Lower GI Flashcards
What is an Anal Fissure?
A tear in the squamous epithelium of the anal canal.
Usually Posterior Midline (if Primary)
How do Anal Fissures typically present?
Young Person
Painful Rectal Bleeding on defecation (Blood on wiping)
Chronic ulceration can lead to a skin tag forming.
How would you manage an Anal Fissure?
Analgesics for pain (Paracetamol/Ibuprofen, Topical Lidocaine)
Chronic treatment involves topical GTN, Botulinum Injection and Internal Sphincterectomy
Increased Fibre & Fluid intake and a laxative to ease hardness of stools.
What are Haemorrhoids?
Engorgement of Vascular Cushions in the anal canal.
What are the main causes of Haemorrhoids?
Constipation/Straining
Raised IAP - Pregnancy, Lifting, Chronic Cough
How do Haemorrhoids typically present?
Painless Rectal Bleeding
Large ones can cause rectal fullness, tenesmus, soiling.
What are the main complications of Haemorrhoids?
Thrombosis of external haemorrhoids - extreme pain + purple oedematous mass, requires surgical incision.
Strangulartion of internal haemorrhoids
How would you manage a typical case of Haemorrhoids?
Stool Softening (Fibre, Fluid, Laxatives)
Rubber band ligation/ Injection sclerotherapuy
Possible Haemorrhoidectomy
What are the main causes of Colorectal Cancer?
FHx (Autosomal Dominant)
Old, males
Alcohol, smoking, diet, obesity
Adenomatous Polyps
IBD
How does Colorectal Cancer typically present?
Often Insidious
Abdominal Pain, Weight Loss, Fatigue
Right Sided - Anaemia
Left Sided - PR Bleeding, Change in Bowel Habit, Tenesmus, DRE Mass
May present with obstruction
Iron Deficency Anaemia
How is Colorectal Cancer screened?
FIT (Faecal Immunochemical Test) from 60-74 every 2 years.
Flexible Sigmoidoscopy at 56 years.
How would you investigate a case of suspected Colorectal Cancer?
Bloods - FBC, LFTs, CEA (Tumour Marker)
Colonoscopy
‘Apple Core Stricture’ on Barium Enema
TNM Staging (Formerly Duke’s)
Where does Colorectal Cancer commonly metastasise to?
Liver
Lungs
Bone
Brain
How is Colorectal cancer managed?
1) Surgery (Type depending on location)
2) Radiotherapy, Chemotherapy
How do the risk factors for UC/Crohns differ?
UC is associated with HLA-B27, smoking is protective
Crohns is associated with smoking.
How does the pathology of UC/Crohns differ?
UC - rectum to ileocaecal valve, with only continous inflammation. Only affects the mucosa
Crohns - Anus to mouth, with discontinuous patches of inflammation. Transmural Inflammation.
How does IBD present?
Abdo Pain
Diarrhoea (Sometimes bloody, moreso in UC)
B Symptoms (Systemic, Night sweats, weight loss, fever etc)
Perianal Lesions and Mouth Ulcers in Crohns
Malabsorption
What are the main complications of Ulcerative Colitis?
Toxic Megacolon
Colorectal Cancer
What are the main complications of Crohn’s Disease?
Fistulae
Abscesses
What are the main Musculoskeletal manifestations of IBD?
Clubbing
Symmetrical, Polyarticular Arthritis
Asymmetric Oligoarthritis
Osteoporosis
Which manifestations of IBD can be seen in the eyes?
Uveitis (UC)
Episcleritis (Crohns)
What can commonly be seen on the skin in patients with IBD?
Pyoderma Gangrenosum
Erythema Nodosum
Which extra-intestinal manifestations of IBD affect the Hepatobiliary system?
Primary Sclerosing Cholangitis/Cholangiocarcinoma (UC)
Gallstones (Crohns)
How would you investigate a suspected case of IBD?
Bloods - Anaemia of Chronic Disease, ESR/CRP, Low albumin
U&Es, Stool Cultures, Faecal Calprotectin, C.Difficile
Colonoscopy
Barium Enema
How does IBD look on Colonoscopy?
Crohns - Cobblestone Appearance
UC - Loss of Huastra and continuous inflammation
How would you induce remission in Ulcerative Colitis?
Mesalazine (5-ASA)
IV steroids if severe.
How would you induce remission in Crohn’s Disease?
Steroids
Elemental, enteral feeding
How would you maintain remission in UC?
Mesalazine
Azathioprine if severe.
How would you maintain remission in Crohn’s?
Azathioprine
Methotrexate
Surgery
What is IBS?
Diagnosis of exclusion
>6 months of
Abdominal Pain
Bloating
Changes in Bowel Habit (Diarrhoea and Constipation)
How can you manage IBS?
Diet alterations
Antispasmodics for pain
Loperamide for Diarrhoea
Laxatives for constipation
