Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MedEd > Lower GI > Flashcards

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

RFs for anal fissure?

A

Hard stools, pregnancy, opiates (from constipation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Mx for anal fissure?

A

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

Topical GTN
Topical diltiazem

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Mx for persistent fissure?

A

> 8 weeks
Boutlinum toxin injection (EUA)
Surgical sphincterotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Aetiology and RFs for anal fistula?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Presentation of anal fistula?

A

Frequent anal abscess, pain and swelling around anus.

Bloody/foul pus drainage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Anal fistula Ix and Mx?

A

Examination: opening on skin around anus, anoscope or rectoscope

Surgical through fistulotomy or seton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Types of anal abscess?

A

Intersphincteric, perirectal, perianal, supralevator

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Rfs and epidemiology of anal abscess?

A

RFs: anal fistula, crohns and constipation

M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Anal abscess presentation?

A

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

Low grade fever and tachycardia (if systemic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Anal abscess Ix?

A

1st line and diagnostic = clinical exam or EUA

CT/MRI for internal pelvic abscess

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Mx for anal abscess?

A

1st line = surgical drainage
+fistulotomy

Broad Abx if systemic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Ix for Haemorrhoids/

A

1st = anoscopic examination

Maybe colonoscopy or FBC for anaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Complications of haemorrhoids?

A

Thrombosed haemorrhoids: purple, painful, oedematous lump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Rfs and epidemiology of pilonidal sinus?

A

80% male and peak 16-40YO

Young males with stiff hair, hirsuitism and sitting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Presentation of pilonidal sinus?

A

Sacrococcygeal, discharge, pain on sitting and swellign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Ix and Mx for pilonidal sinus?

A

Clinical diagnosis + history

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Presentation of rectal prolapse?

A

Painless protruding mass following defecation, mucoid discharge and incontinence

Not bleeding and much larger than haemorrhoids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Ix for rectal prolapse?

A

1st = clinical diagnosis O/E

Maybe anal manometry, colonoscopy

Mx = delormes

26
Q

WHat are healthy bowel habits to advise?

A

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
Q

Features of colonic cancer>

A

Most common in western world and 4th death in US. 1 of 3 cancer screening in UK and adenocarcinoma is the type

28
Q

Genes for colon cancer?

A

HNPCC (germline mutatons)
FAP (APC gene)
Peutz-Jeghers syndrome (STK11/LKB1)

29
Q

UK colorectal screening features?

A

FIT test and one-off flexi

30
Q

RFs for colonic cancer?

A

Increasing age, obesity, IBD (UC), acromgealy, poor fibre and limited physical activity

M>f, younger and younger patients in western countries

31
Q

Presentation of colonic cancer?

A

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
Q

Ix for colonic cancer?

A

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
Q

Staging for colon cancer?

A

TNM classification

Dukes:
A= Tumour 95% mucosa
B= Tumour invading bowel wall
C= lymph node mets
D= distant mets
34
Q

Management for Colorectal cancer?

A

Surgical excision + adjuvant or neoadjuvant chemo/radiotherapy

LLLBB mets

35
Q

Crohns pathophysiology?

A

Transmural inflammation of the GI tract from mouth to anus. SKIP lesions

Commonly: terminal ileum and perianal

Corms non-caseating granuloma

36
Q

RFs and epidemiology of Crohns?

A

FHx, smoking, OCP, high refined sugars, ?NSAIDS,?not brestfed

Ashkenazi jews and bimodal = 15-40 and 60-80

37
Q

GI Presentation of Crohns?

A

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
Q

Extra- GI presentation og Crohns?

A

Arthropathy
Erytherma nodosum and pyoderma gangrenosum

Uveitis and episcleritis

39
Q

Bloods for Crohns?

A

FBC, iron stidues and vitamin/folate as malnourished

CRP and ESR as inflammatory

40
Q

Ix for Crohns?

A

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
Q

Management of Crohns to induce remission?

A

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
Q

Crohns Mx for maintenance of remission?

A

Immunomodulators = Azathioprine, mercaptopurine, methotrexate
+- biologics e.g. INFLIXIMAB, adalimumab, Vedolizumab

Adjuncts = antispasmotics, antidiarrhoeals

43
Q

UC pathophysiology?

A

Starts from rectum and works proximally and just the mucosa

Environmental + immune dysfunction + genetic predispostion (HLA-B27 e.g. ANkylosing spondylitis)

44
Q

RFs and epidemiology of UC?

A

Rhx, HLA-B27, not smoking as smoking is protective

Western countries, M>F, biomdal 20-40 then >60`

45
Q

UC GI presentation?

A

Bloody diarrhoea, rectal bleeding + mucus, abdo pain and cramps, tenemus and weight loss

46
Q

UC extra-GI presentation?

A

Peripheral arthritis and ankylosing spondylitis

Erytherma nodosum and pyoderma gangrenosum

EPscleritis>uveitis

O/E: anaemic, DRE with gross, occult blood and abdo tenderness

47
Q

UC Ix?

A

Bloods: FBC (anaemia), LFTS (PSC),, CRP and ESR for inflammatory

Stool sample for increased faecal calprotecting

pANCA 70% +ve

48
Q

Complications of UC?

A

PSC and toxic megacolon
Colonic adenocarcinoma

Strictures -> obstruction -> perforation

49
Q

UC scans?

A

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
Q

UC management to induce remission?

A

1) Mesalazine (5-ASA) topical or oral

2) steroids e.g. oral beclametasone

51
Q

UC management to maintain remission?

A

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
Q

Pathophysiology of Coeliac disease?

A

Autoimmune triggered by gliadin

Results in villous atrophy and hypertrophy of intestinal crypts

Increased lymphocytes in epithelium and lamina propria

53
Q

Rfs for coeliac?

A

FHx, IgA deficiency, T1DM and autoimmune thyroid disease

F>M, western countries

54
Q

Coeliac presentation?

A

Chronic or intermittent diarrhoea, bloating, abdo pain, discomfot,

Fatigue, weight loss, and dermatitis herptetiformis

55
Q

Coeliac Ix?

A 
IgA tTg elevated in bloods
Endomysial Antibody (EMA)

Endoscopy = villous atropy and crypt hyperplasia

56
Q

Mx for coelic?

A

Gluten free diet, vitamin and mineral supplements

57
Q

What is IBS?

A

IBS with diarrhoea, with constipation or mixed

58
Q

IBS Rfs and epidemiology?

A

Hx of phsyical sexual abuse, PTSD, PMHx of acte bacterial gastroenteritis, FHX

F>M
<50YO

59
Q

IBS presentation?

A

Abdo Cramping, alteration of stool consistency and defecation relieves pain

60
Q

Ix for IBS and Mx?

A

Rule out everything else

Lifetsyle = fibre, avoid caffeine, lactose, stress and education + probiotics

Medical = laxatives, antispasmotics and antidiarrhoeals

MedEd (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions