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Yr 3 MedEd > Lower GI > Flashcards

Lower GI Flashcards

1
Q

What is an anal fissure?

What is the timeline for acute vs chronic.

Where are primary and secondary anal fissures commonly located?

A

A tear in squamous epithelium of anal canal

Acute< 6 weeks< chronic

Primary in posterior midline. Secondary in varying locations.

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2
Q

Give 3 causes of secondary anal fissures.

A
  • Constipation
  • Crohn’s disease
  • Pregnancy
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3
Q

Give 2 features of a common anal fissure presentation.

What is a sign of a chronic ulcer?

A
  • Young person
  • Painful rectal bleeding on defecation
  • Sentinel pile/ skin tag
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4
Q

Anal fissure patients can enter a pain-constipation cycle.
What is the management for the pain?

What is the management for the constipation?

A
  • Paracetamol/ ibuprofen
    + topical lidocaine.
    Topical GTN/ diltiazem if > 1 week.
  • Increase fluid/ fibre intake
  • Laxative.
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5
Q

What are the two management options for chronic anal fissure?

A
  • Botulinum injection

- Internal sphincterotomy

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6
Q

What is the definition of a haemorrhoid?

A

Engorgement of vascular cushions in anal canal.

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7
Q

What are the two differences between internal and external haemorrhoids?

What are the 4 grades of internal haemorrhoid?

A

Internal: above dentate line, not painful.

External: below dentate line, painful

  1. project into lumen, not palpable
  2. Prolapse w/ straining, spontaneously reduce
  3. prolapse w/ straining, manually reducible
  4. Irreducible
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8
Q

Give two aetiologies of haemorrhoids.

A
  • Constipation/ straining

- Raised intra-abdominal pressure: Pregnancy, lifting, chronic cough.

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9
Q

What is the common presentation of haemorrhoids?

Give an individual complication for both external and internal haemorrhoids.

A
  • Painless rectal bleeding- small amounts of bright red blood on wiping/ in bowl.
  • Strangulation of internal haemorrhoid- severe pain, urgent haemorrhoidectomy.
  • Thrombosis of external haemorrhoids- sever pain, purple oedematous perianal mass. <72 hours surgical incision
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10
Q

Give two investigations for haemorrhoids.

Give 3 steps in management for haemorrhoids.

A
  • Proctoscopy
  • Anaemia
  1. Stool softening: fibre/ fluid laxative
  2. Rubber band ligation/ or injection sclerotherapy
  3. Large grade 3/4 may require haemorrhoidectomy.
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11
Q

What is the most common form of colorectal cancer? Describe it’s global epidemiology.

A

Usually adenocarcinoma.

3rd most common cancer in world.

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12
Q

Give 4 etiological factors for colorectal cancer

A
  1. Genetic: FAP (APC gene), HNPCC - autosomal dominant.
  2. Demographic: old male
  3. Environmental: smoking, diet, alcohol, obesity
    4: other: adenomatous/ neoplastic polyps. IBD (UC > Crohn’s)
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13
Q

What screening tool is used for colorectal cancer for 60-74yrs and how often?

A
  • Screening is Faecal immunochemical test (FIT). Test for trace amounts of blood.

Every 2 years

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14
Q

Give 3 general symptoms of colorectal cancer.

A
  • abdominal pain, weight loss, fatigue.
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15
Q

Differentiate presentation of left (6 factors) and right (2 factors) sided colorectal cancer.

A

Left: more common, present earlier.

  • PR bleeding
  • Change in bowel habit
  • Rectal tenesemus, mass on DRE
  • Can present with obstruction.

Right: less common, present later,
- anaemia

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16
Q

Give 3 blood results and 2 other investigations for colorectal cancer.

What 4 sites are common metastasis locations?

A
  1. Blood:
    - FBC- iron deficiency anaemia
    - LFTs (mets)
    - CEA (tumour marker, not used for diagnosis)
  2. Colonoscopy- gold standard.
  3. Barium enema: apple core stricture.

TNM staging, used to be Duke’s

Common mets: liver, lungs, bone, brain

17
Q

Give the 1s and 2nd line management options for colorectal cancer treatment.

A

1st: Surgery- L/R hemicolectomy, sigmoid colectomy, rectum anterior resection.
2nd: radiotherapy, chemotherapy.

18
Q

When should you refer the following people to 2 week wait for colorectal cancer:

  • age >40
  • age >50
  • age >60
A

40- unexplained weight loss, abdominal pain.
50- unexplained rectal bleeding
60- iron deficiency anaemia or change in bowel habit.

19
Q

Differentiate UC and Crohn’s disease in the following areas:

  • Risk factors
  • Pathology
  • Presentation
  • Complications
A 
UC: 
RF: HLA-B27, not smoking
PA: Rectum- ileocaecal valve, continuous, mucosa
Pres: Abdo pain (L), bloody diarrhoea
Comp: Toxic megacolon, colorectal cancer

Crohn’s:
RF: smoking
Path: Anus- mouth, discontinuous, transmural
Pres: Abdo pain (R), diarrhoea, perianal lesions, mouth ulcers, malabsorption.
Comp: fistulae, abscesses.

20
Q

Differentiate UC and Crohn’s by their extraintestinal manifestations in the following:

  • Eyes,
  • Hepatobiliary

IBD also affects Musculoskeletal and skin.
- IBD gets MESSY

A

UC:

  • Uveitis
  • PSC/ cholangiocarcinoma

Crohn’s:

  • Episcleritis
  • Gallstones (+ kidney stones)
21
Q

Give 3 results from blood test of IBD (chronic inflammation).

Give 3 stool investigations:

What is gold standard investigation for IBD

A
  • FBC: anaemia of chronic disease, high platelets, high white cell count
  • LFT: low albumin
  • ESR/ CRP raised.
  • Stool culture
  • Faecal calprotectin- marker of inflammation, distinguishes IBS and IBD.
  • C. Difficile toxin

Gold standard is colonoscopy.

22
Q

In the management of UC: what are the induction and maintenance medications.

in the management of Crohn’s: what are the induction and management medications.

A

UC:
Induction: Mesalazine (5-ASA). Topical if L-sided, Topical + oral if whole colon). If severe, IV steroids.

Maintenance: Mesalazine topical/ oral. If severe, Azathioprine. mercaptopurine.

Crohn’s:
Induction: steroids: topical/ oral/ IV. Elemental, enteral feeding. If isolated perianal disease- metronidazole. 2nd line is Mesalazine, azathioprine, mercaptopurine, infliximab.

Maintenance: Azathioprine/ mercaptopurine. 2nd line methotrexate.

NBM and fluids.
Surgery common for Crohn’s

23
Q

IBS is more than 6 months of what 3 symptoms.

What criteria is used to diagnose IBS?

A

ABC:
- Abdominal discomfort/ pain on eating, relieved by defecation. Muscle contract causing cramps.
- Bloating- bacteria produce gas
- Change in bowel habit, stool form incl. mucus.
Pellet-like stool is buzzword. Epithelial lining produces mucus.

ROME criteria for diagnosis

Classically young women. Reconsider if >40 yrs.

24
Q

What two investigations exclude other causes from a diagnosis of IBS?

A
  1. FBC/ CRP

2. Coeliac antibodies.

25
Q

Give 4 ways to manage the symptoms of IBS.

A
  1. Diet: low fizzy/ alcohol/ caffeine drinks, lots of water.
  2. Pain: Antispasmodics, low dose TCA.
  3. Diarrhoea: Loperamide
  4. Constipation: Laxative, NOT lactulose.

Psychological therapy after 12 months.

26
Q

Give 3 presenting features of Coeliac disease.

A
  1. Chronic GI symptoms: N&V, diarrhoea, bloating.
  2. Malabsorption: weight loss, osteoporosis, anaemia, neuropathy, steatorrhoea
  3. Dermatitis herpetiformis
27
Q

Give 2 risk factors for coeliac disease.

A
  • Hx/ Fhx autoimmune disease- women

- HLA DQ2/8 alleles

28
Q

What 4 blood results would be seen for investigating coeliac disease?

A
  • Micro/ macrocytic anaemia- increased RCDW
  • Low B12, low ferritin
  • Low calcium/ Vit D
  • LFT- non specific transaminitis.
29
Q

What 3 things can be seen by endoscopy/ duodenal biopsy of a patient with coeliac while having gluten? Need to be on a glutinous diet for 6 weeks before testing.

A
  1. Villous atrophy
  2. Crypt hyperplasia
  3. Intraepithelial WBC
30
Q

Give 3 autoantibody tests for coeliac disease.

A
  • Total IgA levels
  • IgA anti-tissue transglutaminase (TTG)
  • IgA anti-endomysial antibodies
31
Q

Give the two features of coeliac disease management.

What condition is specific to untreated coeliac disease?

A
  • Gluten free diet (excl. rice, corn, potatoes)
  • Pneumococcal vaccine ever 5 years due to hyposplenism

Enteropathy associated T-Cell lymphoma (EATL).

32
Q

What is coeliac disease?

A

T-Cell mediated autoimmune reaction to dietary gluten. Leads to small bowel and systemic disease.

Yr 3 MedEd (31 decks)

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