Lower GI Flashcards
Anal fissure acute vs chronic length
Acute < 6 weeks < Chronic
Causes of secondary anal fissures (3)
Constipation
Crohn’s disease
Pregnancy
Mx of acute anal fissure (pain 3, constipation 2)
Paracetamol/ibuprofen
Topical lidocaine
Topical GTN/diltiazem if >1 week
↑ Fibre/fluid intake
Laxative
What is the difference between internal and external haemorrhoids
Internal: above dentate line, not painful
External: below dentate line, painful if thromboses
What are the 4 grades of haemorrhoids
Grade 1 Project in lumen, not palpable Grade 2 Prolapse w/straining, spontaneously reduce Grade 3 Prolapse w/straining, manually reducible Grade 4 Irreducible
Haemorrhoids presentation
Usually painless rectal bleeding:
Small amounts of bright red blood on wiping/in bowl
Ix for haemorrhoids (3)
Proctoscopy
Anaemia Hb/MCV
Complication of each type of haemorrhoids
Thrombosis of external haemorrhoids
Severe pain + purplish oedematous perianal mass
If <72 hours, surgical incision
Strangulation of internal haemorrhoids
Severe pain
Urgent haemorrhoidectomy
Mx of haemorrhoids (3)
Stool softening: fibre/fluid/laxative
Rubber band ligation/injection sclerotherapy
Large grade ¾ may require haemorrhoidectomy
Colorectal cancer is usually what type of cancer
Adenocarcinoma
How does each form of IBD affect your chances of getting colorectal cancer
IBD (UC > Chron’s)
Which tumour marker suggests colorectal cancer
CEA
Ix for colorectal cancer (4)
Bloods: FBC (iron-deficiency anaemia) LFTs (mets) CEA (tumour marker, NOT used for diagnosis) Colonoscopy (gold standard)
What is seen on a barium enema that suggests colorectal carcinoma
Barium enema, apple core stricture
Where does colorectal cancer often metastasise
Liver
Which IBD can be anywhere in the GI tract
Crohns
RF UC (2)
HLA-B27
NOT smoking
RF Crohn’s
Smoking
Which IBD is transmural vs mucosa only
UC mucosa only
CD transmural
Which IBD causes bloody diarrhoea
UC
Which IBD causes malabsorption
CD
Complications of UC (2)
Toxic megacolon
Colorectal cancer
Complications of CD (2)
Fistulae
Abscesses
What are EI manifestations related to disease activity you see in both IBD’s (3 both, CD)
Erythema nodosum
Asymmetric oligoarthritis
Osteoporosis
CD
Episcleritis
What are EI manifestations unrelated to disease activity in IBD’s (3 both, 3UC, 1 CD)
Clubbing
Symmetrical, polyarticular arthritis
Pyoderma gangrenosum
UC
PSC/cholangiocarcinoma
Uveitis
CD
Gallstones (+ kidney stones)
IBD Ix in bloods (5)
FBC: anaemia of chronic disease, ↑ platelets, ↑ WCC
LFT: low albumin
ESR/CRP
IBD Ix apart from bloods (6)
U&E Stool culture Faecal calprotectin C diff toxin Colonoscopy Barium enema
Mx of UC induction and maintenance (normal and severe)
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
Mx of CD induction and maintenance (first and second line)
Induction
Steroids (topical, oral, IV)
Elemental, enteral feeding
2nd line:
Mesalazine, azathioprine/mercaptopurine, infliximab
Maintenance
Azathioprine/mercaptopurine
2nd line:
Methotrexate
IBS diagnostic criteria (3)
> 6 months of either: (ABC)
Abdominal pain/discomfort, relieved by defecation, brought on by eating
Bloating
Change in bowel habit, stool form (incl. mucus)
IBS normal population
Young women
Mx IBS (4 symptoms)
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
Ix for IBS
FBC/CRP
Coeliac antibodies
Define coeliac disease
T-cell mediated autoimmune reaction to dietary gluten leads to small bowel + systemic disease
Which part of the GI system does coeliac affect
Small bowel
Which gene is involved in Coeliac
HLA DQ2/8 alleles
RF of coeliac (2)
Hx/FHx autoimmune disease women
Presentation of coeliac disease (3 ways)
Chronic GI symptoms: N&V, diarrhoea, bloating Malabsorption Calories: weight loss/failure to thrive Vitamins & minerals: osteoporosis, anaemia, neuropathy Fats: steatorrhoea 3. Dermatitis herpetiformis
Coeliac Ix (4)
Microcytic/macrocytic anaemia (increased RCDW)
Haematinics: low b12 and ferritin
Low calcium/vit D
LFT non specific transaminitis
Confirm with endoscopy and duodenal biopsy
AUTO-ANTIBODIES to test in coeliac (2)
IgA anti-tissue transglutaminase (TTG)
IgA anti-endomysial antibodies
What is seen in the biopsy of coeliac (3)
Villous atrophy
Crypt hyperplasia
Intraepithelial WBC
Mx of coeliac (2)
Gluten free diet
+ pneumococcal vaccine (every 5 years) due to hyposplenism
What is coeliac associated with that we should always look out for (4)
Enteropathy associated T-cell lymphoma (EATL)
NHL and HL
Other small bowel adenocarcinomas
What are EI manifestations unrelated to disease activity you only see in UC (3)
PSC/cholangiocarcinoma
Uveitis
What are EI manifestations unrelated to disease activity you only see in CD
Gallstones (+ kidney stones)
What are EI manifestations related to disease activity you only see in CD
Episcleritis
What are EI manifestations related to disease activity you see in both IBD’s (3)
Erythema nodosum
Asymmetric oligoarthritis
Osteoporosis
What are EI manifestations unrelated to disease activity you see in both IBD’s (3)
Clubbing
Symmetrical, polyarticular arthritis
Pyoderma gangrenosum
Mx of UC induction (normal and severe)
Mesalazine (5-ASA)
(topical if L-sided, topical +oral if whole colon)
If severe:
IV steroids
Mx of CD induction (first and second line)
Steroids (topical, oral, IV)
Elemental, enteral feeding
2nd line:
Mesalazine, azathioprine/mercaptopurine, infliximab
Mx of UC maintenance (normal and severe)
Mesalazine (topical/oral)
If severe:
Azathioprine/mercaptopurine
Mx of CD maintenance (first and second line)
Azathioprine/mercaptopurine
2nd line:
Methotrexate
