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Year 3 - MedEd Lectures > Lower GI > Flashcards

Lower GI Flashcards

1
Q

What is an Anal Fissure?

A

A tear in the squamous epithelium of the anal canal.

Usually Posterior Midline (if Primary)

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2
Q

How do Anal Fissures typically present?

A

Young Person

Painful Rectal Bleeding on defecation (Blood on wiping)

Chronic ulceration can lead to a skin tag forming.

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3
Q

How would you manage an Anal Fissure?

A

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.

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4
Q

What are Haemorrhoids?

A

Engorgement of Vascular Cushions in the anal canal.

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5
Q

What are the main causes of Haemorrhoids?

A

Constipation/Straining

Raised IAP - Pregnancy, Lifting, Chronic Cough

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6
Q

How do Haemorrhoids typically present?

A

Painless Rectal Bleeding

Large ones can cause rectal fullness, tenesmus, soiling.

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7
Q

What are the main complications of Haemorrhoids?

A

Thrombosis of external haemorrhoids - extreme pain + purple oedematous mass, requires surgical incision.

Strangulartion of internal haemorrhoids

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8
Q

How would you manage a typical case of Haemorrhoids?

A

Stool Softening (Fibre, Fluid, Laxatives)

Rubber band ligation/ Injection sclerotherapuy

Possible Haemorrhoidectomy

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9
Q

What are the main causes of Colorectal Cancer?

A

FHx (Autosomal Dominant)

Old, males

Alcohol, smoking, diet, obesity

Adenomatous Polyps

IBD

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10
Q

How does Colorectal Cancer typically present?

A

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

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11
Q

How is Colorectal Cancer screened?

A

FIT (Faecal Immunochemical Test) from 60-74 every 2 years.

Flexible Sigmoidoscopy at 56 years.

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12
Q

How would you investigate a case of suspected Colorectal Cancer?

A

Bloods - FBC, LFTs, CEA (Tumour Marker)

Colonoscopy

‘Apple Core Stricture’ on Barium Enema

TNM Staging (Formerly Duke’s)

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13
Q

Where does Colorectal Cancer commonly metastasise to?

A

Liver

Lungs

Bone

Brain

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14
Q

How is Colorectal cancer managed?

A

1) Surgery (Type depending on location)
2) Radiotherapy, Chemotherapy

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15
Q

How do the risk factors for UC/Crohns differ?

A

UC is associated with HLA-B27, smoking is protective

Crohns is associated with smoking.

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16
Q

How does the pathology of UC/Crohns differ?

A

UC - rectum to ileocaecal valve, with only continous inflammation. Only affects the mucosa

Crohns - Anus to mouth, with discontinuous patches of inflammation. Transmural Inflammation.

17
Q

How does IBD present?

A

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

18
Q

What are the main complications of Ulcerative Colitis?

A

Toxic Megacolon

Colorectal Cancer

19
Q

What are the main complications of Crohn’s Disease?

A

Fistulae

Abscesses

20
Q

What are the main Musculoskeletal manifestations of IBD?

A

Clubbing

Symmetrical, Polyarticular Arthritis

Asymmetric Oligoarthritis

Osteoporosis

21
Q

Which manifestations of IBD can be seen in the eyes?

A

Uveitis (UC)

Episcleritis (Crohns)

22
Q

What can commonly be seen on the skin in patients with IBD?

A

Pyoderma Gangrenosum

Erythema Nodosum

23
Q

Which extra-intestinal manifestations of IBD affect the Hepatobiliary system?

A

Primary Sclerosing Cholangitis/Cholangiocarcinoma (UC)

Gallstones (Crohns)

24
Q

How would you investigate a suspected case of IBD?

A

Bloods - Anaemia of Chronic Disease, ESR/CRP, Low albumin

U&Es, Stool Cultures, Faecal Calprotectin, C.Difficile

Colonoscopy

Barium Enema

25
Q

How does IBD look on Colonoscopy?

A

Crohns - Cobblestone Appearance

UC - Loss of Huastra and continuous inflammation

26
Q

How would you induce remission in Ulcerative Colitis?

A

Mesalazine (5-ASA)

IV steroids if severe.

27
Q

How would you induce remission in Crohn’s Disease?

A

Steroids

Elemental, enteral feeding

28
Q

How would you maintain remission in UC?

A

Mesalazine

Azathioprine if severe.

29
Q

How would you maintain remission in Crohn’s?

A

Azathioprine

Methotrexate

Surgery

30
Q

What is IBS?

A

Diagnosis of exclusion

>6 months of

Abdominal Pain

Bloating

Changes in Bowel Habit (Diarrhoea and Constipation)

31
Q

How can you manage IBS?

A

Diet alterations

Antispasmodics for pain

Loperamide for Diarrhoea

Laxatives for constipation

Year 3 - MedEd Lectures (29 decks)

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