

A

infection with tropheryma whipplei

associated with HLA B27

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20
Q

ix of whipples disease

A

OGD + jejunal biopsy –> PAS (periodic acid-schiff) positive macrophages and saggy mucosa

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21
Q

tx whipples disease

A

LT antibiotics - oral co trim 1 year

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22
Q

2 main RF for diverticular disease

A

low fibre

age

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23
Q

tx diverticulosis

A

high fibre diet

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24
Q

ix diverticular disease

A

colonoscopy

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25
Q

ix diverticulitis

A

erect CXR - rule out perforation
AXR - assess for obstruction
abdo CT with contrast to identify cause/local comps e.g. abscess

NOT colonoscopy due to risk of perforation in acute disease

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26
Q

mild diverticulitis tx

A

oral abx

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27
Q

severe diverticulitis tx

A

IV abx and IV fluids - cephalosporin and metronidazole

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28
Q

tx diverticular abscess

A

USS guided percutaneous drainage

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29
Q

diverticulitis + perforation/obstruction

A

probably hartmanns

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30
Q

AF predisposes to what bowel problem

A

acute mesenteric ischaemia

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31
Q

ischaemic colitis in young person

A

cocaine possibly

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32
Q

ischaemic colitis ix of choice

A

CT

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33
Q

where is ischaemic colitis most likely to occur

A

splenic flexure

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34
Q

AXR of ischaemic colitis

A

mucosal thumb printing

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35
Q

diagnostic ix of ischaemic colitis

A

sigmoidoscopy + biopsy - withering crypts

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36
Q

screening for ischaemic colitis

A

AXR

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37
Q

presentation of large bowel ischaemia / ischaemic colitis

A

intermittent LLQ pain
rectal bleeding
diarrhoea
hx of CVD/risk factors

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38
Q

tx ischaemic colitis

A

conservative

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39
Q

fresh intermittent PR bleeding in elderly
IDA on FBC
no mass

A

angiodysplasia

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40
Q

ix for angiodysplasia

A

rule out cancer - FIT, colonscopy

diagnostic - mesenteric angiography is acutely bleeding

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41
Q

tx angiodysplasia

A

embolisation, endoscopic lazer cautery

2nd line - resection

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42
Q

dx and tx of colorectal polyp

A

colonscopy + polypectomy

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43
Q

how often are people with FAP screened

A

sigmoidoscopy annually from 15

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44
Q

inheritance of FAP

A

AD

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45
Q

what cancer does HNPCC predispose to

A

colorectal
ovarian
endometrial

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46
Q

screening in HNPCC

A

colonoscopy every 1-2 years from age 25

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47
Q

inheritance of HNPCC

A

AD

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48
Q

inheritance of gardners

A

AD

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49
Q

describe DUKES staging of colorectal cancer

A

A Tumour confined to mucosa.
B Tumour invaded through bowel wall.
C Involvement of local lymph nodes.
D Distant metastasis.

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50
Q

describe the bowel cancer screening

A

every 2 years to people aged 60-74 (england) and 50-74 (scotland) using FIT

51
Q

gold standard ix for bowel cancer if FIT positive

A

colonoscopy + biopsy

52
Q

what is used to detect lynch syndrome (HNPCC) if colonoscopy diagnoses bowel cancer

A

CT colonography

53
Q

staging of rectal cancer

A

MRI

54
Q

staging of colonic cancer

A

CTCAP

55
Q

monitoring of bowel cancer

A

CEA

56
Q

tx bowel cancer

A

surgical 1st line - most with curative intent

57
Q

surgery for Ceacal, ascending, proximal transverse

A

right hemicolectomy

58
Q

surgery for Distal transverse or descending

A

left hemicolectomy

59
Q

surgery for sigmoid

A

high anterior resection

60
Q

surgery for upper or lower rectum

A

anterior resection

61
Q

surgery for anal verge

A

abdomino-perineal excision of rectum

62
Q

who gets chemo for colorectal cancer

A

Dukes C and above

63
Q

chemo used in colonic cancer

A

5FU and oxaliplatin

64
Q

is radiotherapy used in rectal cancer

A

yes - post op reduces local recurrence

65
Q

monoclonal AB used in stage 4 colonic or metastatic disease

A

cetuximab

66
Q

diagnostic criteria for IBS

A

3 month history of abdo pain/discomfort for 3 days/week that is relieved by defacation, associated with change in stool frequency and consistency with 2 + additional symptoms

diagnosis of exclusion - suspect ovarian/bowel cancer

67
Q

tx diarrhoea in IBS

A

loperamide

68
Q

tx constipation in IBS

A

bulking agents - fybogel, hyocine, avoid lactulose

69
Q

tx bloating in IBS

A

meveberine

70
Q

tx IBS if failed symptomatic control

A

psychotherapy, amitriptyline

71
Q

eye problems in

  • UC
  • crohns
A

UC - uveitis
crohns episcleritis

(both can occur in both)

72
Q

PSC is associated more with which IBD

A

UC

73
Q

describe distribution of UC

A

rectum to ileoceacal valve
continuous
superficial inflammation

74
Q

histology of UC

A

o Goblet cell depletion.
o Acute cryptitis and crypt abscesses.
o Superficial inflammation involving only the mucosa and submucosa.

75
Q

is UC associated with bloody stool

A

yes

76
Q

where is pain in UC typically felt

A

Left

77
Q

diagnosis of UC

A

colonoscopy + biopsy

78
Q

XR appearance of UC

A

lead pipe colon - short and narrow

79
Q

ix of UC with severe colitis

A

flexible sigmoidoscopy

80
Q

assessing extent of UC

A

colonoscopy

81
Q

risks of UC

A

colorectal cancer

toxic megacolon

82
Q

dx toxic megacolon

A

AXR - thumb printing and colon > 6cm in diameter

83
Q

remission induction:

Tx UC proctitis

A

topical ASA

84
Q

remission induction:

Tx UC proctitis if remission not achieved in 4 weeks with topical ASA

A

add oral ASA

85
Q

remission induction:

Tx UC if remission not achieved with topical and oral ASA

A

add topical or oral steroid

86
Q

remission induction:

Tx UC proctosigmoiditis/left sided UC

A

topical ASA

87
Q

remission induction:

Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA

A

add high dose oral ASA or switch to high dose oral ASA and topical steroid

88
Q

remission induction:

Tx UC proctosigmoiditis/left sided UC if not resolved in 4 weeks on topical ASA/steroid and oral ASA

A

stop topical treatments

offer oral ASA and oral corticosteroid

89
Q

remission induction:

Tx UC extensive disease

A

topical ASA and high dose oral ASA

90
Q

remission induction:

Tx UC extensive disease if remission not achieved in 4 weeks with topical ASA and oral ASA

A

stop topical treatments and offer high dose oral ASA and oral steroid

91
Q

tx severe UC

A

IV steroids in hospital - IV methylprednisolone

92
Q

tx severe UC if no improvement in 72 hours with IV steroids

A

add IV ciclosporin

93
Q

tx UC maintaining remission mild/moderate flare up proctitis/proctosigmoiditis

A

topical ASA
oral and topical ASA
or low dose oral ASA alone

94
Q

tx UC maintaining remission if left sided UC/ extensive disease

A

low dose oral ASA

95
Q

Tx UC severe relapse or > 2 exacerbations in a year

A

oral azathioprine or mercaptopurine

96
Q

first line treatment of UC and mainstay for remission

A

5 ASA (mesalazine)

97
Q

what is a risk of using mesalazine

A

acute pancreatitis

98
Q

describe the distribution of crohns

A

any part of alimentary canal from mouth to anus
transmural inflammation
skip lesions (cobblestone)

99
Q

where is pain typically felt in crohns

A

right hand side - most commonly affects terminal ileum

100
Q

histology of crohns

A

o Non caseating granuloma.
o Deep, transmural (extends from mucosa to serosa) inflammation that can cause fissures and gives the mucosa a cobblestone appearance.
o Goblet cells

101
Q

deficiency common in crohns

A

B12 - macrocytic anaemia

102
Q

is crohns associated with blood

A

not as much as UC

yes if crohns colitis

103
Q

does UC or crohns get perianal disease

A

crohns

104
Q

anaemia seen in crohns

A

macrocytic

105
Q

what inflammatory marker correlates with disease activity in crohns

A

CRP

106
Q

ix of crohns

A

colonoscopy and biopsy

107
Q

what feacal marker is rasied in crohns

A

faecal calprotectin

108
Q

dx of crohns

A

flexible sigmoidoscopy

109
Q

treatment crohns - remission induction

A

glucocorticoids - oral topical or IV

enteral feeding with elemental diet

110
Q

what can be used as an add on medication to induce remission in crohns but not as a monotherapy

A

azathioprine or mercaptopurine

methotrexate is alternative

111
Q

drug used in treatment crohns in refractory disease and fistulating disease

A

infliximab

112
Q

isolated perianal disease in treatment crohns

A

metronidazole

113
Q

1st line treatment crohns maintaining remission

A

azathioprine or mercaptopurine

114
Q

2nd line treatment crohns maintaining remission

A

methotrexate

115
Q

what needs to be measured before starting azatioprine

A

TMPT activity

116
Q

ix for suspected perianal fistula

A

MRI

117
Q

tx complex fistula

A

draining seton

118
Q

tx perianal abscess

A

incision and drainage and antibiotics

119
Q

tx severe flares in crohns

A

IV steroids

azathioprine and mercaptopurine can be added on

120
Q

most important advice in crohns

A

STOP SMOKING

121
Q

where are ileostomies found

A

RIF

122
Q

where are colostomys found

A

LIF

123
Q

5ASA side effect that patients need to be aware of

A

agranulocytosis - if get a cold sore throat etc need to check FBC

1. 4th year (23 decks)

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