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Lower GI Flashcards

1
Q

What is an anal fissure?

A

Split in the mucousal liing of the distal anal canal wth pain on defecation and rectal bleeding. Caused by hard stools and poor blood supply

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2
Q

RFs for anal fissure?

A

Hard stools, pregnancy, opiates (from constipation)

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3
Q

Presentation and Ix for anal fissure?

A

Very bad pain on defection ‘ shards of glass’
Tearing sensation and fresh blood on toilet paper

Clinical diagnosis for Iz 1st line and maybe EUA

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4
Q

Mx for anal fissure?

A

1st line = conservative (manage constipation, high fibre diet, adequate fluids and sitz baths)

Topical GTN
Topical diltiazem

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5
Q

Mx for persistent fissure?

A

> 8 weeks
Boutlinum toxin injection (EUA)
Surgical sphincterotomy

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6
Q

Aetiology and RFs for anal fistula?

A

Clogged anal glands and anal abscesses, crohns, radiation and trauma

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7
Q

Presentation of anal fistula?

A

Frequent anal abscess, pain and swelling around anus.

Bloody/foul pus drainage

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8
Q

Anal fistula Ix and Mx?

A

Examination: opening on skin around anus, anoscope or rectoscope

Surgical through fistulotomy or seton

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9
Q

Types of anal abscess?

A

Intersphincteric, perirectal, perianal, supralevator

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10
Q

Rfs and epidemiology of anal abscess?

A

RFs: anal fistula, crohns and constipation

M>F

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11
Q

Anal abscess presentation?

A

Perinanal pain, not related to defecation.
Perianal swellling and tenderness

Low grade fever and tachycardia (if systemic)

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12
Q

Anal abscess Ix?

A

1st line and diagnostic = clinical exam or EUA

CT/MRI for internal pelvic abscess

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13
Q

Mx for anal abscess?

A

1st line = surgical drainage
+fistulotomy

Broad Abx if systemic

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14
Q

Types of haemorrhoids?

A

can be above/belov the dentate/pectinate line

Grade 1: no prolapse, only bleeds

2: prolapse on bearing but reduce on their own
3: prolapse on bearing and need manual reduction
4: permanent prolapse and cannot be reduced

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15
Q

Rfs and presentation of haemorrhoids?

A

Constipation, pregnancy and SOL in pelvis

Bleeding on defection (painless)

Can be painful with palpable mass and anal pruritus

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16
Q

Ix for Haemorrhoids/

A

1st = anoscopic examination

Maybe colonoscopy or FBC for anaemia

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17
Q

Mx for haemorrhoids?

A

Conservative: constipation advice, disciourage straining

1: topical corticosteroids
2: rubber band ligation
3: ‘’
4: surgical haemorrhoidectomy (classic excision of using stapler)

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18
Q

Complications of haemorrhoids?

A

Thrombosed haemorrhoids: purple, painful, oedematous lump

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19
Q

What is a pilonidal sinus?

A

Forceful insertation of hairs into the skin of the natal cleft in the sacrococcygeal area promotes inflammation and causes a sinus

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20
Q

Rfs and epidemiology of pilonidal sinus?

A

80% male and peak 16-40YO

Young males with stiff hair, hirsuitism and sitting

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21
Q

Presentation of pilonidal sinus?

A

Sacrococcygeal, discharge, pain on sitting and swellign

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22
Q

Ix and Mx for pilonidal sinus?

A

Clinical diagnosis + history

Surgical treatment = excision of cyst + sinus + Abx + hair removal + hygeine advice

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23
Q

RFs for rectal prolapse?

A

Chronic constipation and straining, weakened pevic floor muscles (pregnanyc, surgery or trauma), obesity

Older ages
anything causing pelvic floor weakness

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24
Q

Presentation of rectal prolapse?

A

Painless protruding mass following defecation, mucoid discharge and incontinence

Not bleeding and much larger than haemorrhoids

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25
Ix for rectal prolapse?
1st = clinical diagnosis O/E Maybe anal manometry, colonoscopy Mx = delormes
26
WHat are healthy bowel habits to advise?
Increase liquids and fibres and use wipes, pat gently wipe front to back, dont strain and dont spent loads of time, use foot stool
27
Features of colonic cancer>
Most common in western world and 4th death in US. 1 of 3 cancer screening in UK and adenocarcinoma is the type
28
Genes for colon cancer?
HNPCC (germline mutatons) FAP (APC gene) Peutz-Jeghers syndrome (STK11/LKB1)
29
UK colorectal screening features?
FIT test and one-off flexi
30
RFs for colonic cancer?
Increasing age, obesity, IBD (UC), acromgealy, poor fibre and limited physical activity M>f, younger and younger patients in western countries
31
Presentation of colonic cancer?
1) change in bowel habits 2) rectal bleeding 3) Weight loss and FLAWs Tenesmus Anaemia symptoms O/E Anaemic, palpable mass, distention/ascites, lymohadenopathy
32
Ix for colonic cancer?
Bloods: FBC (anaemia, LFTS (mets) CEA marker Colonoscopy + biopsy is diagnostic Double contrast Barium enema = apple core lesion as stricturing Pre-op staging with CT CAP
33
Staging for colon cancer?
TNM classification ``` Dukes: A= Tumour 95% mucosa B= Tumour invading bowel wall C= lymph node mets D= distant mets ```
34
Management for Colorectal cancer?
Surgical excision + adjuvant or neoadjuvant chemo/radiotherapy LLLBB mets
35
Crohns pathophysiology?
Transmural inflammation of the GI tract from mouth to anus. SKIP lesions Commonly: terminal ileum and perianal Corms non-caseating granuloma
36
RFs and epidemiology of Crohns?
FHx, smoking, OCP, high refined sugars, ?NSAIDS,?not brestfed Ashkenazi jews and bimodal = 15-40 and 60-80
37
GI Presentation of Crohns?
ABDO pain, crampy or constant and in RLQ or peri-umbilical for terminal ileum Diarrhoea, mucus, blood, pus, nocturnal occasionally, Peri-anal lesions e.g. skin tags, fistulae, abscess Fatigue, weight loss, painful oral lesions (apthous ulcers)
38
Extra- GI presentation og Crohns?
Arthropathy Erytherma nodosum and pyoderma gangrenosum Uveitis and episcleritis
39
Bloods for Crohns?
FBC, iron stidues and vitamin/folate as malnourished CRP and ESR as inflammatory
40
Ix for Crohns?
Plain AXR - bowel dilation CT = dowel wall thickening and skip lesions XRay + barium enema = Rose thorn ulcers (ulceration) and string sign of Kantor (fibrosis + stricture) Colonoscopy + Biopsy = ulcercer, cobblestone and skip lesions Histo = trasmural involvement with noncaseating granuloma Last is Confirmative test
41
Management of Crohns to induce remission?
1) steroids e.g. prednisolon, budenoside 2) Immunomodulators 1st = azathioprine, then mecraptopurine, methotrexate 3) biologic therapy (IV) 1st = adalimumab, infliximab, vedolizumamab 4) surgery Adjuncts = nutritional therapy, perianal disease management nd smoking cessation
42
Crohns Mx for maintenance of remission?
Immunomodulators = Azathioprine, mercaptopurine, methotrexate +- biologics e.g. INFLIXIMAB, adalimumab, Vedolizumab Adjuncts = antispasmotics, antidiarrhoeals
43
UC pathophysiology?
Starts from rectum and works proximally and just the mucosa Environmental + immune dysfunction + genetic predispostion (HLA-B27 e.g. ANkylosing spondylitis)
44
RFs and epidemiology of UC?
Rhx, HLA-B27, not smoking as smoking is protective Western countries, M>F, biomdal 20-40 then >60`
45
UC GI presentation?
Bloody diarrhoea, rectal bleeding + mucus, abdo pain and cramps, tenemus and weight loss
46
UC extra-GI presentation?
Peripheral arthritis and ankylosing spondylitis Erytherma nodosum and pyoderma gangrenosum EPscleritis>uveitis O/E: anaemic, DRE with gross, occult blood and abdo tenderness
47
UC Ix?
Bloods: FBC (anaemia), LFTS (PSC),, CRP and ESR for inflammatory Stool sample for increased faecal calprotecting pANCA 70% +ve
48
Complications of UC?
PSC and toxic megacolon Colonic adenocarcinoma Strictures -> obstruction -> perforation
49
UC scans?
Plain AXR = dilated e.g. toxic megacolon if >6cm ith thumbprinting Double contrast barium enema = lead pipe appearance Colonsocpy + biopsy -> continuous erytherma , bleeding and ulcers with histology = cryspt abscessm depletion of goblet cell mucin
50
UC management to induce remission?
1) Mesalazine (5-ASA) topical or oral | 2) steroids e.g. oral beclametasone
51
UC management to maintain remission?
1) immunosuppresives e.g. AZAthioprine, mercaptopurine 2) biologics (anti-TNF) e.g. infliximab, adalimumab 3) Biologics (integrin recept antagonists) = vedolizumab 4) Ciclosporing 5) Total colectomy
52
Pathophysiology of Coeliac disease?
Autoimmune triggered by gliadin Results in villous atrophy and hypertrophy of intestinal crypts Increased lymphocytes in epithelium and lamina propria
53
Rfs for coeliac?
FHx, IgA deficiency, T1DM and autoimmune thyroid disease F>M, western countries
54
Coeliac presentation?
Chronic or intermittent diarrhoea, bloating, abdo pain, discomfot, Fatigue, weight loss, and dermatitis herptetiformis
55
Coeliac Ix?
``` IgA tTg elevated in bloods Endomysial Antibody (EMA) ``` Endoscopy = villous atropy and crypt hyperplasia
56
Mx for coelic?
Gluten free diet, vitamin and mineral supplements
57
What is IBS?
IBS with diarrhoea, with constipation or mixed
58
IBS Rfs and epidemiology?
Hx of phsyical sexual abuse, PTSD, PMHx of acte bacterial gastroenteritis, FHX F>M <50YO
59
IBS presentation?
Abdo Cramping, alteration of stool consistency and defecation relieves pain
60
Ix for IBS and Mx?
Rule out everything else Lifetsyle = fibre, avoid caffeine, lactose, stress and education + probiotics Medical = laxatives, antispasmotics and antidiarrhoeals

MedEd (32 decks)

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