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Y3 MedEd > Lower GI > Flashcards

Lower GI Flashcards

1
Q

Anal fissure acute vs chronic length

A

Acute < 6 weeks < Chronic

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2
Q

Causes of secondary anal fissures (3)

A

Constipation
Crohn’s disease
Pregnancy

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3
Q

Mx of acute anal fissure (pain 3, constipation 2)

A

Paracetamol/ibuprofen
Topical lidocaine

Topical GTN/diltiazem if >1 week

↑ Fibre/fluid intake
Laxative

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4
Q

What is the difference between internal and external haemorrhoids

A

Internal: above dentate line, not painful
External: below dentate line, painful if thromboses

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5
Q

What are the 4 grades of haemorrhoids

A 
Grade 1
Project in lumen, not palpable
Grade 2
Prolapse w/straining, spontaneously reduce
Grade 3
Prolapse w/straining, manually reducible
Grade 4
Irreducible
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6
Q

Haemorrhoids presentation

A

Usually painless rectal bleeding:

Small amounts of bright red blood on wiping/in bowl

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7
Q

Ix for haemorrhoids (3)

A

Proctoscopy

Anaemia Hb/MCV

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8
Q

Complication of each type of haemorrhoids

A

Thrombosis of external haemorrhoids
Severe pain + purplish oedematous perianal mass
If <72 hours, surgical incision

Strangulation of internal haemorrhoids
Severe pain
Urgent haemorrhoidectomy

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9
Q

Mx of haemorrhoids (3)

A

Stool softening: fibre/fluid/laxative
Rubber band ligation/injection sclerotherapy
Large grade ¾ may require haemorrhoidectomy

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10
Q

Colorectal cancer is usually what type of cancer

A

Adenocarcinoma

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11
Q

How does each form of IBD affect your chances of getting colorectal cancer

A

IBD (UC > Chron’s)

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12
Q

Which tumour marker suggests colorectal cancer

A

CEA

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13
Q

Ix for colorectal cancer (4)

A 
Bloods: 
FBC (iron-deficiency anaemia)
LFTs (mets)
CEA (tumour marker, NOT used for diagnosis)
Colonoscopy (gold standard)
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14
Q

What is seen on a barium enema that suggests colorectal carcinoma

A

Barium enema, apple core stricture

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15
Q

Where does colorectal cancer often metastasise

A

Liver

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16
Q

Which IBD can be anywhere in the GI tract

A

Crohns

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17
Q

RF UC (2)

A

HLA-B27

NOT smoking

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18
Q

RF Crohn’s

A

Smoking

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19
Q

Which IBD is transmural vs mucosa only

A

UC mucosa only

CD transmural

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20
Q

Which IBD causes bloody diarrhoea

A

UC

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21
Q

Which IBD causes malabsorption

A

CD

22
Q

Complications of UC (2)

A

Toxic megacolon

Colorectal cancer

23
Q

Complications of CD (2)

A

Fistulae

Abscesses

24
Q

What are EI manifestations related to disease activity you see in both IBD’s (3 both, CD)

A

Erythema nodosum
Asymmetric oligoarthritis
Osteoporosis

CD
Episcleritis

25
Q

What are EI manifestations unrelated to disease activity in IBD’s (3 both, 3UC, 1 CD)

A

Clubbing
Symmetrical, polyarticular arthritis
Pyoderma gangrenosum

UC
PSC/cholangiocarcinoma
Uveitis

CD
Gallstones (+ kidney stones)

26
Q

IBD Ix in bloods (5)

A

FBC: anaemia of chronic disease, ↑ platelets, ↑ WCC
LFT: low albumin
ESR/CRP

27
Q

IBD Ix apart from bloods (6)

A 
U&amp;E
Stool culture
Faecal calprotectin
C diff toxin
Colonoscopy
Barium enema
28
Q

Mx of UC induction and maintenance (normal and severe)

A

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

29
Q

Mx of CD induction and maintenance (first and second line)

A

Induction
Steroids (topical, oral, IV)
Elemental, enteral feeding

2nd line:
Mesalazine, azathioprine/mercaptopurine, infliximab

Maintenance
Azathioprine/mercaptopurine

2nd line:
Methotrexate

30
Q

IBS diagnostic criteria (3)

A

> 6 months of either: (ABC)

Abdominal pain/discomfort, relieved by defecation, brought on by eating

Bloating

Change in bowel habit, stool form (incl. mucus)

31
Q

IBS normal population

A

Young women

32
Q

Mx IBS (4 symptoms)

A

Diet: low caffeine/alcohol/fizzy drinks, lots of water
Pain: antispasmodics (mebeverine [anticholinergic]), low dose TCA
Diarrhoea: loperamide
Constipation: laxative (NOT lactulose)

Psychological therapy after 12 months

33
Q

Ix for IBS

A

FBC/CRP

Coeliac antibodies

34
Q

Define coeliac disease

A

T-cell mediated autoimmune reaction to dietary gluten leads to small bowel + systemic disease

35
Q

Which part of the GI system does coeliac affect

A

Small bowel

36
Q

Which gene is involved in Coeliac

A

HLA DQ2/8 alleles

37
Q

RF of coeliac (2)

A

Hx/FHx autoimmune disease  women

38
Q

Presentation of coeliac disease (3 ways)

A 
Chronic GI symptoms: 
N&amp;V, diarrhoea, bloating
 Malabsorption
Calories: weight loss/failure to thrive
Vitamins &amp; minerals: osteoporosis, anaemia, neuropathy
Fats: steatorrhoea
3. Dermatitis herpetiformis
39
Q

Coeliac Ix (4)

A

Microcytic/macrocytic anaemia (increased RCDW)
Haematinics: low b12 and ferritin
Low calcium/vit D
LFT  non specific transaminitis

Confirm with endoscopy and duodenal biopsy

40
Q

AUTO-ANTIBODIES to test in coeliac (2)

A

IgA anti-tissue transglutaminase (TTG)

IgA anti-endomysial antibodies

41
Q

What is seen in the biopsy of coeliac (3)

A

Villous atrophy
Crypt hyperplasia
Intraepithelial WBC

42
Q

Mx of coeliac (2)

A

Gluten free diet

+ pneumococcal vaccine (every 5 years) due to hyposplenism

45
Q

What is coeliac associated with that we should always look out for (4)

A

Enteropathy associated T-cell lymphoma (EATL)

NHL and HL

Other small bowel adenocarcinomas

46
Q

What are EI manifestations unrelated to disease activity you only see in UC (3)

A

PSC/cholangiocarcinoma

Uveitis

47
Q

What are EI manifestations unrelated to disease activity you only see in CD

A

Gallstones (+ kidney stones)

48
Q

What are EI manifestations related to disease activity you only see in CD

A

Episcleritis

49
Q

What are EI manifestations related to disease activity you see in both IBD’s (3)

A

Erythema nodosum
Asymmetric oligoarthritis
Osteoporosis

50
Q

What are EI manifestations unrelated to disease activity you see in both IBD’s (3)

A

Clubbing
Symmetrical, polyarticular arthritis
Pyoderma gangrenosum

51
Q

Mx of UC induction (normal and severe)

A

Mesalazine (5-ASA)
(topical if L-sided, topical +oral if whole colon)

If severe:
IV steroids

52
Q

Mx of CD induction (first and second line)

A

Steroids (topical, oral, IV)
Elemental, enteral feeding

2nd line:
Mesalazine, azathioprine/mercaptopurine, infliximab

53
Q

Mx of UC maintenance (normal and severe)

A

Mesalazine (topical/oral)

If severe:
Azathioprine/mercaptopurine

54
Q

Mx of CD maintenance (first and second line)

A

Azathioprine/mercaptopurine

2nd line:
Methotrexate

Y3 MedEd (34 decks)

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