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MedEd Lectures > lower GI > Flashcards

lower GI Flashcards

1
Q

A 22 y/o female presents to her GP with a two year history of intermittent diarrhoea and constipation. She complains of bloating and abdominal pain, which eases with defecation. Which condition is she likely to have?

A. 	Coeliac disease
B. 	Ulcerative colitis
C. 	Crohn’s disease
D. 	Irritable bowel syndrome
E. 	Infectious diarrhoea
A

B. Ulcerative colitis

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2
Q

A 26 y/o male presents to his GP with weight loss, abdominal pain and watery diarrhoea. On examination he looks pale and you notice ulcers in his mouth. Which condition is he likely to have?

A. 	Coeliac disease
B. 	Ulcerative colitis
C. 	Crohn’s disease
D. 	Irritable bowel syndrome
E. 	Infectious diarrhoea
A

C. Crohn’s disease

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3
Q

A 23 y/o female presents to her GP with a limp. On further questioning she reveals she has recently lost weight and has had bloody, mucoid diarrhoea. On examination her right knee is tender and swollen, and her eyes are red. Which condition is she likely to have?

A. 	Coeliac disease
B. 	Ulcerative colitis
C. 	Crohn’s disease
D. 	Irritable bowel syndrome
E. 	Infectious diarrhoea
A

E. Infectious diarrhoea

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4
Q

A 27 y/o male presents with a history of mucoid, bloody diarrhoea and weight loss. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?

A. 	IV corticosteroid
B. 	Oral prednisolone
C. 	Topical mesalazine
D. 	Oral azathioprine
E. 	IV cyclosporin
A

C. Topical mesalazine

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5
Q

A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?

A. 	IV corticosteroid
B. 	Oral prednisolone
C. 	Oral mesalazine
D. 	Oral azathioprine
E. 	IV cyclosporin
A

B. Oral prednisolone

which is a corticosteroid

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6
Q

A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?
After starting treatment, his symptoms improve. Which additional treatment would you start him on to maintain his remission?

A. 	IV corticosteroid
B. 	Oral prednisolone
C. 	Oral mesalazine
D. 	Oral azathioprine
E. 	IV cyclosporin
A

D. Oral azathioprine

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7
Q

A 55 y/o female presents to her GP with an itchy rash on her forearms. On further questioning she reveals she has recently lost weight and has had mucoid diarrhoea. Which test will best confirm her diagnosis?

A. 	Endoscopy with duodenal biopsy
B. 	Serum antibodies to tissue-transglutaminase
C. 	Serum anti-endomysial antibodies
D. 	Colonoscopy
E. 	Endoscopy with ileal biopsy
A

A. Endoscopy with duodenal biopsy

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8
Q

Crohn’s:

  1. Gut layer
  2. Regions most common site
  3. Inflammation
  4. Abscess/fissure
  5. symptoms
  6. Flare patterns
  7. surgery
A
  1. All
  2. mouth to anus (although terminal ileum is common)
  3. patchy - skip lesions
  4. common
  5. Diarrhoea +/- blood (mixed in)
  6. systemically unwell
  7. NOT curative
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9
Q

Ulcerative Colitis

  1. Gut layer
  2. Regions most common site
  3. Inflammation
  4. Abscess/fissure
  5. symptoms
  6. Flare patterns
  7. surgery
A
  1. Mucosa and submucosa
  2. Colon and rectum
  3. continuous
  4. uncommon
  5. bloody +/- mucus diarrhoea (mixed in)
  6. well between attacks
  7. curative
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10
Q

What are other important features of Crohn’s

A
  1. mouth ulcer
  2. fever
  3. perianal lesions
  4. RIF pain (from ileitis)
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11
Q

What are other important features of UC

A
  1. Abdominal pain

2. relapsing-remitting

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12
Q

What are extra-intestinal manifestations of IBD

A

A PILE SAC

A = aphthos

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13
Q

What are extra-intestinal manifestations of IBD

A 
A PILE SAC
A = aphthos (mouth) ulcers [CD>UC]
P = pyoderma gangrenosum
I = (eye) iritis, uveitis, episcleritis [CD>UC]
E = erythema nodosum 
S = sclerosing cholangitis [UC]
A = arthritis 
C = clubbing fingers [CD>UC]
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14
Q

What is the first line investigation for inflammatory bowel disease

A

Stool sample

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15
Q

What are the investigations used to diagnose Crohn’s

A
  1. stool sample
  2. Blood tests
  3. CT/MRI
  4. (colonoscopy and biopsy)
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16
Q

What are the investigations used to diagnose ulcerative colitis

A
  1. stool sample
  2. blood tests
  3. AXR
  4. colonoscopy/flexible sigmoidoscopy and biopsy
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17
Q

What are the radiological signs of inflammatory bowel disease

A
  1. lead pipe sign
  2. thumb printing
  3. toxic megacolon (IBD is serious enough to cause inflammatory colitis)
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18
Q

What drug is used to induce remission in Crohn’s

A

corticosteroids

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19
Q

What drug is used to induce remission in ulcerative colitis

A

Aminosalycilates

  • topical
  • oral (low dose)
  • oral (high dose)
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20
Q

What drugs are used to maintain remission in Crohn’s

A
  1. Azathioprine
  2. methotrexate
  3. cyclosporin
  4. infliximab
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21
Q

What drugs are used to maintain remission in ulcerative colitis

A
  1. Azathioprine
  2. methotrexate
  3. cyclosporin
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22
Q

What is coeliac disease

A

chronic autoimmune disease of the small intestine, categorised by gluten intolerance in genetically susceptible individuals

23
Q

What is the aetiology behind coeliac disease

A 
autoimmune damage to intestinal mucosa leads to 
villous atrophy 
WBC infiltration 
cryptal hyperplasia 
= malabsorption
24
Q

What are the risk factors for coeliac disease

A
  1. female
  2. autoimmune background
    T1DM
    Thyroid disease
  3. Family history
25
Q

What are the symptoms of coeliac disease

A
  1. diarrhoea

which is difficult to flush

26
Q

What are the symptoms of coeliac disease

A 
1. diarrhoea 
which is difficult to flush
2. Bloating 
3. Abdo pain 
after eating gluten 
4. fatigue
27
Q

What are the signs of coeliac disease

A
  1. IgA deficiency
  2. anaemia
  3. dermatitis herpetiformis
28
Q

What is the first line management for coeliac disease

A

stool sample

29
Q

What is the gold standard investigation for coeliac disease

A

Endoscopy + duodenal biopsy

30
Q

What are the investigations for coeliac disease

A
  1. Stool sample
  2. serum anti-body tests:
    antibodies to tissue transglutaminase (TTG)
    anti-
31
Q

What are the investigations for coeliac disease

A
  1. Stool sample
  2. serum anti-body tests:
    antibodies to tissue transglutaminase (TTG)
    anti-endomysial antibodies
  3. Gold standard: endoscopy + duodenal biopsy
32
Q

What is the management of coeliac disease

A
  1. guten-free diet

2. vitamin D supplementation

33
Q

What are the complications of coeliac disease

A
  1. upper GI lymphomas and carcinoma
  2. osteoporosis due to lack of vitamin D
  3. Chronic dermatitis herpetiformis
34
Q

A 67 y/o male presents to his GP following an episode of rectal bleeding. He noticed fresh blood on the toilet paper after wiping. There was no blood mixed in with the stool. He is otherwise fit and well. What is the next appropriate step to take?

A. 	Colonoscopy
B. 	Faecal occult blood test
C. 	Abdominal exam
D. 	Digital rectal exam
E. 	Sigmoidoscopy
A

C. Abdominal exam

35
Q

A 35 y/o male presents to his GP following an episode of rectal bleeding. He noticed fresh blood on the toilet paper after wiping. There was no blood mixed in with the stool. He adds that he is very sore ‘down there’ and it is agony to defecate. Which condition is he likely to have?

A. 	Haemorrhoids
B. 	Anal fissure
C. 	Crohn’s disease
D. 	Ulcerative colitis
E. 	Colorectal carcinoma
A

B. Anal fissure

36
Q

A 67 y/o male presents to his GP complaining of rectal bleeding. Over the last few months he has noticed blood mixed in with his stool. He sometimes feels like he hasn’t completely emptied his bowels after defecating, and is more tired than usual. What is the next step to take?

A. Routine referral to colorectal surgeons
B. Urgent referral to colorectal surgeons
C. FBC
D. Abdominal exam
E. Faecal occult blood test

A

D. Abdominal exam

37
Q

What is an anal fissure

A

It is a split in the skin of the distal anal canal

38
Q

What are the risk factors for anal fissure

A
  1. young, white males

2. can be linked to previous constipation

39
Q

What are the symptoms of an anal fissure

A
  1. pain
    tearing sensation
  2. Blood on paper
40
Q

What are the investigations for an anal fissure

A

purely clinical diagnosis

41
Q

What is the treatment of anal fissures

A
  1. fluids and fibre
  2. topical analgesia
  3. can add topical GTN or diltiazem
  4. surgery in severe, chronic cases
42
Q

What are the complications of anal fissures

A
  1. chronicity

2. incontinence from surgery

43
Q

What are haemorrhoids

A

haemorrhoidal cushions are normal anatomical structures located within the anal canal. As they enlarge, they van protrude outside the anal canal causing symptoms

44
Q

What are the risk factors for haemorrhoids

A

Increased intra-abdominal pressure

45
Q

What are the symptoms of haemorrhoids

A
  1. rectal bleeding
    bright red
    sides of the pan
  2. rectal pain
46
Q

What are the signs of haemorrhoids

A
  1. Lump on DRE

2. 3rd/4th type may be visible on inspection

47
Q

What are the investigations for haemorrhoids

A
  1. DRE

2. Colonoscopy

48
Q

What is the management for haemorrhoids

A
  1. fluid and fibre, topical analgesia
  2. 2nd or 3rd degree: non-surgical removal
  3. 4th: excision
49
Q

What is the most common type of colorectal cancer

A

adenocarcinoma

50
Q

What are the risk factors for colorectal cancer

A
  1. alcohol/smoking/high red meant diet
  2. polyps
  3. Genetic conditions:
    FAP/HNPCC
51
Q

Features of a right sided tumour (colorectal cancer)

A
  1. weight loss
  2. anaemia
  3. abdominal pain
  4. obstruction less likely
  5. harder to detect, presents later
52
Q

Features of left sided tumour (colorectal cancer)

A
  1. bleeding/mucus PR
  2. Altered bowel habit
  3. tenesmus
  4. obstruction
  5. Mass PR
  6. Easier to detect, presents earlier
53
Q

What are the investigations for colorectal cancer

A 
1. Bloods:
FBC (anaemia) 
LFTs (baseline) 
Renal function (baseline) 
2. colonoscopy/barium enema/ CT colonography 
(to find and stage the tumour) 
3. biopsy (to grade tumour

MedEd Lectures (15 decks)

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