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Gastro > Lower GI conditions > Flashcards

Lower GI conditions Flashcards

1
Q

What is a pseudo-obstruction in the bowel?

A

Ogilvie’s syndrome

Acute dilatation of colon in absence of anatomic lesion

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2
Q

What can cause a bowel obstruction?

A 
Faecal impaction
Thickened wall (carcinoma, crohns)
Geometry (volvulus, intussusception)
External compression (hernia, adhesions)
Dementia, Parkinsons, MS
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3
Q

What is the Rockall score used for?

A

Assess risk of rebleed in GI bleeds

Uses age, shock, co-morbidity, diagnosis + evidence of current bleeding

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4
Q

S+S bowel obstruction

A

Colicky abdo pain, distension, N+V, constipation

Tinkling bowel sounds

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5
Q

Management of bowel obstruction

A

IV morphine + cyclizine
NG tube to suck up gastric fluids + IV fluids
Neostigmine (anti-paralytic) if paralytic ileus
Gastrografin as part of nonoperative treatment
Surgery - if bowel ischaemia present or cause that requires surgery eg hernia strangulation

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6
Q

Investigations + results for ?bowel obstruction

A

FBC, U+E (high urea, hypokalaemia), CRP, high lactate
AXR (valvulae conniventes visible in small bowel obstruction, Haustral lines on large bowel obstruction) - dilated loops of bowel with air fluid levels, proximal bowel dilation or gasless abdomen
CT is diagnostic

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7
Q

When are caecal + sigmoid volvulus common?

A 
Caecal = 25-35y/o
Sigmoid = elderly, constipated
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8
Q

Investigations for ?volvulus

A

AXR - coffee bean “inverted U” loop of bowel

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9
Q

Management of volvulus

A

Sigmoidoscopy + insertion of flatus tube

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10
Q

What criteria is used to diagnose constipation?

A

Rome IV

Spontaneous BM less than 3 times a week

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11
Q

What is the definition of chronic constipation?

A

Symptoms present for at least 12 weeks in last 6 months

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12
Q

What is functional constipation?

A

Without known cause

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13
Q

Management of constipation

A

Increase fibre + fluids
Manage faecal loading
Oral laxatives - bulk forming first, then osmotic, then stimulant if needed

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14
Q

What investigations should be done if management of constipation has failed?

A

FBC, TFT, HbA1c, U+E, clacium

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15
Q

What is the definition of acute, persistent + chronic diarrhea?

A

3 or more loose stools a day
Acute = less than 14 days
Persistent = more than 14 days
Chronic = more than 4 weeks

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16
Q

Causes of acute diarrhea

A

Infection, drugs, anxiety, food allergy, appendicitis

17
Q

Causes of chronic diarrhea

A

IBS, diet, IBD, coeliac, bowel cancer

18
Q

When should diarrhea be sent for microbiology review?

A 
Systemically unwell/ needs abx 
Blood or pus in stool 
Immunocompromised 
Occurring after foreign travel 
Over 14 days
19
Q

Complications of bowel obstruction

A

Ischemia, necrosis, perforation

20
Q

What is the most common cause of small bowel obstruction?

A

Adhesions post surgery (appendicectomy, gynae surgery, resection for malignancy) or due to intestinal inflammation (Crohns + diverticular disease)

21
Q

What is post-op ileus?

A

Obstipation + intolerance of oral intake after surgery

22
Q

Pathology of post-op ileus

A

Inflammation of intestinal smooth muscle leading to disruption of propulsive motor activity in gut

23
Q

RF for prolonged post-op ileus

A

Prolonged abdominal or pelvic surgery, lower gastrointestinal surgery, open surgery
Delayed enteral nutrition/nasogastric tube placement, intra-abdominal inflammation

24
Q

S+S of post-op ileus

A
  • Abdominal distention, bloating, and “gassiness”
  • Diffuse, persistent abdominal pain
  • Nausea and/or vomiting
  • Delayed passage of or inability to pass flatus
  • Inability to tolerate an oral diet
25
Q

Investigations + results for ?post-op ileus

A

AXR - air in colon or rectum with no transition zone/ free air
CBC, U+E, BUN, LFT, lipase + amylase
CT

26
Q

Management of post-op ileus

A

Pain control, IV fluids + electrolytes, dietary restriction, NG tube

27
Q

What are the features of pseudo obstruction?

A

Usually involves caecam + right hemicolon

28
Q

S+S of pseudo-obstruction

A

Abdo distension, N+V, abdo pain, constipation or diarrhea

29
Q

Investigations + results for pseudo obstruction

A

AXR = dilated colon, normal haustral markings

CT to exclude mechanical obstruction

30
Q

Management of pseudo obstruction

A

Conservative measures
Neostigmine in pts at risk of perforation
Colonoscopic decompression if neostigmine doesn’t work
Surgical decompression last resort

31
Q

Causes of pseudo obstruction

A

Occurs in hospitalised pts with severe illness after surgery in conjunction with metabolic imbalance or meds

32
Q

Pathology of sigmoid volvulus

A

Air filled loop of sigmoid colon twists about its mesentery
Obstruction of intestinal lumen + impairement of vascular perfusion occur when degree of torsion exceeds 180 + 360 degrees

33
Q

RF for sigmoid volvulus

A

Elderly, institutionalised + debilitated

Hx of constipation

34
Q

S+S sigmoid volvulus

A

Slowly progressive abdo pain, nausea, abdo distension + constipation
Vomiting occurs several days later

35
Q

What is colonic polyposis - pathology, symptoms + types?

A

Protruberance into lumen above surrounding colonic mucosa
Usually asymptomatic but may ulcerate + bleed, cause tenesmus + intestinal obstruction
Neoplastic (adenomas) or non-neoplastic (inflammatory)

36
Q

What are hamartomatous polyps?

A

Made up of tissue elements normally found at that site
Juvenile polyps + Peutz-Jeghers polyps
Increased risk of colon cancer

37
Q

What are serrated polyps?

A

Group of polyps with variable malignant potential

Includes hyperplastic polyps, serrated adenomas + sessile serrated polyps

38
Q

Management of polyps

A

Colonoscopy + removal

Gastro (11 decks)

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