Lower GI Flashcards
Treatment of colon cancer with liver mets
Chemo then surgery
Palliate if widespread or frail
Conditions associated with anal fissures
Sexually transmitted diseases (syphilis, HIV)
Inflammatory bowel disease (Crohn’s up to 50%)
Leukaemia (25% of patients)
Tuberculosis
Previous anal surgery
Mx of IBD with megacolon who has failed conservative tx
Sub total colectomy with loop ileostomy
What can genital skin tags be associated with
Anal fissure
Adenoma with the highest risk of dysplasia
Villous adenoma
Diverticular disease vs diverticulitis presentation
D Disease can bleed- causing no symptoms apart from dark blood per rectum
Diverticulitis- fever, pain, rarely bleeds
Mx of caecal obstruction
If > 12 cm, With functioning valve- will cause perf
Reusus with fluids- laparotomy 2-4 hours later
Mx of high anatomical enter-cutaneous fistula
TPN and ocreotide
Nutritional complications are common especially with high fistula (e.g. high jejunal or duodenal) these may necessitate the use of TPN to provide nutritional support together with the concomitant use of octreotide to reduce volume and protect skin.
Mx of rectal cancer causing obstruction
As if a rectal canacer is adnvaced enough to cause obstruction- likey has spread
So best inital plan is to Create loop colostomy to aid obstrcution then plan definitive surgery if required
Mx of rectal cancer near verge
Patients with T1, 2 and 3 /N0 disease on imaging do not require irradiation and should proceed straight to surgery.
Then AP resection
Patients with T4 disease will typically have long course chemo radiotherapy.
Obstrcuted right colon cancer mx
Right hemicolectomy
Ileocolic anastomosis
Follow up on polyps on colonoscopy
Colorectal cancer- Colonoscopy 1 year post resection
High risk- >5 adenomas, or 3 adenoma with 1 >1cm- 3 year
LNPCP( larger than 2cm)
Large non pedunculated colorectal polyps (LNPCP) R1 or non en bloc resection- Site check at 2-6 months and then a further scope at 12 months
Large non pedunculated colorectal polyps (LNPCP), R0 resection- one off scope 3 years
High risk findings polyp
More than 2 premalignant polyps (adenoma <1cm) including 1 or more advanced colorectal polyps (>1cm)
OR
More than 5 pre malignant polyps
If Surgery for UC?
segmental resections are not undertaken for UC
Histological features of UC vs crohns
Crohns -Granulomas (non caseating epithelioid cell aggregates with Langhans’ giant cells)
UC-Crypt abscesses, Inflammatory cells in the lamina propria
Features typical of crohns vs UC
Crohns- fistula, small bowel strictures, rose thorn ulcers, fat wrapping of terminal ileum
UC- pseudopolyps (mucosal islands)
Treatment of fistulas in ano
Low fistula, intersphincteric- fistulotomy
Dentate line+ above or IBD- loose seton
Trans- seton then fistulotomy later
Supra- seton then fistuolotmy later
Mx of bleeding rectal varices
IV terlipressin
Types of laxatives
Bulk-ispaghula husk and methylcellulose
Osmotic-
Magnesium sulphate
Magnesium citrate
Sodium phosphate
Sodium sulphate
Potassium sodium tatrate
Polyethylene glycol
Docusate
Lactulose
Stimulant-
Bisacodyl
Sodium picosulphate
Senna
What would imply T4 colon cancer
Broken out of colon- i.e tethered to prostate
Mx of bleeding diverticula disease
Conservational and observation
Solitary rectal ulcer syndrome sx
Solitary rectal ulcers are associated with chronic constipation and straining.
Indurated area located proximal to anal verge
It will need to be biopsied to exclude malignancy
Mx of diverticular stricture causing obstruction in sigmoid
Hartmanns
Features of acute appendicits
Neutrophillia
Protein on urine dip
Anorexia
Low grade pyrexia
No diarrhoea or profuse vomitting
Low grade fever and a mass palpable in the right iliac fossa. The rest of his abdomen is soft. An abdominal USS demonstrates matted bowel loops surrounding a thickened appendix.
Appendix mass
Antibiotics
- no peritoneal signs no surgery
Where fissures present usually
90% posteriorly
10% anteriorly