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year 3 > Lower GI > Flashcards

Lower GI Flashcards

IBD, coeliac, IBS, lower GI, colorectal cancer

1
Q

What are the two types of inflammatory bowel disease?

A

Crohn’s disease

Ulcerative colitis

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2
Q

What is Crohn’s disease?

A

A disorder with unknown aetiology characterised by TRANSMURAL inflammation of the GI tract that can affect any part from mouth to anus.
Found as SKIP lesions

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3
Q

What is ulcerative colitis?

A

Relapsing and remitting inflammatory disorder of the colonic mucosa.

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4
Q

What is the aetiology of inflammatory bowel disease?

A

Both have an unknown aetiology.

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5
Q

What are the risk factors for Crohn’s?

A 
Smoking
OCP
Nutrition deficiency
Previous GI infection
FHx 
Diet high in refined sugars
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6
Q

Epidemiology IBD

A

Ashkenazi Jews

Bimodal peak:
15-40
60-80

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7
Q

Which layers of the gut are affected by Crohn’s?

A

All the layers:

  • mucosa
  • submucosa
  • muscularis propria
  • subserosa
  • serosa
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8
Q

Which layers of the gut are affected by UC?

A

Mucosa and submucosa

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9
Q

Which parts of the GI tract are affected by Crohn’s?

A

Mouth to anus

Particularly terminal ileum + perianal

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10
Q

Which parts of the GI tract are affected by UC?

A

Colon and rectum

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11
Q

Which parts of the GI tract are inflamed in Crohn’s?

A

Random patches, with skip lesions

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12
Q

Which parts of the GI tract are inflamed in UC?

A

Continuous from the anus proximally

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13
Q

Which of the IBD’s commonly has fissures/abscesses?

A

Crohn’s

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14
Q

What is the main bowel symptom in Crohn’s?

A

Diarrhoea +/- blood

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15
Q

What is the main bowel symptom in UC?

A

Bloody +/- mucus diarrhoea

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16
Q

What is the difference in flare pattern for Crohn’s and UC?

A

Crohn’s- systemically unwell

UC- feel well between flares

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17
Q

Which of the IBD’s is curative via surgery?

A

UC

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18
Q

How does the presence of blood present in IBD?

A

Mixed in with the stool

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19
Q

Which IBD is likely to present with RIF pain?

A

Crohn’s (terminal ileitis)

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20
Q

Which IBD is likely to present with mouth ulcers?

A

Crohn’s

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21
Q

What are the extra-intestinal manifestations of IBD?

A PIE SAC

A 
Aphthous ulcers (CD>UC)
Pyoderma gangrenosum
I- eye- iritis, uveitis, episcleritis (CD>UC)
Erythema nodosum
Sclerosing cholangitis (UC)
Arthritis
Clubbing fingers (CD>UC)
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22
Q

What bedside/blood investigations would you do on a Pt with Crohn’s?

A

BLOODS:
FBC (anemia)
LFT’s (primary sclerosing cholangitis*)
CRP / ESR (inflammatory disease)

STOOL SAMPLE:
Increased faecal calprotectin (indicates inflammation)

OTHER:
pANCA (70% positive)

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23
Q

What investigations would you do on a Pt with UC?

A

Stool sample
Blood tests
Abdo XR
Colonoscopy/flexisig and biopsy

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24
Q

What would a colonoscopy and biopsy of a Pt with UC show as?

A

Mucin depletion
Diffuse mucosal atrophy
Continuous from the rectum with ANAL SPARING

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25
Q

What may you see on the Abdo XR of a Pt with UC?

A

Toxic megacolon
Lead piping
Thumb printing

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26
Q

Why would you measure the CRP and ESR of a Pt with IBD?

A

To provide baseline markers for inflammation

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27
Q

Why would you measure the LFTs of a Pt with IBD?

A

To check for primary sclerosing cholangitis (UC)

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28
Q

What is lead piping?

A

Loss of the haustral markings

Due to inflammation

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29
Q

What is thumb printing?

A

Large bowel wall thickening

Due to infective/inflammatory process

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30
Q

What is toxic megacolon?

A

IBD/C Diff progressing into inflammatory colitis progressing into toxic megacolon

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31
Q

What are the symptoms of a toxic megacolon?

A

Extreme vomiting
Abdo pain
Abdo distension

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32
Q

How do you induce remission for Crohn’s?

A

Corticosteroids

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33
Q

What is the prognosis of a Pt with Crohn’s?

A

Increased mortality

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34
Q

What is the prognosis of a Pt with UC?

A

Mortality not affected

Risk of developing toxic megacolon

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35
Q

What is Coeliac disease?

A

Systemic autoimmune disease triggered by dietary gluten peptides- GLIADIN

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36
Q

What is the epidemiology of Coeliac disease?

A

Western countries
Peaks at infancy and 50-60 yrs
F:M 2:1

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37
Q

What are the 2 key histological features of Coeliac disease?

A

Villous atrophy

Hypertrophy of intestinal crypts

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38
Q

What are the risk factors for Coeliac disease?

A

FHx
IgA deficiency
T1DM
Autoimmune thyroid disease

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39
Q

What symptoms may a Pt with Coeliac disease present with?

A

Symptoms can be vague/mild:

  • Diarrhoea (chronic / intermittent)
  • Bloating
  • Abdominal pain / discomfort - after eating gluten

EXTRA INTESTINAL

  • Fatigue
  • Weight loss
  • Dermatitis Herpetiformis (elbows)
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40
Q

What signs may a Pt with Coeliac disease present with?

A
  • Anaemia
  • Dermatitis herpetiformis- bilateral itchy vesicles and plaques, usually elbows/extensor surfaces
  • B12/iron/folate deficiency symptoms
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41
Q

What 3 antibodies may be elevated in a patient with Coeliac disease?

A
  1. IgA-tissue transglutaminase (IgA-TTG)
  2. Anti-endomysial antibodies (EMA)
  3. IgG DGP (deamidated gliadin peptide)
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42
Q

What will an endoscopy and duodenal biopsy show in a Pt with Coeliac disease?

A

Villous atrophy
Cryptal hyperplasia
Intraepithelial WBCs

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43
Q

How would you manage a Pt with Coeliac disease?

A

Gluten-free diet

Vitamin D supplementation

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44
Q

What is the prognosis of a Pt with Coeliac disease?

A

> 90% will have complete and lasting resolutions on a gluten-free diet

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45
Q

What are the complications of a Pt with Coeliac disease?

A

Upper GI lymphoma/carcinomas
Osteoporosis
Chronic dermatitis herpetiformis

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46
Q

What is irritable bowel syndrome?

A 
Recurrent abdo pain in the past 3 months associated with at least 2 of the following:
-defecation
-change in stool frequency
-change in stool consistency
[Rome IV criteria]
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47
Q

How is IBS diagnosed?

A

Via a process of exclusion

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48
Q

How would you manage a Pt with IBS?

A 
Avoid precipitating factors
FODMAP diet
Peppermint oil/tea
Anti-diarrhoeal (loperamide)
SSRIs (citalopram)
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49
Q

What is an anal fissure?

A

Anal fissure is a split in the mucosal lining of the distal anal canal characterised by pain on defecation and rectal bleeding

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50
Q

RF for anal fissures

A

HARD STOOL
PREGNANCY
OPIATES

Anything causing constipation

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51
Q

Where do anal fissures most commonly present?

A

Posterior midline of the anal canal (90%)

Recent evidence suggests this may be due to ischaemia, as this is the location with poorest circulation

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52
Q

What symptoms may a Pt with an anal fissure present with?

A

PAIN ON DEFECATION- tearing sensation
“like passing sharp glass”

FRESH BLOOD on toiler paper

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53
Q

What investigations would do you do on a Pt with an anal fissure?

A

NA- anal fissures are a clinical diagnosis + DRE (may be under anaesthesia if very painful)

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54
Q

What is the treatment for a Pt with an anal fissure?

A

1st line – CONSERVATIVE- manage constipation:

  • High fibre diet
  • Adequate fluid intake
  • Sitz baths

ANALGESIA- relaxes anal muscles

  • Topical Glyceryl Trinitrate (GTN)
  • Topical Diltiazem
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55
Q

What is the prognosis for a Pt with an anal fissure?

A

80% heal with treatment

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56
Q

What are the complications of an anal fissure?

A

Chronicity

Incontinence post-op

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57
Q

What are haemorrhoids?

A

Vascular rich tissue cushions located within the anal canal
Prolonged/Repetitive straining causes disruption of the tissues and results in elongation/dilation of the haemorrhoidal tissues

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58
Q

What is the epidemiology of haemorrhoids?

A

4% of the population

Common in 45-65 yrs

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59
Q

What is the main risk factor for haemorrhoids?

A

Raised intra-abdominal pressure:

  • constipation
  • chronic cough
  • pregnancy
  • obesity
  • ascites
  • SOL
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60
Q

What are the four degrees of haemorrhoids?

A

1- no prolapse, just prominent veins
2- prolapse upon bearing, spontaneously reduces
3- prolapse requiring manual reduction
4- prolapse which cannot be manually reduced

61
Q

What symptoms may a Pt with haemorrhoids present with?

A

PAINLESS BLEEDING ASSOCIATED WITH DEFECATION

  • Bright red PR bleed
  • Sides of the pan

Can be painful and cause discomfort
Anal pruritus (itching)
Palpable mass felt

62
Q

What investigations would you do on a Pt with haemorrhoids?

A

1st line + Diagnostic = ANOSCOPIC EXAMINATION

  • Visualise haemorrhoids
  • Confirm diagnosis

Colonoscopy (exclude DDx)

63
Q

What signs can be seen on a PR exam of a Pt with haemorrhoids?

A

Visible lump

3/4th degree may be visible on inspection

64
Q

What is the management for a Pt with haemorrhoids?

A

CONSERVATIVE MX:

  • Constipation advice
  • Discourage straining

GRADE 1: Topical corticosteroids (alleviates pruritus)
GRADE 2+3: Rubber band ligation
GRADE 4: Surgical Haemorrhoidectomy

65
Q

What are the complications of haemorrhoids?

A

Anaemia
Thrombosis- purplish, oedematous, tender subcutaneous perianal mass causing significant pain
Incarceration

66
Q

What is the prognosis for a Pt with haemorrhoids?

A

Surgery has the lowest recurrence rates: 20%

67
Q

What is the ranking for colorectal cancer in terms of incidence?

A

3rd commonest cancer in the UK

Most common cancer in the Western world

68
Q

What is the most common type of colorectal cancer?

A

Adenocarcinoma

Majority of cases they arise from dysplastic adenomatous polyps = adenoma –> carcinoma sequence

69
Q

What are the risk factors for colorectal cancer?

A 
>60yrs
Alcohol/smoking/high red meat diet
Polyps
Genetic conditions (FAP/HNPCC)
Obesity 
IBD (UC) 
Acromegaly
Poor fibre intake 
Limited physical activity
70
Q

What are the symptoms of a left sided colorectal cancer?

A 
Weight loss
Anaemia
Distension / Ascites (late) 
Lymphadenopathy (late)
Palpable mass (late)
71
Q

What are the symptoms of a right sided colorectal cancer?

A 
PR bleeding/mucus
Altered bowel habit
Tenesmus
Obstruction
PR mass
72
Q

Which sided colorectal cancer presents earlier, and is easier to detect?

A

Left sided

73
Q

What investigations would you do on a Pt with colorectal cancer and why?

A

BLOODS

  • FBC- iron deficiency (microcytic) anaemia
  • LFTs- baseline/mets
  • CEA- colorectal ca marker
  1. Colonoscopy + Bx = DIAGNOSTIC
  2. Double contrast barium enema- staging (supplanted by CT colonography)
  3. CT chest/abdo/pelvis - pre-op + staging
74
Q

A 22 y/o female presents to her GP with a two year history of intermittent diarrhoea and constipation. She complains of bloating and abdominal pain, which eases with defecation. Which condition is she likely to have?

A. Coeliac disease
B. Ulcerative colitis
C. Crohn’s disease
D. Irritable bowel syndrome
E. Infectious diarrhoea
A

D. Irritable bowel syndrome

Fits Rome IV criteria

75
Q

A 26 y/o male presents to his GP with weight loss, abdominal pain and watery diarrhoea. On examination he looks pale and you notice ulcers in his mouth. Which condition is he likely to have?

A. Coeliac disease
B. Ulcerative colitis
C. Crohn’s disease
D. Irritable bowel syndrome
E. Infectious diarrhoea
A

C. Crohn’s disease

Mouth ulcers

76
Q

A 23 y/o female presents to her GP with a limp. On further questioning she reveals she has recently lost weight and has had bloody, mucoid diarrhoea. On examination her right knee is tender and swollen, and her eyes are red. Which condition is she likely to have?

A. Coeliac disease
B. Ulcerative colitis
C. Crohn’s disease
D. Irritable bowel syndrome
E. Infectious diarrhoea
A

B. Ulcerative colitis

Blood, mucoid- likely UC

77
Q

A 27 y/o male presents with a history of mucoid, bloody diarrhoea and weight loss. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?

A. IV corticosteroid
B. Oral prednisolone
C. Topical mesalazine
D. Oral azathioprine
E. IV cyclosporin
A

C. Topical mesalazine

Likely to be UC

78
Q

A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After a number of investigations his diagnosis is confirmed. Which treatment would you start him on?

A. IV corticosteroid
B. Oral prednisolone
C. Oral mesalazine
D. Oral azathioprine
E. IV cyclosporin
A

B. Oral prednisolone

Terminal ileitis- likely Crohn’s

79
Q

A 31 y/o male presents with a history of diarrhoea, weight loss and RIF pain. On examination you note a number of red marks on his shins. After taking oral prednisolone, his symptoms improve. Which additional treatment would you start him on to maintain his remission?

A. IV corticosteroid
B. Increase oral prednisolone
C. Oral mesalazine
D. Oral azathioprine
E. IV cyclosporin
A

D. Oral azathioprine

80
Q

A 55 y/o female presents to her GP with an itchy rash on her forearms. On further questioning she reveals she has recently lost weight and has had mucoid diarrhoea. Which test will best confirm her diagnosis?

A. Endoscopy with duodenal biopsy
B. Serum antibodies to tissue-transglutaminase
C. Serum anti-endomysial antibodies
D. Colonoscopy
E. Endoscopy with ileal biopsy
A

A. Endoscopy with duodenal biopsy

81
Q

A 67 y/o male presents to his GP following an episode of rectal bleeding. He noticed fresh blood on the toilet paper after wiping. There was no blood mixed in with the stool. He is otherwise fit and well. What is the next appropriate step to take?

A. Colonoscopy
B. Faecal occult blood test
C. Abdominal exam
D. Digital rectal exam
E. Sigmoidoscopy
A

C. Abdominal exam

[Note from Chang, would argue that DRE is also appropriate]

82
Q

A 35 y/o male presents to his GP following an episode of rectal bleeding. He noticed fresh blood on the toilet paper after wiping. There was no blood mixed in with the stool. He adds that he is very sore ‘down there’ and it is agony to defecate. Which condition is he likely to have?

A. Haemorrhoids
B. Anal fissure
C. Crohn’s disease
D. Ulcerative colitis
E. Colorectal carcinoma
A

B. Anal fissure

83
Q

A 67 y/o male presents to his GP complaining of rectal bleeding. Over the last few months he has noticed blood mixed in with his stool. He sometimes feels like he hasn’t completely emptied his bowels after defecating, and is more tired than usual. What is the next step to take?

A. Routine referral to colorectal surgeons
B. Urgent referral to colorectal surgeons
C. FBC
D. Abdominal exam
E. Faecal occult blood test

A

D. Abdominal exam

[Note from Chang, would argue that “B. Urgent referral to colorectal surgeons”]

84
Q

What is the diagnostic histological finding in chrons?

A

TRANSMURAL, NON-CEASETING GRANULOMA FORMATION

85
Q

How does Chron’s present?

A

Abdominal pain

  • Crampy or constant
  • RIF + Peri Umbilical (terminal ileum)

Diarrhoea

  • Mucus, Blood, Pus
  • May be nocturnal

Peri anal lesions

  • skin tags
  • fistulae
  • abscesses

fatigue, weight loss, malnutrition

86
Q

State the extra-intestinal manifestations of chron’s

A

Occur in 20-40% of pts

Arthropathy
Erythema nodosum
Pyoderma gangrenosum
Uveitis, episcleritis

87
Q

What might you find on examination of a patient with CD?

A

Abdominal tenderness / mass in RIF (terminal ileum)
Apthous ulcers

Peri anal lesions:
Skin tags
Fistulae
Absesses

88
Q

Bloods for CD

A 
FBC
Iron studies 
Vitamin / Folate levels 
CRP
ESR
89
Q

What Ix would you do for CD?

A 
Plain AXR
CT abdo pelvis
Bowel Series (Xray + Barium enema)
Colonoscopy + BX 
HISTOLOGY = diagnostic
90
Q

What would you see on CT in CD?

A

Bowel wall thickening, Skip lesions

91
Q

What would you see on AXR in CD?

A

bowel dilatation

92
Q

What would you see on x-ray + barium enema in CD?

A

“rose thorn ulcers” = deep ulceration

“string sign of Kantor” = fibrosis + strictures

93
Q

What would you see on colonoscopy in CD?

A

Ulcers
cobblestone” appearance
skip lesions

94
Q

Management of CD flare-up

A
  1. STEROIDS (oral or IV +/- topical)
    Prednisolone, Budesonide
  2. IMMUNOMODULATORS (oral or IV)
    Azathioprine, Mercaptopurine, Methotrexate
  3. BIOLOGICAL THERAPY (IV)
    Adalimumab, Infliximab, Vedolizumab
  4. SURGERY
    For severe remissions/presentation, refractory disease and obstructed pts
95
Q

Adalimumab, Infliximab are examples of what type of drug?

A

TNF-a inhibitors

96
Q

Maintaining remission in CD

A

IMMUNOMODULATORS
- Azathioprine, Mercaptopurine, Methotrexate

+ / - BIOLOGICS
- Infliximab, Adalimumab, Vedolizumab

ADJUNCTS

  • Anti-spasmotics (cramp relief)
  • Anti-diarrhoeals
97
Q

70% of UC patients are positive for which blood marker?

A

p-ANCA

- perinuclear anti-neutrophil cytoplasmic antibodies

98
Q

What are are the most common and most severe complications of UC?

A

Toxic megacolon
PSC
Colonic adenocarcinoma
Strictures –> LBO –> perforation

99
Q

Which stool test indicates bowel inflammation?

A

faecal calprotectin

100
Q

What imaging would you do for UC? What classic signs would you see?

A
  • Plain AXR > dilated bowel = THUMBPRINTING
  • Double contrast barium enema = LEAD PIPE
  • Colonoscopy + Biopsy = CONTINUOUS erythema, bleeding, ulcers
101
Q

What histology would you see in UC?

A

Crypt abscesses

Depletion of goblet cell mucin.

102
Q

What type of enema do you use in UC investigations?

A

DOUBLE contrast barium enema

single = less sensitive so cannot detect early changes/small polyps

103
Q

What might be seen on barium enema in UC?

A

LEAD PIPE APPEARANCE = complete loss of haustral markings throughout the colon

STRICTURING

104
Q

Compare the diameter and markings of the small vs large bowel on AXR

A

SMALL

  • max diameter = 35mm
  • valvulae coniventes extend all the way across

LARGE

  • max diameter = 55mm
  • haustra extend 1/3rd the way across
105
Q

How is remission induced in UC?

A
  1. MESALAZINE (5-ASA) = aminosalycate
    Oral / topical - high dose
  2. STEROIDS
    Oral Beclamethasone
106
Q

How is remission maintained in UC?

A
  1. IMMUNOSUPRESSIVES
    Azathioprine, Mercaptopurine
  2. BIOLOGICS (anti- TNFa)
    Infliximab, Adalimumab
  3. BIOLOGICS (integrin receptor antagonists)
    Vedolizumab
  4. CICLOSPORIN
  5. TOTAL COLECTOMY= curative
107
Q

Which genotype increases risk of UC?

A

HLA-B27

108
Q

Which rheumatological condition may be present in UC patients?

A

ankylosing spondylitis

109
Q

What investigations would you do for coeliac disease?

A

serology - IgA tTG + anti-EMA

Endoscopy

110
Q

Define IBS

A

Chronic conditions characterised by recurrent abdominal pain associated with bowel dysfunction

111
Q

How can IBS be classified?

A

IBS-D (with diarrhoea)
IBS-C (with constipation)
IBS-M (mixed)

112
Q

RF for IBS

A

History of Physical/Sexual Abuse
PTSD
PMHx: Acute bacterial gastroenteritis
FHx

113
Q

Epidemiology IBS

A

Females > M (2:1)

<50yo

114
Q

How does IBS present?

A
  • Abdominal cramping in lower/mid abdomen
  • Alteration of stool consistency (diarrhoea ↔ constipation)
  • Defecation RELIEVES abdominal pain/discomfort *

OE: NORMAL

115
Q

What tests might you want to do in IBS to exclude other differentials?

A
  • Anti-tTG (coeliac)
  • Fecal calprotectin, lactoferrin (IBD)
  • Serum CRP (IBD)
  • Colonoscopy (IBD)
  • FBC (anaemia – consider CRC)
  • FOB test (CRC)
116
Q

Lifestyle advice for IBS

A
  • Fibre
  • Avoid: caffeine, lactose, fructose.
  • Stress management
  • Education + Reassurance
    • Probiotics ?
117
Q

medical management IBS

A

symptoms:

  • Laxatives (IBS-C) = lactulose
  • Antispasmotics (cramps) = dicyclomine
  • Antidiarrhoeals (IBS-D) = loperamide
118
Q

Management of persistent fissures

A

Botulinum Toxin Injection (EUA) – Botox

Surgical sphincterectomy

119
Q

Define fistula

A

abnormal connection between vessels or organs that do not usually connect.

120
Q

Define anal fistula

A

A connection between the last part of the bowel and the skin around the anus

121
Q

RF for anal fistula

A

Clogged anal glands and anal abscesses
Crohn’s disease
Radiation (cancer)
Trauma

122
Q

How does anal fistula present?

A

Frequent anal abscesses
Pain and swelling around the anus
Bloody / Foul smelling drainage (pus)

123
Q

What might you use to examine an anal fistula?

A

Anoscope / Rectoscope

124
Q

How is anal fistula managed?

A

SURGICAL MANAGEMENT
Fistulotomy
Seton- encourage drainage before repair

125
Q

How are anal abscesses classified?

A

according to location:

  • Intersphincteric
  • Perianal
  • Perirectal
  • Supra levator
126
Q

RF for anal abscess

A

Anal fistula
Crohn’s disease
Constipation
M>F

127
Q

How does anal abscess present?

A

Perianal Pain
Not related to defecation! (not fissures)
Perianal Swelling and Tenderness
Low grade fever & Tachycardia - if systemic

128
Q

Ix for anal abscess

A

1st line & DIAGNOSTIC = CLINICAL EXAMINATION or EUA

CT / MRI for internal pelvic abscesses

129
Q

Mx anal abscess

A

1st line – SURGICAL DRAINAGE OF ABSCESS
( + fistulotomy)
If systemic infection = Broad spectrum AB

130
Q

3 key red flag symptoms for colon cancer

A

Change in bowel habits

Rectal bleeding

  • “mixed in the stool”
  • Not bright red

Weight loss
- FLAWS

131
Q

What might you see on double contrast barium enema of a colorectal cancer patient?

A

apple core lesion

– cancer causes stricturing

132
Q

What cancer marker is used in CR cancer?

A

Carcinoembryonic antigen (CEA)

  • May be used to monitor for recurrence / assess response to treatment
  • used to assess other types of cancer eg lung/breast
133
Q

What staging system is used in CR cancer? For each stage, state the 5yr survival

A

DUKES

  • Dukes’ A Tumour confined to the mucosa- 95%
  • Dukes’ B Tumour invading bowel wall- 80%
  • Dukes’ C Lymph node metastases- 65%
  • Dukes’ D Distant metastases- 5% (20% if resectable)
134
Q

What is the management of CR cancer?

A

Surgical excision + adjuvant or neoadjuvant chemo / radiotherapy

135
Q

Common areas of metastases for CR cancer

A

Liver, Lung, Bone, Brain

“LL BB”

136
Q

Where are the commonest locations for CR cancer?

A

rectal: 40%
sigmoid: 30

137
Q

Which 3 genetic conditions put people at increased risk of CR cancer?

A
  1. HNPCC – heretidary non-polyposis colorectal cancer
    - FHx of bowel cancer at very young age
  2. FAP – familial adenomatous polyposis
  3. Peutz-Jeghers syndrome: inherited condition with increased risk of hamartomatous polyps in the digestive tract + other cancers
138
Q

What is the pathophysiology of pilonidal sinus?

A

Caused by the forceful insertion of hairs into the skin of the natal cleft in the sacrococcygeal area.

Promotes inflammation and causes a sinus.

139
Q

Epidemiology pilonidal sinus

A

80% M

Peak: 16-40

140
Q

RF pilonidal sinus

A

Young males
Stiff hair
Hirsutism

141
Q

How does pilonidal sinus present?

A

SACROCOCCYGEAL:

  • Discharge – offensive, staining underwear
  • Pain – worst on sitting down
  • Swelling
142
Q

Mx pilonidal sinus

A

Surgical excision of pilonidal cyst + sinus
+ AB
+ Hair removal (laser/shaving)
+ Local Hygiene advice

143
Q

RF for rectal prolapse

A

Chronic constipation + straining
Weakened pelvic floor muscles
Natural birth, surgery, trauma
Obesity

ANYTHING CAUSING WEAKNESS / PRESSURE ONTO PELVIC FLOOR

144
Q

Epidemiology rectal prolapse

A

older age

145
Q

How does rectal prolapse present?

A
  • Painless protruding mass following defecation
    (or straining eg: coughing)
  • Mucoid discharge
  • Incontinence

Differences with haemorrhoids:
Not bleeding
Much much larger

146
Q

Ix for rectal prolapse

A

CLINICAL DIAGNOSIS- ask patient to strain to elicit prolapse

  • Anal manometry
  • Colonoscopy (check for other pathologies)
  • MRI – detailed imagery
147
Q

Outer appearance of different stomas

A

ileostomies RHS
colostomies LHS

(you can also have urostomys which is the connection of the ureter to the abdominal wall)

148
Q

4 types of stoma

A

LOOP allow bowel rest after resection
END- permanent
FLUSH- colostomies
SPOUT- ileostomies, don’t want stomach acid/enzymes in contact with skin

year 3 (38 decks)

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