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Phase 1c > Lower GI > Flashcards

Lower GI Flashcards

1
Q

Genes and conditions associated with colon cancer

A

HNPCC (Lynch syndrome)
- hereditary non-polyposis colorectal cancer
- FHx of bowel cancer at young age
- colonoscopy: tumour without polyps (exclude FAP)

FAP (familial adenomatous polyposis)

Peutz-Jeghers syndrome
- increased risk for developing hamartomatous polyps in the digestive tract as well as other types of cancers

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2
Q

most common colon cancer type

A

adenocarcinoma

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3
Q

UK colorectal cancer screening

A

offered every 2 years to all men and women 60-74 yrs in england. patients over 74 may request

FIT test and one off flexible sigmoidoscopy

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4
Q

colon cancer risk factors and epidemiology

A

increasing age
obesity
IBD (UC)
acromegaly
poor fibre intake
limited physical activity
m > f
western countries

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5
Q

colon cancer presentation

A

for osces: male>55 with FLAWS + altered bowel habits

change in bowel habits
rectal bleeding - not bright red
weight loss (FLAWS)
tenesmus
(microcytic) anaemia symptoms

on examination:
anaemia features
palpable mass (late)
distension/ ascites (late)
lymphadenopathy (late)

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6
Q

colon cancer investigations

A

bloods:
- FBC (anaemia)
- LFTs (mets)

colonoscopy + biopsy
- visualisation of lesion
- diagnostic

double contrast barium enema:
- apple core lesion - cancer causes stricturing

pre-op staging
-CT chest/abdo/pelvis (mets)

cancer marker:
carcinoembryonic antigen (CEA) to monitor recurrence or assess response to treatment

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7
Q

staging of colon cancer

A

TNM and Dukes (specific for colon cancer)

Dukes’ A: tumour confined to the mucosa
Dukes’ B: tumour invading bowel wall
Dukes’ C: lymph node metastases
Duke’s D: distant metastases

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8
Q

colorectal cancer management

A

surgical excision + adjuvant or neoadjuvant chemo/radiotherapy

tumour in patient from HNPCC may be better with panproctocolectomy than segmental resection

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9
Q

common metastasis

A

liver lung bone brain

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10
Q

difference in inflammation pattern with Crohns vs UC

A

crohns: patchy inflammation throughout small and large bowel

uc: continuous and uniform inflammation in large bowel. affects mucosa only

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11
Q

crohns pattern of inflammation

A

transmural inflammation of the GI tract that can affect any part from mouth to anus. found as skip lesions
most commonly affects terminal ileum and perianal

inflammation > ulceration > all layers affected > non-caeseating granuloma formation

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12
Q

crohns disease risk fctors

A

FHx
smoking
oral contraceptive pill
diet high in refined sugars
maybe NSAIDs

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13
Q

crohns disease epidemiology

A

ashkenazi jews
bimodal peak with age:
15-40
60-80

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14
Q

crohns presentation

A

abdominal pain:
- crampy or constant
- RLQ + peri umbilical (terminal ileum)

diarrhoea:
- mucus, blood, pus
- nocturnal sometimes

peri anal lesions:
- skin tags, fistulae, abscesses

other:
- fatigue
- weight loss (they are malnourished)
- painful oral lesions

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15
Q

Crohn’s Ix

A

Bloods
- FBC, iron studies, vitamin/folate levels, CR, ESR

Plain abdo XR - bowel dilation
CT- bowel wall thickening, skip lesions
barium enema- rose thorn ulcers, string sign of Kantor (fibrosis and strictures)
colonoscopy- ulcers, cobblestone appearance, skip lesions

histology- transmural involvement with non-caseating granulomas

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16
Q

crohns management

A

1) steroids (can’t maintain remission)
- prednisolone, budesonide

2) immunomodulators
- azathioprine, methotrexate

3) biological therapy
- adalimumab, infliximab

4) surgery
- severe presentations, obstruction, etc

adjuncts
- nutritional therapy
- perianal disease mx
- smoking cessation
- anti-spasmotics
- anti-diarrhoeals

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17
Q

which gene predisposes you to ulcerative colitis

A

HLA-B27

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18
Q

is smoking a risk factor for ulcerative colitis

A

no. smoking is protective in ulcerative colitis

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19
Q

ulcerative colitis presentation

A

bloody diarrhoea
rectal bleeding + mucus
abdominal pain + cramps
tenesmus
weight loss

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20
Q

Ulcerative colitis extra-intestinal manifestations

A

joints
- peripheral arthritis
- ankylosing spondylitis

skin
- erythema nodosum
- pyoderma gangrenosum

occular
- episcleritis

anaemia signs
DRE- gross or occult blood
abdo tenderness

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21
Q

ulcerative colitis Ix

A

Bloods
-FBC (anaemia)
-LFTs (primary sclerosing cholangitis)
-CRP/ESR (inflammatory disease)

Stool sample
- increased faecal calprotectin

other
-pANCA (70% positive)

AXR- dilated bowel, thumbprinting
double contrast barium enema- lead pipe appearance
colonoscopy - erythema, bleeding ulcers
histology- crypt abscesses, depletion of goblet cell mucin

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22
Q

complications of ulcerative colitis

A

primary sclerosing cholangitis
toxic megacolon
colonic adenocarcinoma

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23
Q

ulcerative colitis mx

A

1) Induce remission

mesalazine
steroids (oral beclamethasone)

2) maintain remission

immunosuppressives
- azathioprine, mercaptopurine

biologics (anti-TNFa)
- infliximab

biologics (integrin receptor antagonist)
- vedolizumab

ciclosporin

total colectomy (cure)

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24
Q

what triggers coeliac disease

A

gliadin

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25
Q

coeliac risk factors

A

FHx
IgA deficiency
T1DM
autoimmune thyroid disease
Female

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26
Q

coeliac disease presentation

A

diarrhoea
bloating
abdo pain
fatigue
weight loss
dermatitis herpetiformis
b12/iron/folate deficiency symptoms

27
Q

coeliac disease ix

A

immunoglobulin A tissue trans glutaminase
endomysial antibody
endoscopy
- villous atrophy + crypt hyperplasia
FBC +blood smear

28
Q

coeliac mx

A

gluten free diet
vitamin + mineral supplements

29
Q

IBS classification

A

IBS - D(iarrhoea)
IBS - C(onstipation)
IBS - M(ixed type)

30
Q

IBS risk factors

A

history of physical/sexual abuse
PTSD
PMHx
FHx
Female

31
Q

IBS presentation

A

abdo cramping in lower/mid abdomen
alteration of stool consistency
defecation relieves abdo pain/discomfort

32
Q

IBS Ix

A

diagnosis of exclusion

Anti-tTG (coeliac)
fecal calprotectin (IBD)
serum CRP (IBD)
colonoscopy (IBD)
FBC (anaemia- consider CRC)
FOB test (CRC)

33
Q

IBS Mx

A

fibre
avoid caffeine, lactose, fructose
stress management
education
probiotics

laxatives (IBS-C)
antispasmotics
antidiarrhoeals (IBS-D)

34
Q

mesenteric adenitis risk factors

A

viral infections
bacterial infections
IBD
lymphoma
children, young adults

35
Q

mesenteric adenitis presentation

A

RLQ pain
history of gastroenteritis

36
Q

mesenteric adenitis ix

A

raised CRP
USS - enlarged mesenteric lymph nodes

37
Q

mesenteric adenitis management

A

self-limiting
simple analgesia

38
Q

constipation RFs

A

low fibre intake, no water
sedentary lifestyle
meds: opiates, CCB
disease: IBS, IBD, cancer
psychological

39
Q

constipation presentation

A

infrequent stools
difficulty defecating
tenesmus
excessive straining
abdominal mass (LLQ)
anal fissures
haemorrhoids
hard stools

40
Q

constipation mx

A

1st line: lifestyle: high fibre, water, exercise
avoid triggering factors

2nd line: osmotic laxatives: macrogol, lactulose
3rd line: stimulant laxatives: senna, bisacodyl

deal with primary cause

41
Q

haemorrhoids presentation

A

painless bleeding associated with defecation
can be painful and cause discomfort
anal pruritus
palpable mass felt

42
Q

haemorrhoids investigations

A

anoscopic examination
colonoscopy (to exclude other pathologies)
FBC (anaemia)

43
Q

haemorrhoid mx

A

constipation advice
discourage straining

grade 1: topical corticosteroids (alleviates pruritus)
grade 2: rubber band ligation
grade 3: rubber band ligation
grade4: surgical haemorrhoidectomy

44
Q

thrombosis of haemorrhoid presentation

A

sudden onset perianal pain and the appearance of a tender nodule adjacent to the anal canal often following a period of vigorous activity

45
Q

haemorrhoid thrombosis mx

A

pain relief
stool softener
consider excision

46
Q

rectal prolapse presentation

A

painless protruding mass following defecation or straining
mucoid discharge
incontinence

47
Q

rectal prolapse ix

A

ask pt to strain to elicit prolapse

48
Q

anal fissures risk factors

A

anything causing constipation like opiates or pregnancy

49
Q

anal fissure presentation

A

pain on defecation
tearing sensation on defecation
fresh blood on toilet paper

50
Q

anal fissure ix

A

clinical diagnosis (hx)

impossible to do DRE - usually examinations under anaesthesia

51
Q

anal fissure mx

A

conservative
- manage constipation
- high fibre, hydration
- sitz baths

topical GTN (analgesia)

topical diltiazem (analgesia)

for persistent fissures
- botox injection
- surgical sphincterectomy

52
Q

anal fistula RFs

A

clogged anal glands and anal abscesses
crohn’s disease
radiation
trauma

53
Q

anal fistula presentation

A

frequent anal abscesses
pain and swelling around the anus
bloody/foul smelling drainage

54
Q

anal fistula ix

A

examination
-opening on skin around anus
-not always visible
-anoscope/rectoscope

consider
-EUA
MRI

55
Q

anal fistula mx

A

fistulotomy
seton

56
Q

anal abscess risk factors

A

anal fistula
crohn’s
constipation

57
Q

anal abscess presentation

A

perianal pain
not related to defecation
perianal swelling and tenderness

maybe low grade fever and tachycardia

58
Q

anal abscess ix

A

clinical examination

EUA
CT/MRI

59
Q

anal abscess management

A

surgical drainage of abscess
fistulotomy

maybe broad spectrum AB

60
Q

what is pilonidal sinus

A

caused by the forceful insertion of hairs into the skin of the natal cleft in the sacrococcygeal area. promotes inflammation and creates a sinus

61
Q

pilonidal sinus RFs

A

male
16-40
stiff hair
hirsutism

62
Q

pilonidal sinus presentation

A

sacrococcygeal:
discharge
pain (worse sitting down)
swelling

63
Q

pilonidal sinus ix

A

clinical diagnosis

64
Q

pilonidal sinus mx

A

surgical excision of pilonidal cyst + sinus
+ AB
+ hair removal (laser)
+ local hygiene advice

Phase 1c (13 decks)

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